Abstract
Concern has been expressed globally over rising caesarean birth rates. Recently, the International Federation of Gynaecology and Obstetrics (FIGO) called for help from governmental bodies, professional organisations, women’s groups, and other stakeholders to reduce unnecessary caesareans. As part of a wider research initiative, we conducted an overview of systematic reviews of antenatal and intrapartum interventions, and reports of evidence based recommendations, to identify and highlight those that have been shown to be effective for reducing caesarean birth, promoting vaginal birth and reducing fear of childbirth. Following registration of the review protocol, (PROSPERO 2018 CRD42018090681), we searched The Cochrane Database of Systematic Reviews, PubMed, CINAHL and EMBASE (Jan 2000-Jan 2018) and searched for grey literature in PROSPERO, and on websites of health professional and other relevant bodies. Screening and selection of reviews, quality appraisal using AMSTAR-2, and data extraction were performed independently by pairs of at least two reviewers. Excluding reviews assessed as ‘critically low’ on AMSTAR-2 (n = 54), 101 systematic reviews, and 10 reports of evidence based recommendations were included in the overview. Narrative synthesis was performed, due to heterogeneity of review methodology and topics. The results highlight twenty-five interventions, across 17 reviews, that reduced the risk of caesarean, nine interventions across eight reviews that increased the risk of caesarean, eight interventions that reduced instrumental vaginal birth, four interventions that increased spontaneous vaginal birth, and two interventions that reduced fear of childbirth. This overview of reviews identifies and highlights interventions that have been shown to be effective for reducing caesarean birth, promoting vaginal births and reducing fear of childbirth. In recognising that clinical practices change over time, this overview includes reviews published from 2000 onwards only, thus providing contemporary evidence, and a valuable resource for clinicians when making decisions on practices that should be implemented for reducing unnecessary caesarean births safely.Protocol Registration: PROSPERO 2018 CRD42018090681. Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018090681
Highlights
Caesarean birth can be a necessary emergency procedure to prevent maternal or neonatal harm or death
A systematic review led by the World Health Organization (WHO) showed that, when caesarean section rates rose above 9–16% at population level, they did not appear to result in any decrease in maternal or neonatal mortality [7]
This overview of reviews and practice based recommendations identifies and highlights antenatal and intrapartum interventions and practices that have been shown to be effective in reducing caesarean birth, promoting vaginal birth and reducing fear of childbirth in low and high-risk maternity populations
Summary
Caesarean birth can be a necessary emergency procedure to prevent maternal or neonatal harm or death. Caesarean birth can result in death or serious morbidity, with evidence to suggest that caesarean birth more than trebles the risk of maternal mortality (3.6 in vaginal births compared with 13.3 in caesareans, per 100,000 births), overall rates are very low [1]. Neonatal respiratory distress requiring oxygen therapy is more common in term babies if birth is by elective or emergency caesarean (35.5 and 12.2 per 1000 live births) compared with vaginal birth (5.3 per 1000 live births) [3]. Caesarean birth costs €739 (elective) or €1180 (emergency) more than vaginal birth [5]
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