Non-Clinical Interventions to reduce overall cesarean sections
"last update: 8 February 2024"
- Formulation of the recommendations
The DECIDE framework was used to guide the formulation of recommendations. DECIDE is an evidence-to-decision tool that allows explicit and systematic consideration of evidence on interventions in terms of six domains: effects, values, resources, equity, acceptability and feasibility. For each priority question, judgements are made on the impact of the intervention against each of these domains, to inform guideline recommendations.
Using the DECIDE framework, members of the GDG prepared evidence-to-decision tables for each priority question, covering evidence on each of these six domains. At the face-to-face meeting (held in July 2023), GDG members collectively reviewed the evidence-to-decision tables and the draft recommendations, and reached consensus on each recommendation, based on explicit consideration of domains within the evidence-to-decision tables. The GDG also identified important considerations for guideline implementation, monitoring and evaluation, and research gaps.
The GDG made three types of recommendation:
1. Recommended: The benefits of implementing this option outweigh the possible harms. This option can be implemented.
2. Context-specific recommendation
2.1. Recommended only in the context of rigorous research: This option indicates that there are important uncertainties about an intervention. In such instances, the implementation can still be undertaken at a large scale, but only as research that is able to address unanswered questions and uncertainties related both to the effectiveness of an intervention.
2.2. Recommended only with targeted monitoring and evaluation: This option indicates uncertainty about the effectiveness or acceptability of an intervention, especially regarding particular contexts or conditions. Interventions classified as such can be considered for implementation (including at large scale), provided they are accompanied by targeted monitoring and evaluation.
3. No recommendation: The reasons for deciding “No recommendation” are either:
3.1. The confidence in effect estimates is low or very low that the GDG considers a recommendation would be speculative.
3.2. Irrespective of the confidence in effect estimates, the trade-offs are so closely balanced, and the values and preferences and resource implications not known or too variable, that the panel has great difficulty deciding on the direction of a recommendation.
➡️Decision-making during the GDG meeting
The GDG meeting was held in July 2023. The GDG members discussed the evidence summarized in the evidence-to-decision tables for each guideline question and then considered the relevant draft recommendation. After discussing each question, the draft recommendation and justification were revised as needed. The final set of recommendations was made by consensus.
➡️Document preparation and peer review
Following the final GDG meeting, a draft of the full guideline document was prepared. The document was sent to the External Review Group for peer review. The External Review Group members were asked to review the final draft guideline to identify errors of fact, comment on clarity of language, and consider issues of implementation, adaptation and context. The Steering Group evaluated the input of the peer reviewers for inclusion in the guideline document and made further revisions to the guideline draft as needed. After the GDG meetings and external peer review, further modifications to the guideline by the Steering Group were limited to corrections of factual error and improvements in language to address any lack of clarity. The revised final version was returned to the GDG for the final approval.
