Variations in childbirth interventions in high-income countries: protocol for a multinational cross-sectional study

Abstract

IntroductionThere are growing concerns about the increase in rates of commonly used childbirth interventions. When indicated, childbirth interventions are crucial for preventing maternal and perinatal morbidity and mortality, but their routine use in healthy women and children leads to avoidable maternal and neonatal harm. Establishing ideal rates of interventions can be challenging. This study aims to describe the range of variations in the use of commonly used childbirth interventions in high-income countries around the world, and in outcomes in nulliparous and multiparous women.Methods and analysisThis multinational cross-sectional study will use data from births in 2013 with national population data or representative samples of the population of pregnant women in high-income countries. Data from women who gave birth to a single child from 37 weeks gestation onwards will be included and the results will be presented for nulliparous and multiparous women separately. Anonymised individual level data will be analysed. Primary outcomes are rates of commonly used childbirth interventions, including induction and/or augmentation of labour, intrapartum antibiotics, epidural and pharmacological pain relief, episiotomy in vaginal births, instrument-assisted birth (vacuum or forceps), caesarean section and use of oxytocin postpartum. Secondary outcomes are maternal and perinatal mortality, Apgar score below 7 at 5 min, postpartum haemorrhage and obstetric anal sphincter injury. Univariable and multivariable logistic regression analyses will be conducted to investigate variations among countries, adjusted for maternal age, body mass index, gestational weight gain, ethnic background, socioeconomic status and infant birth weight. The overall mean rates will be considered as a reference category, weighted for the size of the study population per country.Ethics and disseminationThe Medical Ethics Review Committee of VU University Medical Center Amsterdam confirmed that an official approval of this study was not required. Results will be disseminated at national and international conferences and published in peer-reviewed journals.

Mixed‐methods systematic review: Childbearing women's views, experiences, and decision‐making related to epidural analgesia in labour

“…The National Health Service Maternity Statistics (NHS, 2018) report rates of anaesthetic administration during labour in the United Kingdom, with 57.4% of women aged under 20 and 65.7% of mothers aged more than 40 years receiving analgesia. Similar rates are observed in other high‐income countries (Grond et al., 2000; Seijmonsbergen‐Schermers et al., 2018) with approximately two thirds of pregnant women choosing to have an epidural in the United States (CDC, 2011).…”

“…The use of epidural analgesia for the control of labour pain is an increasingly common phenomenon in high‐income countries worldwide (Seijmonsbergen‐Schermers et al., 2018). In the last two decades, surveys in North America and Europe have shown a trend towards increased use of epidural (Grond, Meuser, Stute, & Göhring, 2000).…”

Analysis of Caesarean Section Rates Using the Robson Classification System at a University Hospital in Spain

“…It is essential to avoid unnecessary interventions in childbearing women, and at the same time, ensure that those interventions that are necessary take place [37]. Every effort must be made to perform these procedures on the women that truly need them rather than merely attempting to reach a given optimal rate [13].…”

Variations in use of childbirth interventions in 13 high-income countries: A multinational cross-sectional study

“…The study methods have been described previously in a prospective study protocol [11]. This study is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline (S1 STROBE Checklist).…”

“…Primary outcomes added after publication of the study protocol [11] were onset of labour (spontaneous; induction of labour; prelabour cesarean section [CS]), intrapartum use of oxytocin, intrapartum antibiotics, and any pharmacological intrapartum pain relief. The variable 'onset of labour' was adjusted with respect to induction of labour and prelabour CS.…”