Deakin University
Browse
chapman-maternityservice-2019.pdf (1.16 MB)

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

Download (1.16 MB)
Version 3 2024-06-18, 15:52
Version 2 2024-06-04, 13:48
Version 1 2019-07-29, 15:30
journal contribution
posted on 2024-06-18, 15:52 authored by Anna ChapmanAnna Chapman, Catherine NagleCatherine Nagle, D Bick, R Lindberg, Bridie KentBridie Kent, J Calache, Alison HutchinsonAlison Hutchinson
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.

History

Journal

BMC Pregnancy and Childbirth

Volume

19

Article number

ARTN 206

Pagination

1 - 21

Location

England

Open access

  • Yes

ISSN

1471-2393

eISSN

1471-2393

Language

English

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2019, The Author(s)

Issue

1

Publisher

BMC