Strategies to Reduce Cesarean Birth in Low-Risk Women PDF Download
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Author: U. S. Department of Health and Human Services
Publisher: CreateSpace
ISBN: 9781483983561
Category : Medical
Languages : en
Pages : 548
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Thirty-two percent of pregnancies in the United States conclude with a cesarean birth. This record high rate reflects a relative increase of 53 percent in use of cesarean from 1991 to 2007. The pattern of increasing use of cesarean has been of concern for decades, with the last decline of 2 to 3 percent, occurring in the mid-1990s, being fully reversed by 1999, and the rate increasing over 50 percent from 1996 to 2007. Nearly one in three births by cesarean translates to a total of 1.4 million cesarean births each year, making cesarean the most commonly performed major surgery in the United States. Cesarean birth is not without consequences. In general, cesarean is more costly to the health care system, is associated with increased risk for both mother and infant, and has the potential to complicate subsequent pregnancies. Indeed, because the effects of these complications can be devastating and include fetal death, emergent hysterectomy, and maternal mortality from associated bleeding, labor and delivery units have increased the use of “code teams” that conduct practice drills to be prepared for such emergencies. Cesarean birth rates vary considerably by geographic region, ranging from 25 to 38 percent among States, with the highest rates in the southeastern United States. One research group examining differences across hospitals documented a span from 9 percent to 37 percent for primary cesarean births. While health care providers and health systems initially viewed such variation as a reflection of underlying differences in the risk profile of the women receiving care at the hospitals, it has become increasingly clear, through use of techniques such as risk adjustment, that a large proportion of variation is not explained by some facilities having much higher or lower risk patients than others. In medical care, when there is variation of the magnitude we see in use of cesarean after taking into account differences in patient characteristics, the conclusion is that provider preferences, and to a lesser extent patient preferences, are important drivers of variation. Nonetheless, relatively little focus has been placed on research specifically designed to assess strategies to reduce use of cesarean. The notable exception is a study of approaches to promote trial of vaginal birth after cesarean (VBAC). The state of general knowledge about evidence-based approaches to reduce cesarean overall is uncharted. In this review we aim to bring that literature to the forefront by systematically examining the outcomes of strategies intended to reduce use of cesarean among low-risk women. The goal of this systematic evidence review is to examine the effects of available strategies to reduce cesarean birth among low-risk pregnant women who have a singleton pregnancy, focusing on the following outcomes: route of birth, maternal morbidity and mortality, and neonatal morbidity and mortality. We synthesized evidence in the published literature to address these Key Questions (KQs): KQ1. What strategies during pregnancy are effective to reduce the use of cesarean birth among women with a singleton pregnancy who are intending a vaginal birth? KQ2. What strategies during labor are effective to reduce the use of cesarean birth among women with a singleton pregnancy who are intending a vaginal birth? KQ3. Where head-to-head comparisons are available, what strategies are shown to be superior in reducing the use of cesarean birth among women with a singleton pregnancy who are intending a vaginal birth? KQ4. What are the nature and frequency of adverse effects resulting from strategies used to reduce cesarean birth among women with a singleton pregnancy who are intending a vaginal birth?
