WHO Guidelines Can Cut Unnecessary C-Section Deliveries In India: Report

Implementing the World Health Organization's guidelines could help improve women's care during childbirth and reduce unnecessary cesarean section deliveries, a pilot study conducted in India has found.

Cesarean sections account for over 1 in 5 childbirths globally, with the numbers set to rise in the coming decade to one-third of all births, according to WHO.

When performed for medical reasons, cesarean sections can be lifesaving and are an essential component of good-quality medical care, but they can also carry inherent risks.

The latest study, published in the journal Nature Medicine, is the world's first randomized trial of the WHO's Labor Care Guide (LCG).

The team, including researchers from Jawaharlal Nehru Medical College in Karnataka, conducted the pilot trial in four hospitals in India to evaluate the implementation of the novel LCG strategy, compared with routine care.

The study showed that it was possible to implement the LCG into routine clinical care, including in busy, limited-resource settings, said study lead author Joshua Vogel, a professor at Burnet Institute in Australia.

"The LCG was released by the WHO to improve clinical and supportive care for women giving birth worldwide. While it was developed to align with the best available evidence, until now we have not been sure of its effects on women and their babies," he said.

Vogel noted that the LCG had the potential to reduce unnecessary cesarean sections, which carried health risks for mothers and their babies.

"In recent decades there has been a generalized trend in health care providers being more 'interventional' during birth-this is shown in high rates of cesarean, augmenting labour with drugs and episiotomy we see in many countries," he said.

"When used at the right time, cesarean sections can improve health outcomes, but they are often used without clear medical need. Our research showed that when the LCG was well-implemented, there were reductions in cesarean section rates, without added harms," Vogel added.

In 2018, the WHO published 56 recommendations to improve the quality of intrapartum care and enhance women's childbirth experiences.

Key recommendations included changing the definition of active first stage of labour from the widely used 3 centimetre (cm) or 4cm to starting from 5cm of cervical dilation, and removal of the 'alert' and 'action' lines.

These changes reflected a growing body of evidence that the historical '1cm per hour' rule for active labour progress is unrealistic for most women, and that slower dilation rates are not associated with adverse birth outcomes.

In response to these recommendations, a 'next generation' partograph known as the WHO LCG was developed in 2020.

The latest trial will generate critical evidence that can reassure women, their families, health care workers and policymakers that using LCG in their setting will not cause unanticipated harms, the researchers said.

The collaborative research between Burnet, international hospitals, universities, and research groups in India and Argentina, is hoped to guide future trials and begin to reverse the worldwide trend of rising rates of cesarean section rates, they added. 

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