Reducing the rate of cesarean delivery on maternal request through institutional and policy interventions in Wenzhou, China

Yu, Yushan; Zhang, Xiangyang; Sun, Chang; Zhou, Huijie; Zhang, Qi; Chun, Chen

doi:10.1371/journal.pone.0186304

Cited by 30 publications

(47 citation statements)

References 25 publications

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“…[104][105][106] Indeed, recent evidence from specific sites and regions in China suggests that using multi-level interventions that include change in government policy, financial incentives, local benchmarking, education of staff and of service users, provision of doula support and access to pain relief, can limit the rise in CS rates. 107,108…”

Section: Implementing Change Effectivelymentioning

confidence: 99%

Interventions to reduce unnecessary caesarean sections in healthy women and babies

et al. 2018

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Section: Implementing Change Effectivelymentioning

confidence: 99%

Interventions to reduce unnecessary caesarean sections in healthy women and babies

et al. 2018

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“…On the other hand, two Chinese retrospective observational studies suggested that multifaceted interventions involving government policy, finical incentives, local benchmarking, health education for health professionals and pregnant women, doula care, and access to labor analgesia could decrease the CS use effectively [40,41]. In a retrospective study at a large maternity hospital in Shanghai, Liu et al compared CS rates before and after the implementation of a multifaceted intervention [41], which included government and hospital measures.…”

Section: Discussionmentioning

confidence: 99%

“…NA not applicable changed by institutional interventions and government policy [40]. Institutional interventions consisted of three aspects: providing health education to mothers and their families; training obstetricians and midwives, issuing CS indications and guidelines, and conducting audits every month; promoting labor analgesia and doula care by midwives.…”

Section: Discussionmentioning

confidence: 99%

“…Instead, the interventions initiated by the maternity hospitals themselves showed a larger reduction in CS use [36,42,43]. Furthermore, the government-led efforts were more effective when the CS rate was included as a benchmark for hospital performance [40,41]. For example, a nationwide intervention strategy in Portugal even reversed the national upward trend of the CS rate [38].…”

Section: Discussionmentioning

confidence: 99%

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A cluster-randomized field trial to reduce cesarean section rates with a multifaceted intervention in Shanghai, China

Zhang

et al. 2020

BMC Med

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Background: Cesarean section (CS) rate has risen dramatically and stayed at a very high level in China over the past two to three decades. Given the short-and long-term adverse effects of CS, effective strategies are needed to reduce unnecessary CS. We aimed to evaluate whether a multifaceted intervention would decrease the CS rate in China. Methods:We carried out a cluster-randomized field trial with a multifaceted intervention in Shanghai, China, from 2015 to 2017. A total of 20 hospitals were randomly allocated into an intervention or a control group. The intervention consisted of more targeted health education to pregnant women, improved hospital CS policy, and training of midwives/doulas for 8 months. The study included a baseline survey, the intervention, and an evaluation survey. The primary outcome was the changes of overall CS rate from the pre-intervention to the post-intervention period. A subgroup analysis stratified by the Robson classification was also conducted to examine the CS change among women with various obstetric characteristics.Results: A total of 10,752 deliveries were randomly selected from the pre-intervention period and 10,521 from the post-intervention period. The baseline CS rates were 42.5% and 41.5% in the intervention and control groups, respectively, while the post-intervention CS rates were 43.4% and 42.4%, respectively. Compared with the control group, the intervention did not significantly reduce the CS rate (adjusted OR = 0.92; 95% CI 0.73, 1.15). Similar results were obtained in subgroup analyses stratified by the risk level of pregnancy, maternal age, number of previous CS, or parity. Scarred uterus and maternal request remained the primary reasons for CS after the interventions in both groups. The intervention did not alter the perinatal outcomes (adjusted change of risk score = − 0.06; 95%CI − 0.43, 0.31). Conclusions: A multifaceted intervention including more targeted prenatal health education, improved hospital CS policy, and training of midwives/doulas, did not significantly reduce the CS rate in Shanghai, China. However, our experience in implementing a multifaceted intervention may provide useful information to other similar areas with high CS use. Trial registration: This trial was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn) (ChiCTR-IOR-16009041) on 17 August 2016.

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“…Most obstetric centers in China cannot meet the rising expectations of pregnant women, such as lacking the company of family members especially husband, analgesia, or emotional support in labor [3,4] . In recent years, a few Chinese hospitals have started to control the unusually high CD rates with health education, painless delivery, doula delivery and psychological comforting and training programs for midwives and obstetricians [17] . In our birth center, with the help of NPLD program, NA was available for women who requested in to relieve labor pain from May 1, 2015.…”

Section: Discussionmentioning

confidence: 99%

The initiation of a neuraxial analgesia service on the rate of cesarean delivery in Hubei, China. a 1-year restrospective studyThe initiation of a neuraxial analgesia service on the rate of cesarean delivery in Hubei, China. a 1-year restrospective study

Zhao¹,

Gao²,

Sun³

et al. 2020

Preprint

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Background No Pain Labor ＆Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change is overall cesarean delivery (CD) and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service. Methods The neuraxial labor analgesia（NA） was initiated in May 1st 2015 by the help of NPLD. Since then, the application of NA became a routine operation in our hospital, and every parturient can choose to use NA or not according to her own requirement. The monthly rates of NA, CD, MRCD, multiparous women, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia of vaginal delivery were analyzed from May 1st 2015 to April 30th 2016. Results The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 (p<0.001); the rate of CD was decreased from 50.4% in May 2015 to 36.3% in April 2016 ( p<0.001); the rate of MRCD was decreased from 10.8% in May 2015 to 5.7% in April 2016 (p<0.001), but the rate of multiparous women had no change (p＞0.05). There was a negative correlation between the rate of NA and that of overall CD, r=-0.803 (95%CI[-0.951, -0.642], p=0.002), and also a negative correlation between the utilization rate of NA and that of MRCD, r=-0.790 (95%CI[-0.971, -0.497], p=0.004). The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in women underwent vaginal delivery as well as the rates of intrapartum CD, neonatal asphyxia, and PPH in women underwent CD remained unchanged from May 1st 2015 to April 30th 2016. Conclusions: Our study shows that the rates of CD and MRCD in our department significantly were decreased over a year period (2015. 05.01~2016. 04.30), which may be due to the increasing use of NA during vaginal delivery by the help of NPLD. Key Words: Neuraxial Labor Analgesia; Cesarean Delivery; Maternal Request Cesarean Delivery

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Reducing the rate of cesarean delivery on maternal request through institutional and policy interventions in Wenzhou, China

Cited by 30 publications

References 25 publications

Interventions to reduce unnecessary caesarean sections in healthy women and babies

Interventions to reduce unnecessary caesarean sections in healthy women and babies

A cluster-randomized field trial to reduce cesarean section rates with a multifaceted intervention in Shanghai, China

The initiation of a neuraxial analgesia service on the rate of cesarean delivery in Hubei, China. a 1-year restrospective studyThe initiation of a neuraxial analgesia service on the rate of cesarean delivery in Hubei, China. a 1-year restrospective study

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