Guideline

WHO recommendations non-clinical interventions to reduce unnecessary caesarean sections

Year of Publication

2018

Issuing Institution

World Health Organization

Links

WHO IRIS,WHO IRIS

Recommendations

5 included recommendations

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, 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.

Status

Maintained

Context specific recommendation

Only in specific contexts

Certainty of evidence

Low

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.

Status

Maintained

Context specific recommendation

Only in specific contexts

Certainty of evidence

High

Implementation of evidence-based clinical practice guidelines, caesarean section audits and timely feedback to health-care professionals are recommended to reduce caesarean births.

Status

Maintained

Recommended

Certainty of evidence

High

For the sole purpose of reducing caesarean section rates, 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

Status

Maintained

Recommendation in research context

Only in research contexts

Certainty of evidence

Low

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.

Status

Maintained

Recommendation in research context

Only in research contexts

Certainty of evidence

Very low