Mandatory Second Opinion to reduce Unnecessary C-Sections: WHO 2018 Guidelines

WHO released guidelines on Non-Clinical Interventions to Reduce Unnecessary Caesarean Sections

A structured, mandatory second opinion for caesarean section indication in clinical settings is recommended to reduce caesarean births, according to the recently released guidelines by the World Health Organisation.

The guidelines also call for implementation of evidence-based clinical practice guidelines, caesarean section audits and timely feedback to health-care professionals are recommended to reduce caesarean births in hospitals.

The guidelines come in light of the fact that Caesarean section rates have increased steadily worldwide over the last decades. However, this trend has not been accompanied by significant maternal or perinatal benefit, in fact quite the contrary. Further, High rates of caesarean section are associated with substantial health-care costs.

Read Also: Labor induction at 39 weeks reduces need for cesarean section: NEJM

In India, as well the rates of cesarean section are skyrocketing, with the medical profession being put to blame for the same, and the demands even being made to name and shame the gynaecologists who do Caesarean deliveries for no reason at all except money

Read Also: Name and shame Gynacologists who conduct unnecessary C-sections: Maneka Gandhi

Addressing the very issue of growing C-section rates, in 2018 WHO released guidelines on Non-Clinical Interventions to Reduce Unnecessary Caesarean Sections, with recommendations being targeted at women, healthcare professionals as well as institutions.

Following are the major recommendations:

A. INTERVENTIONS TARGETED AT WOMEN

Recommendation 1. Health education for women is an essential component of antenatal care. The following educational interventions and support programmes are recommended to reduce caesarean births only with targeted monitoring and evaluation.

◆ Childbirth training workshops (content includes sessions about childbirth fear and pain, pharmacological pain-relief techniques and their effects, non-pharmacological pain-relief methods, advantages and disadvantages of caesarean sections and vaginal delivery, indications and contraindications of caesarean sections, among others).

◆ Nurse-led applied relaxation training programme (content includes group discussion of anxiety and stress-related issues in pregnancy and purpose of applied relaxation, deep breathing techniques, among other relaxation techniques).

◆ Psychosocial couple-based prevention programme (content includes emotional self-management, conflict management, problem-solving, communication and mutual support strategies that foster positive joint parenting of an infant). "Couple" in this recommendation includes couples, people in a primary relationship or other close people.

◆ Psychoeducation (for women with fear of pain; comprising information about fear and anxiety, fear of childbirth, normalization of individual reactions, stages of labour, hospital routines, the birth process, and pain relief [led by a therapist and midwife], among other topics).

When considering the educational interventions and support programmes, no specific format (e.g. pamphlet, videos, role play education) is recommended as more effective.

B. INTERVENTIONS TARGETED AT HEALTH-CARE PROFESSIONALS

Recommendation 2.1. Implementation of evidence-based clinical practice guidelines combined with structured, mandatory second opinion for caesarean section indication is recommended to reduce caesarean births in settings with adequate resources and senior clinicians able to provide mandatory second opinion for caesarean section indication

Recommendation 2.2. Implementation of evidence-based clinical practice guidelines, caesarean section audits and timely feedback to health-care professionals are recommended to reduce caesarean births.

C. INTERVENTIONS TARGETED AT HEALTH ORGANIZATIONS, FACILITIES OR SYSTEMS

Recommendation 3.1. For the sole purpose of reducing caesarean section rates, the collaborative midwifery-obstetrician model of care (i.e. a model of staffing based on care provided primarily by midwives, with 24-hour back-up from an obstetrician who provides in-house labour and delivery coverage without other competing clinical duties) is recommended only in the context of rigorous research. This model of care primarily addresses intrapartum caesarean sections.

Recommendation 3.2. For the sole purpose of reducing unnecessary caesarean sections, financial strategies (i.e. insurance reforms equalizing physician fees for vaginal births and caesarean sections) for health-care professionals or health-care organizations are recommended only in the context of rigorous research.

To read the complete guidelines, click on the following link

http://www.who.int/reproductivehealth/publications/non-clinical-interventions-to-reduce-cs/en/