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


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/

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Meghna Singhania
Meghna A Singhania is the founder and Editor-in-Chief at Medical Dialogues. An Economics graduate from Delhi University and a post graduate from London School of Economics and Political Science, her key research interest lies in health economics, and policy making in health and medical sector in the country. She can be contacted at meghna@medicaldialogues.in. Contact no. 011-43720751
Source: With inputs from WHO

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  1. WHO EVER TELL\’S CESARIAN NOT NECESSARY, AND 2 OPINION, LET THEM DO DUTY WITH OBSTETRICIAN, FOR ONE MONTH, SEE AND STUDY PATIANT REACTION FOR THAT. OBSTETRICIAN WILL NOT DO CEASRIAN UNTILL SECOND OPINION. FOR THE SAFTY OBSTETRICIAN WILL DO ONLY SAFE CESARIANS, LET THEM DO COMPLICATED CESARIAN BY SECOND OPINION OBSTRECIAN

  2. user
    Dr paresh pujara Medicolegal Advocate November 1, 2018, 6:23 pm

    If wHO /Government has no trust in their Doctors/Gynaecologist then they can plan LSCS only in Government Hospital. In private setup only ND allowed. All responsibility regarding treatment willon government.

  3. if there is clear cut indication for lscs then what is need for second opinion and if pt is also ready then why should one gynac should wait for other\’s opinion. as pt n babys responsibility on primary doctor

  4. user
    Dr Nirpaul Singh November 7, 2018, 8:09 am

    I agree with Zurekha. No need for second opinion when there is clear cut indication. And also in emergency no need to wait as whole responsibility lies on th obstetrician concerned.

  5. May be possible only at corporate hospitals that too situated at metros. In reality at rest of the places trial of labour done at home, by some quack, Ashas, mamta, or any untrained person. In India majority of pregnant patient reaches hospital only in emergency situations that too without any ANC and investigations. In rural or many districts lscs are still being conducted by quacks. So people or government is not looking into the real health system of our country. In case of fetal distress will anyone find the second gynaecologist or safe the fetus.

  6. True Dr.Archana..these guidelines are not for our place.

  7. user
    dr. Gaurang Shah October 31, 2018, 12:22 pm

    It is sad irony that all clutches are applied on poor doctors only, our political head do what ever comes in their messy head and they don\’t need to take any expert opinion, and here in a middle of night why other gynecologist would run to give second opinion, and who knows even they can make nexus , so what is the point of whole exercise, plus making all rates equal i.e. for normal as well as lscs birth will put huge cost on society, let the wisdom of treating doctor drive the case, and better stay away from meddling ,you government.

  8. When the medicolegal issues about the fetal outcome is threatening doctors , if the newborn is accepted in whatever condition it is then all gynaecolists wil dare to try till last.. now its the era of public litigation if small problem happen to baby also. No doctor will do sections for the sake of money