The annual conference of the OptiBIRTH research project was held in Gothenburg in May 27. Financed by the European Commission’s Seventh Framework Programme, OptiBirth strives to increase the percentage of vaginal births after caesarean (VBAC) by supporting woman-centred care.
Professor Cecily Begley at Trinity College Dublin is coordinating the project. An intervention is currently tested in Germany, Ireland and Italy. Sweden, Finland and The Netherlands are participating as paradigms. The face-to-face intervention is based partly on focus group interviews with obstetricians and midwives in each of the six countries. WP3 (led by Professor Marlene Sinclair at Ulster University) developed a web portal, mobile apps and on-line educational resources to help women with shared decision-making. Prof Koen Putman from Vrije University in Belgium is assessing all the costs involved.
In conjunction with the conference, a meeting was held for Western Sweden on May 28 on the topic of retaining and improving Sweden’s impressive record from the perspective of obstetricians and midwives when it comes to the percentage of caesareans.
Professor Ingela Lundgren, the scientific leader of the team that designed the face-to face intervention, and Associate Professor Lars Ladfors, consulting physician and scientific advisor to OptiBirth, hosted the meeting .
Professor Ladfors presented caesarean statistics for various Swedish counties: Östergötland was lowest at 12.8%, Stockholm was second highest at 20.8% and Gotland was highest at 21.0%. At 15.9%, Västra Götaland was under the 2013 average of 17.3%. South Stockholm General Hospital was the third highest, Karolinska University Hospital the second highest and Danderyd Hospital the highest at 22.6%. Sollefteå Hospital was the lowest at 7.2%. Adjusting for the client group, Linköping, Östersund and Malmö Hospital were lower. Mölndal had 14.8% and Östra 16.8% at Sahlgrenska University Hospital but the fact that all high-risk births are at Östra must be taken into consideration.
Professor Lundgren and Christina Nilsson, a midwife and researcher, presented the findings of interviews with women, obstetricians and midwives. Social attitudes, decision making procedures, the identity of decision makers, cooperation among obstetricians, midwives and women, and follow-up after a first caesarean are key factors in determining the percentages. Both women and healthcare professions in Sweden, Finland and The Netherlands were pleased that the final decision about whether to perform a caesarean is made by the obstetrician and that everyone regards vaginal birth as the first option in the absence of elevated risk factors or complications. Women, however, requested a little more attention that would enable them to prepare for vaginal childbirth—given that they had experienced only caesareans previously, they felt as if they were going through it for the first time. The professionals felt that these women should be treated like others during labour but receive extra attention.
Sandra Morano, a professor and obstetrician in Genoa who is in charge of the study in her country, talked about the situation there. Her presentation addressed fear of childbirth among not only women, but obstetricians and midwives as well. One apprehension is that obstetrics will become a surgical specialty due to ignorance and lack of training in the art of childbirth. For example, the CS rate is 60% in Naples (which is part of the OptiBIRTH project).
Professor and midwife Mechthild Gross, Hanover, described a pattern by which the proportion is lower in former East Germany (down to 22% in Saxony) than former West Germany (up to 34% in Hesse). Germany has many more small hospitals, among which the frequency of caesareans varies substantially, than Sweden. A total of 1.3% of childbirths are outside the hospital (planned or unplanned) or on the way there. Germany keeps statistics of such events and Professor Gross presented the numbers for 2013 based on 10,600 births. Sweden does not keep any such statistics.
Liselotte Bergqvist and Anna-Karin Rinkqvist, organizational developers and midwives at Sahlgrenska University Hospital, presented value based healthcare at Sahlgrenska University hospital.. The initiative includes the percentage of cesareans in primiparous women as an outcome measure – the statistics reveal favorable results.
BY: INGELA LUNDGREN
