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Analysis

Cutting c-sections

21 January, 2014

Cutting c-sections

Midwives in North Lincolnshire and Goole have achieved one of the lowest CS rates in the country and, as a result, have won the RCM award for promoting normality.
Midwives magazine: Issue 1 :: 2014

Midwives in North Lincolnshire and Goole have achieved one of the lowest CS rates in the country and, as a result, have won the RCM award for promoting normality.


Kim Sheppard and Ann Lille

The rise in the rate of CS in developed countries has become a worry in recent years. WHO (2007) cites prenatal risks, inequity in access and cost as the reasons for concern.

In Scunthorpe General Hospital, the multidisciplinary maternity team has decided to tackle the issue head-on. Over the past two years, they have promoted the benefits of a vaginal delivery. As a result, the rate of CS dropped from 18.9% in 2011 to 16.2% the following year. The hospital now has one of the lowest CS rates in the country and is well below the national average of 24%.

Given that the cost of CS is significantly more than that of a normal vaginal birth, the success has meant considerable savings for the Northern Lincolnshire and Goole Hospitals NHS Foundation Trust. In just one year, the initiative has saved more than £61,000.

And this is only the start. The evidence-based approach is so simple, low-cost and effective that there is potential for it to be transferred to other units and areas of practice, thereby saving more money and improving service.

Evidence based
The initiative began with an exploration of best practice and existing guidelines to support normal birth following a CS. The health innovation and education cluster tool was used and, as a result, several steps were taken. 

A VBAC clinic was established and has been successful. The rate for women who have previously had a CS and gone on to have a vaginal delivery was 69% in 2013.

Extra funding was secured to provide equipment to help encourage women’s normal birth choice and the team worked closely with service user groups to find the best ways of providing up-to-date information on research to women and their families. Relevant information was provided in leaflet form to help support women and their choices.

An audit of admission in labour was completed for as many women as possible in November, March and June 2011-12. In March 2012, 100% of audited women who were low-risk on admission to Scunthorpe General Hospital had a spontaneous vaginal delivery (ChiMat, 2012). The proportion of audited low-risk women who were mobile in labour was 80%, with 40% being off the bed during the second stage of labour (ChiMat, 2012).

Principles
To enshrine the efforts of promoting normal childbirth, a list of principles was drawn up under the acronym OUR LABOURS
Our women are our priority
Understanding individual needs
Respect each other
Latent phase is normal – best place is home
Autonomous practitioners – midwives
Best practice supported by evidence
Offer feeds and skin-to-skin early
Utilise different positions for effective labour
Reduce infection – always wash your hands and remind others to do so
Support is the strongest analgesia.

The team is proud of its achievement in bringing down the CS rate and the cost saving is, of course, welcome. But it is the women and their families who gained the most from the initiative. By avoiding undergoing major abdominal surgery, with the long-term risks that it entails, has been incredibly positive.

Ann Lilley
Deputy community manager and SoM, North Lincolnshire and Goole NHS Foundation Trust

Kim Sheppard
Delivery suite manager and SoM, North Lincolnshire and Goole NHS Foundation Trust



Reference


Betrán AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, Wagner M. (2007) Rates of caesarean section, analysis of global, regional and national estimates. Paediatric and Perinatal Epidemiology 21(2): 98-113.





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