Is evidence used to reduce interventions in low risk labour ?
Research type
Research Study
Full title
The use of interventions in the labour and childbirth of low risk women who use obstetric settings for birth: an assessment of use of evidence and exploration of the impact of ecological, individual practitioner, professional groups, and service-user influences.
IRAS ID
226761
Contact name
Florence Darling
Contact email
Sponsor organisation
City, University Of London
Duration of Study in the UK
1 years, 11 months, 15 days
Research summary
Despite worldwide efforts to reduce cesarean section rates, global and regional trends show that they continues to rise. Currently, 18.6% of all births occur by cesarian-section, ranging from 6% to 27.2% in the least and most developed regions, respectively. In the United Kingdom, the cesarean-section rate ranges between 26.5% to 31%, A rate of >15% is seen as medically unnecessary by the World Health Organisation. Aside from cesarean-sections, other interventions that are on the rise include the use of drugs to start or hasten labour, instrumental deliveries, epidurals for pain relief and episiotomy incision to assist birth.
When interventions are used routinely in the absence of valid clinical indications they are likely to pose more harm than benefit (Kings Fund, 2008). Despite several years of policies and guidelines to reduce interventions a recent audit by the Royal College of Obstetricians and Gynecologists, United Kingdom (2015) shows wide variations in the use of interventions amongst labour wards in National Health Service Trust in England. This raises questions about the implementation of evidence.
This study is concerned with the use of evidence in low risk women who choose labour wards for birth. The assessment of the use of evidence in this setting is identified as a priority for the purpose of reducing wide variations in the use of interventions. The study also seeks to understand how individual practitioners work with other professionals and involve women in the use of evidence to reduce interventions.
This is an ethnographic study. It uses mixed methods in the observation of practice. A quantitative method will assess the use of evidence-informed skills, using a previously developed and tested evidence-based Tool. A qualitative method will explore how the individual practitioner works with other professionals and involve women in using evidence to reduce interventions.
REC name
Social Care REC
REC reference
17/IEC08/0037
Date of REC Opinion
20 Oct 2017
REC opinion
Further Information Favourable Opinion