Maternity service organisational interventions that aim to reduce caesarean section: a systematic review and meta-analyses

Chapman, Anna, Nagle, Catherine, Bick, Debra, Lindberg, Rebecca, Kent, Bridie, Calache, Justin and Hutchinson, Alison M 2019, Maternity service organisational interventions that aim to reduce caesarean section: a systematic review and meta-analyses, BMC pregnancy and childbirth, vol. 19, pp. 1-21, doi: 10.1186/s12884-019-2351-2.

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Title Maternity service organisational interventions that aim to reduce caesarean section: a systematic review and meta-analyses
Author(s) Chapman, AnnaORCID iD for Chapman, Anna
Nagle, CatherineORCID iD for Nagle, Catherine
Bick, Debra
Lindberg, Rebecca
Kent, Bridie
Calache, Justin
Hutchinson, Alison MORCID iD for Hutchinson, Alison M
Journal name BMC pregnancy and childbirth
Volume number 19
Article ID 206
Start page 1
End page 21
Total pages 21
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2019
ISSN 1471-2393
Keyword(s) Caesarean section
Systematic review
Organisational interventions
Maternity service
Midwife-led care
Science & Technology
Life Sciences & Biomedicine
Obstetrics & Gynecology
Summary Background: Caesarean sections (CSs) are associated with increased maternal and perinatal morbidity, yet rates continue to increase within most countries. Effective interventions are required to reduce the number of non-medically indicated CSs and improve outcomes for women and infants. This paper reports findings of a systematic review of literature related to maternity service organisational interventions that have a primary intention of improving CS rates. Method: A three-phase search strategy was implemented to identify studies utilising organisational interventions to improve CS rates in maternity services. The database search (including Cochrane CENTRAL, CINAHL, MEDLINE, Maternity and Infant Care, EMBASE and SCOPUS) was restricted to peer-reviewed journal articles published from 1 January 1980 to 31 December 2017. Reference lists of relevant reviews and included studies were also searched. Primary outcomes were overall, planned, and unplanned CS rates. Secondary outcomes included a suite of birth outcomes. A series of meta-analyses were performed in RevMan, separated by type of organisational intervention and outcome of interest. Summary risk ratios with 95% confidence intervals were presented as the effect measure. Effect sizes were pooled using a random-effects model. Results: Fifteen articles were included in the systematic review, nine of which were included in at least one meta-analysis. Results indicated that, compared with women allocated to usual care, women allocated to midwife-led models of care implemented across pregnancy, labour and birth, and the postnatal period were, on average, less likely to experience CS (overall) (average RR 0.83, 95% CI 0.73 to 0.96), planned CS (average RR 0.75, 95% CI 0.61 to 0.93), and episiotomy (average RR 0.84, 95% CI 0.74 to 0.95). Narratively, audit and feedback, and a hospital policy of mandatory second opinion for CS, were identified as interventions that have potential to reduce CS rates. Conclusion: Maternity service leaders should consider the adoption of midwife-led models of care across the maternity episode within their organisations, particularly for women classified as low-risk. Additional studies are required that utilise either audit and feedback, or a hospital policy of mandatory second opinion for CS, to facilitate the quantification of intervention effects within future reviews.
Language eng
DOI 10.1186/s12884-019-2351-2
Indigenous content off
Field of Research 1114 Paediatrics and Reproductive Medicine
1117 Public Health and Health Services
1110 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2019, The Author(s)
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Document type: Journal Article
Collections: Faculty of Health
School of Nursing and Midwifery
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