Non-Clinical Interventions to reduce overall cesarean sections

- Executive summary

➡️Introduction

The number of women who deliver by Cesarean section has increased steadily in Egypt over the last three decades, from 4.6% in 1992 (1) to 51.8% in 2014 (2).

Cesarean birth is associated with short- and long-term risks that can extend many years beyond the current delivery and affect the health of the woman, the child, and future pregnancies. High rates of cesarean section are associated with substantial health-care costs (3).

The factors contributing to the rise in cesarean section rates are complex, and identifying interventions to address them is challenging. Factors associated with cesarean births include changes in the characteristics of the population such as increase in the prevalence of multiple pregnancies, assisted reproduction, and increase in the proportion of nulliparous women with advanced age. Other non-clinical factors such as women increasingly wanting to determine how and when their child is born, generational shifts in work and family responsibilities, physician factors, increasing fear of medical litigation, as well as organizational, economic and social factors have all been implicated in this increase (4).

The sustained, unprecedented rise in cesarean section rates in Egypt is a major public health concern. There is an urgent need for evidence-based guidance to address the trend. This is the national guideline on non-clinical interventions (defined as interventions applied independently of a clinical encounter between a health-care provider and a patient in the context of patient care).

The objective of this guideline is to provide evidence-based recommendations on non-clinical interventions specifically designed to reduce cesarean sections. Clinical interventions that could help to reduce cesarean section rates are being prepared in a second guideline.

➡️Target audience

The primary audience for this guideline includes health-care professionals including obstetricians, midwives, nurses, and general medical practitioners, as well as managers of maternal and child health programs and public health policymakers in Egypt.

➡️Guideline development methods

We used the GRADE-Adolopment methodology for the guideline adaptation process (5). Briefly, this included, identifying and training guideline panelists, prioritizing questions and outcomes, identifying existing guideline (6), assessing quality and adaptability of the identified guideline, reviewing GRADE evidence tables and EtD frameworks, and formulating and grading strength of recommendations.

The identified existing guideline was developed by the WHO in accordance with standard procedures set out in the WHO handbook for guideline development (7). The evidence, in the identified guideline, on the effectiveness of interventions was derived from an updated Cochrane review of 29 studies (8).