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Area of Science:

  • Obstetrics and Gynecology
  • Public Health
  • Health Services Research

Background:

  • Global caesarean section rates are increasing, necessitating effective interventions.
  • Non-clinical interventions target women, healthcare professionals, or organizations to address determinants of caesarean births.
  • This review update informs a new World Health Organization (WHO) guideline on reducing unnecessary caesarean sections.

Purpose of the Study:

  • To evaluate the effectiveness and safety of non-clinical interventions aimed at reducing unnecessary caesarean sections.
  • To synthesize evidence on interventions targeting women, healthcare professionals, and organizations.
  • To inform clinical practice and policy regarding caesarean section reduction strategies.

Main Methods:

  • Systematic review including randomized trials, non-randomized trials, controlled before-after, interrupted time series, and repeated measures studies.
  • Searched multiple databases (CENTRAL, MEDLINE, Embase, CINAHL) and trials registers up to March 2018.
  • Narrative description of results from individual studies, assessing primary outcomes: caesarean section, spontaneous vaginal birth, and instrumental birth.

Main Results:

  • Interventions for women (e.g., childbirth training, relaxation programs) showed potential to reduce caesarean sections but with low-certainty evidence.
  • Interventions for healthcare professionals (guideline implementation, audit/feedback, opinion leader education) demonstrated moderate to high-certainty evidence for reducing caesarean section rates.
  • Few interventions targeting healthcare organizations showed benefit, and evidence for many interventions was of low or very low certainty, with limited data from low-income countries.

Conclusions:

  • Non-clinical interventions, particularly those targeting healthcare professionals, can safely reduce caesarean section rates.
  • Evidence for interventions targeting women and healthcare organizations is less certain, highlighting a need for further research.
  • Implementation of guidelines and professional education are key strategies, but more research is needed, especially in low-income settings.