Non-clinical interventions that increase the uptake and success of vaginal birth after caesarean section: a systematic review

Catling, Christine; Johnston, Rebecca; Ryan, Clare; Foureur, Maralyn; Homer, Caroline

doi:10.1111/j.1365-2648.2011.05662.x

Cited by 32 publications

(18 citation statements)

References 57 publications

(76 reference statements)

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“…Our study confirms previous findings that hospitals with residents, midwives, and not-for-profit or public status have higher VBAC rates than other hospitals 15,16 and that many of these factors also are associated with a decreased primary cesarean delivery rate. 17,18 However, our multivariable regression models controlled for these known confounders and many others, and still, the association between VBAC rate and decreased primary cesarean delivery rates persisted.…”

Section: Discussionsupporting

confidence: 91%

Association Between Vaginal Birth After Cesarean Delivery and Primary Cesarean Delivery Rates

Rosenstein

Kuppermann

Gregorich

et al. 2013

Obstetrics &Amp; Gynecology

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OBJECTIVE To estimate the association between vaginal birth after cesarean delivery (VBAC) rates and primary cesarean delivery rates in California hospitals. METHODS Hospital VBAC rates were calculated using birth certificate and discharge data from 2009, and hospitals were categorized by quartile of VBAC rate. Multivariable logistic regression analysis was performed to estimate the odds of cesarean delivery among low-risk nulliparous women with singleton pregnancies at term in vertex presentation (nulliparous term singleton vertex) by hospital VBAC quartile while controlling for many patient-level and hospital-level confounders. RESULTS There were 468,789 term singleton births in California in 2009 at 255 hospitals, 125,471 of which were low-risk nulliparous term singleton vertex. Vaginal birth after cesarean delivery rates varied between hospitals, with a range of 0–44.6%. Rates of cesarean delivery among low-risk nulliparous term singleton vertex women declined significantly with increasing VBAC rate. When adjusted for maternal and hospital characteristics, low-risk nulliparous term singleton vertex women who gave birth in hospitals in the highest VBAC quartile had an odds ratio of 0.55 (95% confidence interval 0.46–0.66) of cesarean delivery compared with women at hospitals with the lowest VBAC rates. Each percentage point increase in a hospital’s VBAC rate was associated with a 0.65% decrease in the low-risk nulliparous term singleton vertex cesarean delivery rate. CONCLUSION Hospitals with higher rates of VBAC have lower rates of primary cesarean delivery among low-risk nulliparous women with singleton pregnancies at term in vertex presentation.

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Section: Discussionsupporting

confidence: 91%

Association Between Vaginal Birth After Cesarean Delivery and Primary Cesarean Delivery Rates

Rosenstein

Kuppermann

Gregorich

et al. 2013

Obstetrics &Amp; Gynecology

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“…[11,15–17,63–64] However, the interventions tested have resulted in limited success to date. The barriers and facilitators highlighted by this QES are a step forward to understanding why interventions may have limited success, how health system and cultural factors converge, and what the mechanisms of effect to achieve change are.…”

Section: Discussionmentioning

confidence: 99%

Non-clinical interventions to reduce unnecessary caesarean section targeted at organisations, facilities and systems: Systematic review of qualitative studies

2018

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ObjectiveWhen medically indicated, caesarean section can prevent deaths and other serious complications in mothers and babies. Lack of access to caesarean section may result in increased maternal and perinatal mortality and morbidity. However, rising caesarean section rates globally suggest overuse in healthy women and babies, with consequent iatrogenic damage for women and babies, and adverse impacts on the sustainability of maternity care provision. To date, interventions to ensure that caesarean section is appropriately used have not reversed the upward trend in rates. Qualitative evidence has the potential to explain why and how interventions may or may not work in specific contexts. We aimed to establish stakeholders’ views on the barriers and facilitators to non-clinical interventions targeted at organizations, facilities and systems, to reduce unnecessary caesarean section.MethodsWe undertook a systematic qualitative evidence synthesis using a five-stage modified, meta-ethnography approach. We searched MEDLINE, CINAHL, PsychINFO, EMBASE and grey literature databases (Global Index Medicus, POPLINE, AJOL) using pre-defined terms. Inclusion criteria were qualitative and mixed-method studies, investigating any non-clinical intervention to reduce caesarean section, in any setting and language, published after 1984. Study quality was assessed prior to data extraction. Interpretive thematic synthesis was undertaken using a barriers and facilitators lens. Confidence in the resulting Summaries of Findings was assessed using GRADE-CERQual.Results8,219 studies were identified. 25 studies were included, from 17 countries, published between 1993–2016, encompassing the views of over 1,565 stakeholders. Nineteen Summary of Findings statements were derived. They mapped onto three distinct themes:Health system, organizational and structural factors (6 SoFs); Human and cultural factors (7 SoFs); and Mechanisms of effect to achieve change factors (6 SoFs). The synthesis showed how inter- and intra-system power differentials, and stakeholder commitment, exert strong mechanisms of effect on caesarean section rates, independent of the theoretical efficacy of specific interventions to reduce them.ConclusionsNon-clinical interventions to reduce caesarean section are strongly mediated by organisational power differentials and stakeholder commitment. Barriers may be greatest where implementation plans contradict system and cultural norms.Protocol registrationPROSPERO: CRD42017059456

