Optimising the use of caesarean section: a generic formative research protocol for implementation preparation

Area of Science:

• Maternal Health
• Public Health
• Implementation Science

Background:

• Rising caesarean section rates globally present a public health concern due to associated harms.
• Disparities in rates exist, with both very high and very low rates posing risks.
• Optimizing caesarean section use is crucial for quality, sustainable maternity care.

Purpose of the Study:

• To provide a generic formative research protocol for contextual assessment of caesarean section use.
• To identify locally relevant determinants of caesarean birth.
• To understand factors affecting the implementation of strategies to optimize caesarean section rates.

Main Methods:

• The protocol comprises document review, readiness assessment, and primary qualitative research.
• Tools are provided for mapping local policies, protocols, and care organization.
• Qualitative research uses modular interventions with interview guides for diverse stakeholders.

Main Results:

• The protocol facilitates a comprehensive understanding of the service context prior to intervention.
• It enables detailed assessment of factors influencing caesarean section practices.
• The modular approach allows for targeted investigation of twelve potential optimization interventions.

Conclusions:

• This protocol supports the formative stage of implementation research for optimal caesarean section use.
• It encourages adaptation and adoption by researchers, policymakers, and health ministries.
• Sharing findings can accelerate the uptake of effective strategies for optimizing caesarean birth.