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Improving the organisation of maternal health service delivery, and optimising childbirth, by increasing vaginal birth after caesarean section (VBAC) through enhanced women-centred care

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Optimisation of childbirth in Europe

Caesarean section (CS) rates vary considerably throughout Europe. An EU-funded project aimed to lower these rates by increasing vaginal birth after caesarean section (VBAC).


According to the 2008 Perinatal Health Report, there is 'widespread concern' over rising CS rates. Furthermore, VBAC rates in Germany, Ireland and Italy are significantly lower (29-36 %) than they are in the Netherlands, Finland and Sweden (45-55 %). As a result, 160 000 unnecessary CSs are performed each year at an extra direct annual cost of EUR 156 million. The project OPTIBIRTH brought together service users – women and their families, midwives and obstetricians as well as researchers from epidemiology, health economics and industry to conduct studies at 15 sites in the 3 countries with low VBAC rates. Research was very wide-ranging taking in both low and high-rate VBAC countries. The intervention was designed to increase the empowerment, engagement and involvement of women with a history of at least one CS. The objective was that VBAC rates will be able to increase from 25 to 40 %. Two systematic reviews of clinician-led and women-led interventions as well as focus group interviews with 71 women and 115 clinicians in the six countries were completed. The final intervention used a motivational design and consisted of appointment of midwife and obstetrician opinion leaders (MOLs and OOLs) in each site. There were also two antenatal education and support classes for women and their partners of two hours each (inclusive of group meeting with the MOL and OOL at the end). For maximum use, the team translated the intervention into online format with a website and developed three mobile phone applications. The intervention was tested through a cluster randomised trial. A full-cost analysis and quality of life was also conducted as well as meetings with decision makers to enhance transfer of findings into mainstream practice. It is expected that the intervention will result in a decrease in repeat CSs and an increase in VBAC rates in Germany, Ireland and Italy. OPTIBIRTH also may improve the organisation of maternity health systems and service delivery in Europe by enhancing patients' involvement.


Caesarean section, vaginal birth after caesarean section, OPTIBIRTH, randomised trial, maternity health

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