Is evidence used to reduce overuse of interventions in labour?
Research type
Research Study
Full title
Reducing overuse of medical interventions in the labour care of low risk women who use obstetric settings: an assessment of implementation integrity and exploration of the impact of individual practitioner, professional groups and women on implementation.
IRAS ID
226761
Contact name
Florence Darling
Contact email
Sponsor organisation
City, University Of London
Duration of Study in the UK
2 years, 0 months, 24 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, medical interventions also include the use of drugs to start or hasten labour, instrumental deliveries, epidurals for pain relief and episiotomy:an incision to assist birth.
In childbirth, both underuse and overuse of medical interventions cause harm. This study is concerned with overuse. Overuse is defined as care where the risks of a therapy outweigh the benefits. In childbirth, this is commonly referred to as the medicalisation of birth. Despite several years of policies and guidelines to reduce overuse, a recent audit by the Royal College of Obstetricians and Gynecologist, United Kingdom (2015) shows wide variations in the use of medical interventions among National Health Service Trust in England. This raises questions about the implementation of evidence. Factors that influence implementation can operate on many levels. This study is concerned with implementation of evidence by practitioners. The study assesses the use of evidence in care of women who birth in labour wards. Reducing overuse in labour wards is identified as a priority. The study also seeks to understand the impact of the individual practitioner, professional groups, and women on implementation.
This is an ethnographic study. It uses mixed methods in observations 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 identify the impact of the individual practitioner, professional groups, and women factors on implementation.
REC name
London - Surrey Borders Research Ethics Committee
REC reference
17/LO/1211
Date of REC Opinion
27 Jul 2017
REC opinion
Unfavourable Opinion