Advertisement

Midwives’ views of an evidence-based intervention to reduce caesarean section rates in Ireland

Published:February 20, 2022DOI:https://doi.org/10.1016/j.wombi.2022.01.002

      Abstract

      Problem

      A worldwide increase of caesarean section (CS) rates has been estimated at a rate of 4% per year and numerous interventions to reduce the rates have not been successful, perhaps because they are not acceptable to clinicians.

      Background

      A caesarean section (CS) can be a life-saving operation, but has been associated with short- and long-term risk factors and shown to affect subsequent pregnancies.

      Aim

      To explore midwives’ views on CS rates and evaluate the feasibility and acceptability of an evidence-based intervention programme (REDUCE) designed to decrease overall CS rates in Ireland by 7%.

      Methods

      Following ethical approval, a qualitative exploratory design was used to seek midwives’ views of the evidence-based intervention. A total of 28 midwives from one large tertiary maternity hospital took part in four focus group interviews. Data were analysed using thematic analysis.

      Findings

      Five themes emerged, illustrating the midwives’ views of what could be improved in the present system and how CS rates could be reduced in future. The themes included: (i) Induction of labour; (ii) Education; (iii) Auditing of practice; (iv) Clinical practice; (v) Midwife-Obstetrician collaboration.

      Discussion

      This study noted a rising CS rate year on year, with a rate of 37% at the time of the study, and the midwives voiced their very real concerns over the increased high rates.

      Conclusion

      The study provided support for the evidence based ‘REDUCE’ intervention, which now needs to be tested empirically within this Irish population.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sandall J.
        • Tribe R.M.
        • Avery L.
        • Mola G.
        • Visser G.H.
        • Homer C.S.
        • et al.
        Short-term and long-term effects of caesarean section on the health of women and children.
        Lancet. 2018; 392: 1349-1357
        • Betrán A.P.
        • Torloni M.R.
        • Zhang J.J.
        • Gülmezoglu A.M.
        WHO statement on caesarean section rates.
        BJOG. 2016; 123: 667-670
        • Harrison M.S.
        • Betrán A.P.
        • Suresh K.
        • Vogel J.P.
        • Goldenberg R.L.
        • Gülmezoglu A.M.
        Risk factors associated with adverse maternal outcomes following intrapartum cesarean birth: a secondary analysis of the WHO global survey on maternal and perinatal health, 2004–2008.
        BMC Pregnancy Childbirth. 2020; 20: 1-11
      1. Organisation for Economic Co-operation and Development OECD, Caesarean sections (indicator) https://doi.org/10.1787/adc3c39f-en. (Accessed 16 June 2021).

        • Moran P.S.
        • Normand C.
        • Gillen P.
        • Wuytack F.
        • Turner M.
        • Begley C.
        • et al.
        Economic implications of reducing caesarean section rates — analysis of two health systems.
        PLoS One. 2020; 15e0228309
        • World Health Organization
        Appropriate technology for birth.
        Lancet. 1985; 2: 436-437
        • World Health Organization (WHO)
        Recommendations Non-clinical Interventions to Reduce Unnecessary Caesarean Sections.
        World Health Organization, Geneva2018 (Available from http://apps.who.int/iris/bitstream/handle/10665/275377/9789241550338-eng.pdf?ua=1. (Accessed 15 June 2021))
        • Euro-Peristat Project
        European Perinatal Health Report: Core Indicators of the Health and Care of Pregnant Women and Babies in Europe in 2015.
        2018 (Available from www.europeristat.com. (Accessed 15 June 2021))
        • Betran A.P.
        • Ye J.
        • Moller A.B.
        • Souza J.P.
        • Zhang J.
        Trends and projections of caesarean section rates: global and regional estimates.
        BMJ Glob. Health. 2021; 6e005671
        • Betrán A.P.
        • Temmerman M.
        • Kingdon C.
        • Mohiddin A.
        • Opiyo N.
        • Torloni
        • et al.
        Interventions to reduce unnecessary caesarean sections in healthy women and babies.
        Lancet. 2018; 392: 1358-1368
        • Chen I.
        • Opiyo N.
        • Tavender E.
        • Mortazhejri S.
        • Rader T.
        • Petkovic J.
        • et al.
        Non‐clinical interventions for reducing unnecessary caesarean section.
        Cochrane Database Syst. Rev. 2018; 9CD005528
        • Reynolds C.M.
        • McMahon L.E.
        • O’Malley E.G.
        • O’Connell M.P.
        • Sheehan S.R.
        • Turner M.J.
        Trends in private maternity care in Ireland’s capital during and after the Great Economic Recession 2009–2017.
        Irish J. Med. Sci. (1971–). 2020; : 1-8
        • Smith V.
        • Gallagher L.
        • Carroll M.
        • Hannon K.
        • Begley C.
        Antenatal and intrapartum interventions for reducing caesarean section, promoting vaginal birth, and reducing fear of childbirth: an overview of systematic reviews.
        PLoS One. 2019; 14 (Available from)e0224313
      2. Gallagher, L., Begley, C., Smith, V., Carroll, M., Lawler, D., Hannon, K. (2022). What would reduce caesarean section rates? — Views from pregnant women and clinicians in Ireland. Submitted to PLoS One.