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Languages : en
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Author: U. S. Department of Health and Human Services
Publisher: CreateSpace
ISBN: 9781484033104
Category : Medical
Languages : en
Pages : 100
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This investigation of future research needs builds on the Comparative Effectiveness Review (CER) Strategies To Reduce Cesarean Birth in Low-Risk Women, conducted by the Vanderbilt Evidence-based Practice Center (EPC). The rationale for the review is a concerning increase in cesarean use over the past decade. Thirty-two percent of pregnancies in the United States conclude with a cesarean birth. This record high rate reflects a relative increase of 53 percent in use of cesarean from 1991 to 2007. The pattern of increasing use of cesarean has been of concern for decades, with the last decline of 2 to 3 percent, occurring in the mid-1990s, being fully reversed by 1999, and the rate increasing more than 50 percent from 1996 to 2007. Nearly one in three births by cesarean translates to a total of 1.4 million cesarean births each year, making cesarean the most commonly performed major surgery in the United States. Research has addressed predictors of cesarean such as the shift toward older maternal age, higher body mass index, greater maternal comorbidity, use of assisted reproductive technology, and increased incidence of multiple gestations. Nonetheless, relatively little focus has been placed on research specifically designed to assess strategies to reduce use of cesarean. The CER aimed to bring that literature to the forefront by systematically examining the outcomes of interventions intended to reduce use of cesarean among low-risk women. The Comparative Effectiveness Review addressed the following Key Questions (KQs): KQ1. What strategies during pregnancy are effective to reduce the use of cesarean birth among women with a singleton pregnancy who are intending a vaginal birth? KQ2. What strategies during labor are effective to reduce the use of cesarean birth among women with a singleton pregnancy who are intending a vaginal birth? KQ3. Where head-to-head comparisons are available, what strategies are shown to be superior in reducing the use of cesarean birth among women with a singleton pregnancy who are intending a vaginal birth? KQ4. What are the nature and frequency of adverse effects resulting from strategies used to reduce cesarean birth among women with a singleton pregnancy who are intending a vaginal birth? After reviewing the evidence, the EPC investigators concluded that, while some strategies show promise, no particular strategy was uniformly successful in reducing cesareans. The strength of the evidence was low to insufficient for each of the strategies reviewed. The CER noted topic-related evidence gaps in the literature and common methodologic issues. These gaps are summarized and categorized by the most relevant PICOTS (population, intervention, comparator, outcome, timing, and setting) elements. Two of the eight topic-related evidence gaps do not fit within the PICOTS framework and are described as “determinants.” These gaps relate to macrolevel factors that influence patient, provider, and system preferences about cesarean and decisions to use cesarean.
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Author: Rashonda M. Lewis
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Languages : en
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OBJECTIVES: The objective of this Future Research Needs project is to identify top-priority research needs in the area of strategies to reduce cesarean birth in low-risk women. The research needs identified in this report include knowledge gaps related to the effectiveness of specific strategies for reducing use of cesarean birth compared with usual care, knowledge gaps about factors that drive patient and provider preferences and attitudes, and recommendations for methodologic improvements. This project builds on the evidence gaps and methodologic issues identified in the Comparative Effectiveness Review (CER) Strategies To Reduce Cesarean Birth in Low-Risk Women. DATA SOURCES: In Phase 1, stakeholders participated in a teleconference and then a Web-based survey to build a comprehensive list of research questions and methodologic recommendations. In Phase 2, stakeholders participated in one conference call and completed three Web-based surveys to prioritize research questions and recommendations. We identified currently funded and recently completed research between February 2012 and June 2012. To identify currently funded or recently completed randomized controlled trials intended to reduce use of cesarean delivery, we conducted searches of U.S. government resources (i.e., ClinicalTrials.gov, NIH Reporter), international trial registries (e.g., Current Controlled Trials), and other potential funding sources such as relevant associations and organizations (e.g., American College of Nurse-Midwives, American Congress of Obstetricians and Gynecologists). RESULTS: Thirteen stakeholders representing the perspective of patient advocacy groups, academic researchers, obstetrician-gynecologists, nursing and nurse-midwifery professional organizations, payers, and national foundations and societies agreed to participate in one or more of the stages of ranking and prioritization. The group included five Key Informants/Technical Expert Panel members from the draft CER. In Phase 1, stakeholders generated a "snowballed" list of 47 research questions and 17 methodologic recommendations. In Phase 2, stakeholders worked from the snowballed list to prioritize research needs. In Phase 3, the Evidence-based Practice Center investigators developed recommendations for optimal study design. CONCLUSIONS: Our multistep process for identifying, multiplying, and prioritizing research questions to advance research in the area of strategies to reduce cesarean birth in low-risk women resulted in an actionable list of research topics to fill specific knowledge gaps. The top-tier research questions reflect a focus on standardization strategies for induction and arrest of labor (three of the top five research questions), systems-level strategies (one of five), and novel staffing models (one of five). For strategies that standardize induction and definitions of arrest of labor, we recommend cluster randomized controlled trials with randomization of entire labor and delivery units. For trials of systems-level strategies and staffing models, we recommend multisite studies to improve power and generalizability. The top-tier methodologic improvements focused on improving the capture of short- and long-term birth outcomes.
