Cochrane Summaries

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Non-clinical interventions for reducing unnecessary caesarean section

Khunpradit S, Tavender E, Lumbiganon P, Laopaiboon M, Wasiak J, Gruen RL
Published Online: 
15 June 2011

A caesarean section is an operation used to reduce complications of childbirth. While it can be lifesaving for both the mother and the baby, a caesarean section is not without risk and should not be done when not necessary. The number of caesarean sections has been increasing in both developed and developing countries. While there may be medical reasons for this increase, many believe that non-medical factors are at least partly responsible. 

This review examines the effect and safety of strategies to reduce unnecessary caesarean sections. This review does not examine medical strategies to reduce unnecessary caesarean sections, such as external cephalic version (when doctors try to turn a breech baby before delivery) or support to the mother during labour. This review examines strategies such as providing education to health professionals and mothers, or making it mandatory to have a second opinion.

This review found 16 studies.  

For low-risk pregnancies, nurse-led relaxation classes and birth preparation classes for mothers may decrease the number of caesarean sections. However, prenatal education and support programmes, computer patient decision-aids, decision-aid booklets and intensive group therapy have not been shown to decrease caesarean sections effectively.  Implementation of guidelines with mandatory second opinion, implementation of guidelines with support from local opinion leaders, and audit and feedback given to the individual provider may decrease caesarean sections. These conclusions are based on individual studies and caution should be exercised applying them to very different populations or with substantially different interventions.