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“…It may be that women who want a repeat caesarean section think they are more likely to get it under private care, or it may be that the higher rate of scheduled caesareans in the nulliparous private patients results in an escalation in repeat caesarean sections with subsequent births. A systematic review of the literature reports inconsistent evidence that having private health insurance is a barrier to the uptake and success of VBAC 32. How risk-based information is provided is likely to be the critical factor 30.…”

Section: Discussionmentioning

confidence: 99%

“…Although speculative, it seems quite likely that private patients are provided with greater choice in relation to a scheduled caesarean section. It is debatable whether this is actually in the woman's best interest, particularly when it comes to the next birth 16 32 34. What does need to be addressed is whether higher rates of scheduled caesarean sections among private patients create access issues for medically indicated caesarean sections, and whether these patients place a disproportionate burden on the service in the postoperative period 35…”

Section: Discussionmentioning

confidence: 99%

A retrospective cohort study of mode of delivery among public and private patients in an integrated maternity hospital setting

Murphy

Fahey

2013

BMJ Open

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ObjectiveTo examine the associations between mode of delivery and public versus privately funded obstetric care within the same hospital setting.DesignRetrospective cohort study.SettingUrban maternity hospital in Ireland.PopulationA total of 30 053 women with singleton pregnancies who delivered between 2008 and 2011.MethodsThe study population was divided into those who booked for obstetric care within the public (n=24 574) or private clinics (n=5479). Logistic regression analyses were performed to examine the associations between operative delivery and type of care, adjusting for potential confounding factors.Main outcome measuresCaesarean section (scheduled or emergency), operative vaginal delivery (vacuum or forceps), indication for caesarean section as classified by the operator.ResultsCompared with public patients, private patients were more likely to be delivered by caesarean section (34.4% vs 22.5%, OR 1.81; 95% CI 1.70 to 1.93) or operative vaginal delivery (20.1% vs 16.5%, OR 1.28; 95% CI 1.19 to 1.38). The greatest disparity was for scheduled caesarean sections; differences persisted for nulliparous and parous women after controlling for medical and social differences between the groups (nulliparous 11.9% vs 4.6%, adjusted (adj) OR 1.82; 95% CI 1.49 to 2.24 and parous 26% vs 12.2%, adj OR 2.08; 95% CI 1.86 to 2.32). Scheduled repeat caesarean section accounted for most of the disparity among parous patients. Maternal request per se was an uncommonly reported indication for caesarean section (35 in each group, p<0.000).ConclusionsPrivately funded obstetric care is associated with higher rates of operative deliveries that are not fully accounted for by medical or obstetric risk differences.

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Non-clinical interventions that increase the uptake and success of vaginal birth after caesarean section: a systematic review

Abstract: Non-clinical factors can have a significant impact on vaginal birth after caesarean section uptake and success.

Cited by 32 publications

References 57 publications

Association Between Vaginal Birth After Cesarean Delivery and Primary Cesarean Delivery Rates

Association Between Vaginal Birth After Cesarean Delivery and Primary Cesarean Delivery Rates

Non-clinical interventions to reduce unnecessary caesarean section targeted at organisations, facilities and systems: Systematic review of qualitative studies

A retrospective cohort study of mode of delivery among public and private patients in an integrated maternity hospital setting

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