WHO released guidelines on Non-Clinical
Interventions to Reduce Unnecessary Caesarean Sections
A structured, mandatory second opinion for
caesarean section indication in clinical settings is recommended to reduce
caesarean births, according to the recently released guidelines by the World
Health Organization.
The guidelines also call for implementation
of evidence-based clinical practice guidelines, caesarean section audits and
timely feedback to health-care professionals are recommended to reduce
caesarean births in hospitals.
The guidelines come in light of the fact
that Caesarean section rates have increased steadily worldwide over the
last decades. However, this trend has not been accompanied by significant
maternal or perinatal benefit, in fact quite the contrary. Further, High
rates of caesarean section are associated with substantial health-care costs.
In India, as well the rates of cesarean section
are skyrocketing, with the medical profession being put to blame for the same,
and the demands even being made to name and shame the gynaecologists who
do Caesarean deliveries for no reason at all except money
Addressing the very issue of growing C-section
rates, in 2018 WHO released guidelines on Non-Clinical Interventions to Reduce
Unnecessary Caesarean Sections, with recommendations being targeted at women,
healthcare professionals as well as institutions.
Following are the major recommendations:
A. INTERVENTIONS TARGETED AT WOMEN
Recommendation 1. Health
education for women is an essential component of antenatal care. The following
educational interventions and support programmes are recommended to reduce caesarean
births only with targeted monitoring and evaluation.
◆ Childbirth training workshops
(content includes sessions about childbirth fear and pain, pharmacological
pain-relief techniques and their effects, non-pharmacological pain-relief
methods, advantages and disadvantages of caesarean sections and vaginal
delivery, indications and contraindications of caesarean sections, among
others).
◆ Nurse-led applied relaxation
training programme (content includes group discussion of anxiety and
stress-related issues in pregnancy and purpose of applied relaxation, deep
breathing techniques, among other relaxation techniques).
◆ Psychosocial couple-based
prevention programme (content includes emotional self-management, conflict
management, problem-solving, communication and mutual support strategies that
foster positive joint parenting of an infant). “Couple” in this recommendation
includes couples, people in a primary relationship or other close people.
◆ Psychoeducation (for women with
fear of pain; comprising information about fear and anxiety, fear of
childbirth, normalization of individual reactions, stages of labour, hospital
routines, the birth process, and pain relief [led by a therapist and midwife],
among other topics).
When considering the educational interventions
and support programmes, no specific format (e.g. pamphlet, videos, role play
education) is recommended as more effective.
B. INTERVENTIONS TARGETED AT HEALTH-CARE
PROFESSIONALS
Recommendation 2.1.
Implementation of evidence-based clinical practice guidelines combined with
structured, mandatory second opinion for caesarean section indication is
recommended to reduce caesarean births in settings with adequate resources and
senior clinicians able to provide mandatory second opinion for caesarean section
indication
Recommendation 2.2. Implementation of
evidence-based clinical practice guidelines, caesarean section audits and
timely feedback to health-care professionals are recommended to reduce
caesarean births.
C. INTERVENTIONS TARGETED AT HEALTH ORGANIZATIONS,
FACILITIES OR SYSTEMS
Recommendation 3.1. For the sole
purpose of reducing caesarean section rates, the collaborative
midwifery-obstetrician model of care (i.e. a model of staffing based on care
provided primarily by midwives, with 24-hour back-up from an obstetrician who
provides in-house labour and delivery coverage without other competing clinical
duties) is recommended only in the context of rigorous research. This model of
care primarily addresses intrapartum caesarean sections.
Recommendation 3.2. For the sole
purpose of reducing unnecessary caesarean sections, financial strategies (i.e.
insurance reforms equalizing physician fees for vaginal births and caesarean
sections) for health-care professionals or health-care organizations are recommended
only in the context of rigorous research.
To read the complete guidelines, click on the
following link
Read Also: Labor
induction at 39 weeks reduces need for cesarean section: NEJM
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