Abstract
BackgroundCaesarean section (CS) rates are rising worldwide. In the Netherlands, the most significant rise is observed in healthy women with a singleton in vertex position between 37 and 42 weeks gestation, whereas it is doubtful whether an improved outcome for the mother or her child was obtained. It can be hypothesized that evidence-based guidelines on CS are not implemented sufficiently.Therefore, the present study has the following objectives: to develop quality indicators on the decision to perform a CS based on key recommendations from national and international guidelines; to use the quality indicators in order to gain insight into actual adherence of Dutch gynaecologists to guideline recommendations on the performance of a CS; to explore barriers and facilitators that have a direct effect on guideline application regarding CS; and to develop, execute, and evaluate a strategy in order to reduce the CS incidence for a similar neonatal outcome (based on the information gathered in the second and third objectives).MethodsAn independent expert panel of Dutch gynaecologists and midwives will develop a set of quality indicators on the decision to perform a CS. These indicators will be used to measure current care in 20 hospitals with a population of 1,000 women who delivered by CS, and a random selection of 1,000 women who delivered vaginally in the same period. Furthermore, by interviewing healthcare professionals and patients, the barriers and facilitators that may influence the decision to perform a CS will be measured. Based on the results, a tailor-made implementation strategy will be developed and tested in a controlled before-and-after study in 12 hospitals (six intervention, six control hospitals) with regard to effectiveness, experiences, and costs.DiscussionThis study will offer insight into the current CS care and into the hindering and facilitating factors influencing obstetrical policy on CS. Furthermore, it will allow definition of patient categories or situations in which a tailor-made implementation strategy will most likely be meaningful and cost effective, without negatively affecting the outcome for mother and child.Trial registrationhttp://www.clinicaltrials.gov: NCT01261676
Highlights
Caesarean section (CS) rates are rising worldwide
This rise is relatively low compared to other countries, a striking detail is that the most impressive rise, in absolute numbers, was among healthy women with a singleton in vertex position between 37 and 42 weeks gestation [3]
In view of the rising CS rate, this study aims are: 1. To develop a set of quality indicators on the decision to perform a CS based on key recommendations of both Dutch and international guidelines
Summary
Caesarean section (CS) rates are rising worldwide. In the Netherlands, the most significant rise is observed in healthy women with a singleton in vertex position between 37 and 42 weeks gestation, whereas it is doubtful whether an improved outcome for the mother or her child was obtained. In the Netherlands, the overall CS rate has increased from 8.1% to 13.6% over the recent decade. This rise is relatively low compared to other countries, a striking detail is that the most impressive rise, in absolute numbers, was among healthy women with a singleton in vertex position between 37 and 42 weeks gestation [3]. CS are associated with an increased risk of maternal mortality as well as serious morbidity, such as admission to the intensive care unit (Odds Ratios (ORs) between 30.8 and 63.4), hysterectomy (ORs between 3.2 and 13.5), and puerperal infection (OR 3.0) [5,6,7].
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