Implementation of WHO Guidelines to reduce unnecessary C-Sections in India
WHO issued 56 recommendations to enhance intrapartum care, advocating for evidence-based practices and challenging outdated norms
Cesarean sections (C-sections) are a common childbirth method, making up over 20% of global deliveries. The World Health Organization (WHO) anticipates this number rising to one-third in the next decade. While crucial in emergencies, C-sections carry risks when performed without medical necessity. A recent pilot study in India explored the effectiveness of implementing WHO guidelines, specifically the Labor Care Guide (LCG), to enhance women’s care during childbirth and reduce unnecessary C-sections.
Background on C-Sections:
C-sections are sometimes life-saving, but their increasing prevalence raises concerns. WHO emphasizes the need for judicious use to prevent unnecessary risks for both mothers and babies. In 2018, WHO issued 56 recommendations to enhance intrapartum care, advocating for evidence-based practices and challenging outdated norms.
The WHO’s Labor Care Guide (LCG):
The LCG, developed in response to WHO recommendations, aims to improve clinical and supportive care for women during childbirth. The recent pilot study conducted in India was the world’s first randomized trial to evaluate the LCG’s impact. Researchers, including those from Jawaharlal Nehru Medical College, focused on implementing LCG in four hospitals, comparing it with routine care.
Study Findings:
The study demonstrated the feasibility of integrating the LCG into routine clinical care, even in resource-limited settings. Lead author Joshua Vogel highlighted the potential of LCG in reducing unnecessary C-sections, a positive outcome for maternal and neonatal health. Vogel emphasized the need to balance the benefits of C-sections with their overuse, which can lead to avoidable health risks.
Historical Trends in Birth Interventions:
Over the years, healthcare providers have shown a trend toward more intervention during childbirth, resulting in high rates of C-sections, drug augmentation, and episiotomies. Vogel emphasized the importance of utilizing interventions like C-sections judiciously, as their overuse without medical necessity can have adverse effects.
WHO’s Recommendations and LCG Development:
In 2018, WHO recommended changes to improve intrapartum care, including revising the definition of the active first stage of labor and modifying the traditional ‘1cm per hour’ rule. These recommendations influenced the development of the LCG in 2020, offering a more evidence-based approach to childbirth care.
LCG’s Positive Impact:
The pilot trial indicated that well-implemented LCG could lead to a reduction in C-section rates without compromising maternal or neonatal well-being. Vogel stressed the importance of aligning clinical practices with evidence-based guidelines to ensure better outcomes for both mothers and babies.
Global Collaboration in Research:
The study involved collaboration between Burnet Institute, international hospitals, universities, and research groups in India and Argentina. This collaborative effort aimed to generate crucial evidence reassuring various stakeholders, including women, families, healthcare workers, and policymakers, about the safety and effectiveness of using LCG.
Looking Ahead: Future Trials and Reversing Trends:
The researchers expressed hope that the findings from this trial would guide future research and contribute to reversing the global trend of rising C-section rates. The goal is to encourage evidence-based practices and promote a thoughtful approach to childbirth care, ensuring the well-being of mothers and infants.
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