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
ISBN: 0309669820
Category : Social Science
Languages : en
Pages : 369
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The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings.
Author: Magnus Murphy, M.D.
Publisher: Prometheus Books
ISBN: 1616145129
Category : Health & Fitness
Languages : en
Pages : 339
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Obstetrician and gynecologist Magnus Murphy, MD, and journalist/advocate Pauline McDonagh Hull offer a compelling case for surgical delivery as a legitimate birth choice for informed women. By offering a wealth of medical evidence from around the world and thoughtfully countering the many objections detractors have lodged against it, the authors convincingly demonstrate that a planned cesarean birth at thirty-nine- plus weeks is a safe and often preferred alternative to a planned vaginal delivery. An indispensable guide for women, their families, and medical professionals.
Author: Christopher Norwood
Publisher: Simon & Schuster
ISBN: 9780671469160
Category : Health & Fitness
Languages : en
Pages : 252
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Author: Eric Jauniaux
Publisher: Oxford University Press
ISBN: 0191076317
Category : Medical
Languages : en
Pages : 217
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Book Description
Caesarean Section has become the most common major operation in the world, and with the increasing number there are many serious and long-term healthcare implications for gynaecology, general surgery, neonatology, and epigenetics. A full perspective of the procedure and its consequences is therefore essential for practitioners, residents, and trainees alike. The Textbook of Caesarean Section is the key textbook on this subject, and is an informative and practical tool for clinicians performing this procedure in all areas of the world. The accompanying professional medical videos demonstrate in clear and expert detail the two alternative procedures for caesarean section, ensuring that readers of this book gain an in-depth understanding of the techniques involved, and supporting blended learning in postgraduate education globally. Written by a distinguished team of expert contributors, this book carefully describes current best practice for caesarean section alongside key chapters on the history of caesarean section, and other important and related issues that obstetricians must be aware of, such as anaesthesia, prevention of complications of surgery, reproduction after C-section, and perinatal outcomes. The text is extensively illustrated with colour images, and fully referenced throughout, providing all the information essential for the reader to perform the optimal caesarean delivery procedures, and diagnose and manage the short- and long-term complications associated with different methods of caesarean sections.
Author: Robert Black
Publisher: World Bank Publications
ISBN: 1464803684
Category : Medical
Languages : en
Pages : 419
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Book Description
The evaluation of reproductive, maternal, newborn, and child health (RMNCH) by the Disease Control Priorities, Third Edition (DCP3) focuses on maternal conditions, childhood illness, and malnutrition. Specifically, the chapters address acute illness and undernutrition in children, principally under age 5. It also covers maternal mortality, morbidity, stillbirth, and influences to pregnancy and pre-pregnancy. Volume 3 focuses on developments since the publication of DCP2 and will also include the transition to older childhood, in particular, the overlap and commonality with the child development volume. The DCP3 evaluation of these conditions produced three key findings: 1. There is significant difficulty in measuring the burden of key conditions such as unintended pregnancy, unsafe abortion, nonsexually transmitted infections, infertility, and violence against women. 2. Investments in the continuum of care can have significant returns for improved and equitable access, health, poverty, and health systems. 3. There is a large difference in how RMNCH conditions affect different income groups; investments in RMNCH can lessen the disparity in terms of both health and financial risk.
