Review examines prevention of unneeded C-sections | National Nursing News.

Review Examines Prevention Of Unneeded C-sections

A meta-analysis by researchers with The Cochrane Library provides insight to the effectiveness and safety of non-clinical interventions for reducing unnecessary caesarean sections.

The researchers analyzed various randomized controlled trials and other studies. Their review ended up including 16 studies, in which participants included pregnant women and their families, healthcare providers who work with expectant mothers and community and advocacy groups.

Six studies specifically targeted pregnant women, the researchers wrote. Two randomized controlled trials proved effective in reducing caesarean section rates, including one via a nurse-led relaxation training program for women with a fear or anxiety of childbirth. The researchers noted, however, that both trials were small in size and targeted younger mothers who were pregnant for the first time.

“There is insufficient evidence that prenatal education and support programs, computer patient decision-aids, decision-aid booklets and intensive group therapy are effective,” they wrote.

Another 10 studies targeted health professionals. Three were effective in reducing caesarean section rates, including one involving implementation of guidelines with mandatory second opinion. The researchers did not find sufficient evidence that audit and feedback, training of public health nurses, insurance reform, external peer review and legislative changes are effective in reducing unnecessary caesarean sections.

“Implementation of guidelines with mandatory second opinion can lead to a small reduction in caesarean section rates, predominantly in intrapartum sections,” the researchers concluded. “Peer review, including pre-caesarean consultation, mandatory second opinion and postcaesarean surveillance can lead to a reduction in repeat caesarean rates.

“Guidelines disseminated with endorsement and support from local opinion leaders may increase the proportion of women with previous caesarean sections being offered a trial of labor in certain settings. Nurse-led relaxation classes and birth preparation classes may reduce caesarean section rates in low-risk pregnancies.”

The review appears in the latest issue of The Cochrane Library.

Read it at http://bit.ly/jJE7yd.