DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20201224

Interventions to reduce caesarean section rates at government medical college and hospital Aurangabad, India

Shrinivas Gadappa, Honey Gemavat, Sonali Deshpande, Ankita Shah

Abstract


Background: Caesarean sections are effective in saving maternal and infant lives, but only when they are performed for medically indicated reasons, The Objective of this study was to reduce caesarean Section rate at GMCH, Aurangabad and to improve overall birthing experience with respectful maternity care.

Methods: The caesarean sections done at GMCH Aurangabad were audited using Robson`s Ten Group classification system to identify the major contributors to the overall CS rate. The following clinical and non-clinical interventions were applied dynamically to control the caesarean section rates. Clinical Interventions were changes in protocols regarding induction of labour, Intermittent auscultation as opposed to continuous electronic foetal monitoring in low risk cases, use of a partogram, encouragement of different birthing positions, promoting TOLAC to reduce the secondary CS rate. Nonclinical interventions include encouragement of DOULA (birth companion), ante-natal counselling of the expectant mothers, training of healthcare staff for respectful maternity care and use of evidence based clinical practice guidelines with mandatory second opinion for every non recurrent indication of CS. Auditing of caesarean section using Robson classification.

Results: In this study there has been steady decline in LSCS rates from 33% to 26.9%. On analysis with Robson classification, group 5 (previous LSCS) made largest contribution of 36.9% followed by Group 1, 2, 10 each contributed 18.01%,13.2% and 11.2% respectively. Group 6 to 10 account for 23%. Various birthing positions lowered use of oxytocics from 33 % to 19% as well lowered episiotomy rates with greater success in vaginal delivery.

Conclusions: Modification of induction protocols have reduced the primary LSCS rates and successful VBAC using FLAMM score was helpful in reducing the repeat caesarean Sections. Various birthing positions, DOULA gave greater success in vaginal delivery. LSCS rates in mothers with breech, multiple or oblique/transverse lies were largely unmodifiable. Limiting the CS rate in low-risk pregnancies by individualizing every labour and not to set a time limit as long as mother and baby are closely monitored.


Keywords


vBirthing position, Caesarean rates, Clinical interventions, Doula, Non-clinical interventions, Respectful maternity care, Robson classification

Full Text:

PDF

References


World Health Organization. WHO statement on caesarean section rates caesarean section rates at the hospital level and the need for a universal classification system. Geneva, Switzerland: Author. World Health Organization. Available at: http://apps. who. int/iris/bitstream/ 10665/161442/1/WHO_RHR_15. 02_eng. pdf. 2015. Accessed on 10th January 2020.

Pettker M, Funai EF, Illuzzi JL. Contributing Indications to the Rising Cesarean Delivery Rate. Obstet Gynecol. 2013;118(1):29-38.

Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. The Lancet Global Health. 2015;3(5):e260-70.

Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Report. 2010;30(1):1-31.

Caughey AB, Cahill AG, Guise JM, Rouse DJ, American College of Obstetricians and Gynecologists. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014;210(3):179-93.

Gizzo S, Di Gangi S, Noventa M, Bacile V, Zambon A, Nardelli GB. Women’s choice of positions during labour: return to the past or a modern way to give birth? A cohort study in Italy. BioMed Res Inter. 2014;2014.

Saeed KB, Greene RA, Corcoran P, O'Neill SM. Incidence of surgical site infection following caesarean section: a systematic review and meta-analysis protocol. BMJ Open. 2017;7(1):e013037.

Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship between cesarean delivery rate and maternal and neonatal mortality. JAMA. 2015;314(21):2263-70.

The L. Stemming the global caesarean section epidemic. Lancet (London, England). 2018;392(10155):1279.

Focus on: caesarean section,” NHS Institute for Innovation and Improvement". Institute.nhs.uk. 2009. Available at: https://www.qualitasconsortium. com/index.cfm/reference-material/delivering-value-quality/focus-on-csection/. Accessed on 10th January 2020.

Brick A, Layte R. Recent trends in the Caesarean section rate in Ireland 1999-2006. ESRI working Paper; 2009.

Australia has higher C-Section rate of 30.9%. Available at: https://www1.health.gov.au/internet /publications/publishing.nsf/Content/pacd-maternit yservicesplan-toc~pacd-maternityservicesplan-chapter2. Accessed on 10th January 2020.

Birara M, Gebrehiwot Y. Factors associated with success of vaginal birth after one caesarean section (VBAC) at three teaching hospitals in Addis Ababa, Ethiopia: a case control study. BMC Preg Childbirth. 2013;13(1):31.

Gangwar R, Chaudhary S. Caesarean section for foetal distress and correlation with perinatal outcome. J Obstet Gynecol India. 2016;66(1):177-80.