To evaluate, within the framework of a randomized trial, the effect of an intervention aimed at reducing Caesarean section (CS) rates in Latin America. The intervention consists of the two following: (i) systematic second opinion before surgery (ii) practitioner education about decreasing CS rates through alternative guidelines for effective and safe management of childbirth.
* Exploratory assessment of rates and needs of CS in Africa and Asia
* Dissemination of results of a study of maternal needs and demands concerning childbirth
The main project & appended proposals:
The main project will assess the effectiveness of a package of co-interventions aimed at curbing the excess rate of CS in Latin America. Should this prove effective, replicating the interventions should not be an issue, as they are mainly behavioural, and therefore their extension to routine care should be neither costly nor complicated. Should the interventions not be effective within the framework of this trial, further assessment of the determinants of the failure will be essential and further in-depth work along the Bradby study would be recommended.
The efficacy of the intervention will be assessed in a multicenter cluster randomized controlled trial with two (three) further nested studies: (i) assessment of women's opinions (ii) care-giver's opinions (this survey is optional) and (iii) organisational and cost survey.
In maternity units randomized to the intervention arm, practitioners will systematically discuss the indication for caesarean section with a colleague before resorting to surgery (see a second opinion) and fill in a special form. Educational seminars on ways of decreasing CS will also be organised for the care-givers in the intervention arm maternity units. The trial will be conducted in six Latin American countries: Argentina, Brazil, Chile, Cuba, Guatemala and Mexico contributing a minimum of 17 pairs of maternity units.
The main outcome is CS rate, secondary outcomes include measures of maternal and perinatal morbidity. Satisfaction, acceptability and economic aspects will be assessed in the nested studies. Because of the risk of contamination between intervention and non-intervention units, CS levels will be assessed in all participating units prior to the study.
* Prevalence and needs of CS in Africa and Asia will be assessed.
* Translation and dissemination of a related previous study will be performed.
Funding SchemeCSC - Cost-sharing contracts
10400 La Habana 4
04000 Col.villa Coyoacan
751 85 Uppsala