Cochrane · systematic review · CD005528
Non‐clinical interventions for reducing unnecessary caesarean section
Chen, I, Opiyo, N, Tavender, E, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Effective Practice and Organisation of CareAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
63
current version
GRADE rated
37
No studies
26
Included studies
NR
No studies 26 · 41.3%Ungraded 0 · 0%Very low 5 · 7.9%Low 9 · 14.3%Moderate 8 · 12.7%High 15 · 23.8%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Interventions targeted at women or families
Population: mixed population (women with a fear of childbirth; women with high levels of anxiety; husbands of pregnant women; pregnant women and couples; and pregnant women with no particular health condition)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary outcome measure | no estimate extracted | NR | No studies |
Caesarean section | RR 0.55 [0.33, 0.89] | NR | Low |
Spontaneous vaginal birth | RR 2.25 [1.16, 4.36] | NR | Low |
Instrumental vaginal birth | no estimate extracted | NR | No studies |
Maternal mortality or morbidity | no estimate extracted | NR | No studies |
Neonatal mortality or morbidity | no estimate extracted | NR | No studies |
Spontaneous vaginal birth – physiologic birth | no estimate extracted | NR | Moderate |
Spontaneous vaginal birth – normal vaginal birth | RR 0.84 [0.62, 1.14] | NR | Moderate |
Caesarean section – elective | RR 0.95 [0.58, 1.56] | NR | Moderate |
Caesarean section – emergency | RR 0.91 [0.67, 1.23] | NR | Moderate |
Caesarean section – elective repeat | no estimate extracted | NR | Moderate |
Caesarean section – for psychological reasons | RR 0.82 [0.5, 1.36] | NR | Low |
Caesarean section – overall | RR 0.81 [0.56, 1.18] | NR | Very low |
Caesarean section – VBAC | no estimate extracted | NR | Low |
Caesarean section – scheduled | RR 0.9 [0.74, 1.11] | NR | Moderate |
Caesarean section – urgent | RR 0.88 [0.58, 1.33] | NR | Moderate |
Maternal mortality | no estimate extracted | NR | No studies |
Maternal morbidity, neonatal morbidity or mortality | no estimate extracted | NR | Moderate |
Interventions targeted at healthcare professionals
Population: nurses, midwives, physicians
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary outcome measure | no estimate extracted | NR | No studies |
Caesarean section – all | no estimate extracted | NR | High |
Caesarean section – elective | no estimate extracted | NR | High |
Caesarean section – intrapartum | no estimate extracted | NR | High |
Spontaneous vaginal birth | no estimate extracted | NR | No studies |
Instrumental vaginal birth | no estimate extracted | NR | No studies |
Maternal mortality | no estimate extracted | NR | High |
Maternal morbidity | no estimate extracted | NR | No studies |
Neonatal mortality | no estimate extracted | NR | High |
Neonatal morbidity | no estimate extracted | NR | High |
Caesarean section ‐ overall | no estimate extracted | NR | High |
Caesarean section ‐ low risk group | no estimate extracted | NR | High |
Elective repeat caesarean section | no estimate extracted | NR | High |
Major maternal morbidity | RD 0.03 | NR | High |
Minor maternal morbidity | RD 0.3 | NR | High |
Major neonatal morbidity | no estimate extracted | NR | High |
Minor neonatal morbidity | no estimate extracted | NR | High |
Intrapartum and neonatal deaths | no estimate extracted | NR | High |
Caesarean section – unscheduled | no estimate extracted | NR | High |
Maternal mortality or morbidity | no estimate extracted | NR | No studies |
Caesarean section | OR 1.29 [0.99, 1.67] | NR | Low |
Neonatal mortality or morbidity | no estimate extracted | NR | No studies |
Interventions targeted at healthcare organisations or facilities
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary outcome measure | no estimate extracted | NR | No studies |
Caesarean section | no estimate extracted | NR | Very low |
Spontaneous vaginal birth | no estimate extracted | NR | No studies |
Instrumental vaginal birth | no estimate extracted | NR | No studies |
Maternal mortality or morbidity | no estimate extracted | NR | No studies |
Neonatal mortality or morbidity | no estimate extracted | NR | No studies |
Primary caesarean section | OR 0.56 | NR | Low |
VBAC | OR 2.03 | NR | Low |
Maternal mortality | no estimate extracted | NR | No studies |
Maternal morbidity | OR 1.07 [0.88, 1.3] | NR | Low |
Neonatal mortality | no estimate extracted | NR | No studies |
Neonatal morbidity | OR 1.09 [0.69, 1.72] | NR | Low |
'Cross‐cutting' interventionsa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary outcome measure | no estimate extracted | NR | No studies |
Caesarean section | no estimate extracted | NR | Very low |
Spontaneous vaginal birth | no estimate extracted | NR | No studies |
Instrumental vaginal birth | no estimate extracted | NR | No studies |
Maternal mortality | no estimate extracted | NR | No studies |
Maternal morbidity | no estimate extracted | NR | Very low |
Neonatal morbidity | no estimate extracted | NR | No studies |
Maternal or neonatal mortality | no estimate extracted | NR | No studies |
VBAC | no estimate extracted | NR | Very low |
Maternal mortality or morbidity | no estimate extracted | NR | No studies |
Neonatal mortality | no estimate extracted | NR | No studies |