        • Sandelowski M.
        What’s in a name? Qualitative description revisited.
        Res. Nurs. Health. 2010; 33: 77-84
        • Kim H.
        • Sefcik J.S.
        • Bradway C.
        Characteristics of qualitative descriptive studies: a systematic review.
        Res. Nurs. Health. 2017; 40: 23-42https://doi.org/10.1002/nur.21768
        • Braun V.
        • Clarke V.
        What can “thematic analysis” offer health and wellbeing researchers?.
        Int. J. Qual. Stud. Health Wellbeing. 2014; 9
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qual. Res. Psychol. 2006; 3: 77-101
        • Grobman W.A.
        • Rice M.M.
        • Reddy U.M.
        • Tita A.T.
        • Silver R.M.
        • Mallett G.
        • et al.
        Labor induction versus expectant management in low-risk nulliparous women.
        N. Engl. J. Med. 2018; 379: 513-523
        • Carmichael S.L.
        • Snowden J.M.
        The ARRIVE trial: interpretation from an epidemiologic perspective.
        J. Midwifery Womens Health. 2019; 64 (Epub 2019 Jul 2): 657-663https://doi.org/10.1111/jmwh.12996
        • Horey D.
        • Kealy M.
        • Davey M.A.
        • Small R.
        • Crowther C.A.
        Interventions for supporting pregnant women’s decision-making about mode of birth after a caesarean.
        Cochrane Database Syst. Rev. 2013; 7CD010041
        • Hadizadeh-Talasaz F.
        • Ghoreyshi F.
        • Mohammadzadeh F.
        • Rahmani R.
        Effect of shared decision making on mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section: a randomized clinical trial.
        BMC Pregnancy Childbirth. 2021; 21: 144
        • Lundgren I.
        • Healy P.
        • Carroll M.
        • Begley C.
        • Matterne A.
        • Gross M.M.
        • et al.
        Clinicians’ views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a study from countries with low VBAC rates.
        BMC Pregnancy Childbirth. 2016; 16: 350
        • Lundgren I.
        • Smith V.
        • Nilsson C.
        • Vehvilainen-Julkunen K.
        • Nicoletti J.
        • Devane D.
        • et al.
        Clinician-centred interventions to increase vaginal birth after caesarean section (VBAC): a systematic review.
        BMC Pregnancy Childbirth. 2015; 15: 16
        • Panda S.
        • Begley C.
        • Daly D.
        Clinicians’ views of factors influencing decision-making for caesarean section: a systematic review and metasynthesis of qualitative, quantitative and mixed methods studies.
        PLoS One. 2018; 13e0200941
        • Finucane E.M.
        • Murphy D.J.
        • Biesty L.M.
        • Gyte G.M.L.
        • Cotter A.M.
        • Ryan E.M.
        • et al.
        Membrane sweeping for induction of labour.
        Cochrane Database Syst. Rev. 2020; 2CD000451
        • Romijn A.
        • Teunissen P.W.
        • de Bruijne M.C.
        • Wagner C.
        • de Groot C.J.M.
        Interprofessional collaboration among care professionals in obstetrical care: are perceptions aligned?.
        BMJ Qual. Saf. 2018; 27: 279-286
        • Skinner J.P.
        • Foureur M.
        Consultation, referral, and collaboration between midwives and obstetricians: lessons from New Zealand.
        J. Midwifery Womens Health. 2010; 55: 28-37