| Ayres‐De‐Campos 2015 |
Transmission of information and training of healthcare professionals, together with the inclusion of CS rates as a criterion for hospital funding |
Concerted action to reduce CS
Regional CS committee visited all state‐owned hospitals with CS rates above 35% and held meetings with the obstetric and midwifery staff to present data on international CS rates, individual hospital comparisons, risks associated with CS, financial aspects related with CS, and to share proposed measures to decrease CS rates. Some of these measures required local implementation, such as avoidance of labour inductions without a health indication before 41 weeks of gestation; promotion of vaginal birth after caesarean; implementation of external cephalic version; and conduction of regular CS audits. Courses on intrapartum foetal monitoring and simulation‐based training of obstetric emergencies were organised in 2010 and 2011, and made available free of charge to healthcare professionals in state‐owned hospitals. From 2010 onwards, an important percentage of hospital funding was indexed to the annual CS rate, and individual targets were negotiated with each state‐owned hospital.
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| Runmei 2012 |
Continuous quality improvement programme (educational programme for hospital staff and women, auditing surgeon practices, public health education, monitoring caesarean section rates and neonatal outcomes) |
Continuous quality improvement programme
Stage 1: January 2005 to December 2006
Educational programme for hospital staff -
Discouragement of unnecessary caesarean deliveries by:
depriving surgeons of potential financial incentives for cesarean deliveries reviewing indications for caesarean deliveries performed every day implementing international guidelines on caesarean delivery (e.g. those of the American or the Royal College of Obstetricians and Gynaecologists) improving labour monitoring and assessment
Active promotion of public health education on the advantages of natural delivery and the risks associated with caesarean deliveries among pregnant women, both through antenatal school and the public media
Stage 2 (January to June 2007)
Stage 3 (Jan 2005‐Dec 2011)
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