Multi-professional simulation training on prolonged labor in Tanzania: A quasi-experimental, pre-post interventional
Signe Egenberg1, Lacatus Nyombi2, Torbjørn Moe Eggebø1,3
1Department of Obstetrics and Gynaecology, Stavanger University Hospital, Stavanger, Norway.
Introduction:
In many middle-income countries, cesarean section rates have increased substantially and reached levels of more than 50% in urban regions. Prolonged labor and non-reassuring fetal heart rate are the most common indications for intrapartum cesarean section. This intervention can be a life-saving procedure; however, unnecessary cesarean sections can be harmful for the mother and the baby. Reducing the cesarean section rates is highly warranted. We aimed to investigate whether intrapartum cesarean section rates could be reduced by multiprofessional simulation training, and whether the training influenced labor duration and the timing of intrapartum cesarean section.
Material And Methods:
A quasi-experimental, pre-post, interventional study comprising multiprofessional simulation training on prolonged labor and shared decision-making was carried out from May 2022 to September 2024. The training intervention in January 2023 was conducted by local faculty and maternity staff (n = 84) at Kilimanjaro Christian Medical Centre, Tanzania. Preintervention data were collected from May-December 2022, and post-intervention data from February 2023 to September 2024. The primary outcome measure was cesarean section rates during the active labor phase, while labor duration and timing of cesarean sections were secondary outcomes. Survival methods were used to estimate duration of labor and probability of delivery.
Results:
The study population comprised 3415 women; 1159 preintervention and 2256 post-intervention. The cesarean section rate during the active labor phase was significantly lower after the training: 7.4% preintervention and 2.7% post-intervention (p < 0.01). The overall cesarean section rate was 54.5% preintervention and 51.6% post-intervention (p = 0.11). Most cesarean sections were performed prelabor or during the latent phase. The estimated median duration until vaginal delivery was 330 min (95% CI, 310-350) preintervention and 435 min (95% CI, 426-443) post-intervention. The hazard ratio of cesarean section during the first 20 hours of the active labor phase was 0.33 (95% CI, 0.24-0.46), with preintervention as a reference.
Conclusions:
This study demonstrated a significant reduction in cesarean section rates during the active labor phase after multiprofessional simulation training on prolonged labor and shared decision-making. The median duration of the active labor phase was longer, and the probability of cesarean section within 20 h of active labor was three times lower.