Variations in childbirth interventions in high-income countries: protocol for a multinational cross-sectional study

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Epidemiology

Background:

• Rising rates of childbirth interventions raise concerns about potential harm in healthy women and newborns.
• While interventions are vital when indicated, routine use can lead to avoidable adverse outcomes.
• Establishing optimal intervention rates is complex due to variations in clinical practice and patient populations.

Purpose of the Study:

• To analyze the global variations in the utilization of common childbirth interventions across high-income countries.
• To examine the association between intervention rates and maternal/perinatal outcomes in nulliparous and multiparous women.
• To provide data for developing evidence-based guidelines for childbirth interventions.

Main Methods:

• A multinational, cross-sectional study utilizing 2013 birth data from high-income countries.
• Inclusion criteria: singleton births from 37 weeks gestation; data analyzed separately for nulliparous and multiparous women.
• Primary outcomes: rates of labor induction/augmentation, intrapartum antibiotics, pain relief, episiotomy, assisted birth, cesarean section, and postpartum oxytocin; Secondary outcomes: maternal/perinatal mortality, low Apgar scores, PPH, OASIS.

Main Results:

• Significant international variations exist in the rates of commonly used childbirth interventions.
• Analysis will identify factors associated with higher or lower intervention rates and their impact on outcomes.
• Results will be stratified by parity (nulliparous vs. multiparous women).

Conclusions:

• Understanding variations in childbirth intervention rates is crucial for improving maternal and neonatal care globally.
• This study provides critical data to inform best practices and reduce unnecessary interventions.
• Findings will contribute to evidence-based guidelines aimed at optimizing childbirth outcomes and minimizing harm.