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Wonderfull example of "where there is a will there
is a way!
Thank you denise
----- Original Message -----
Sent: Sunday, November 24, 2002 1:36
PM
Subject: [ozmidwifery] How to halve the
CS rate ..
Dear Listers
I am cross-posting this posting from a
National Childbirth Trust (NCT) list that I am on in the UK. This is
timely given the bit in the newspaper today the CS rate in WA is nearly
27%. The UK government are committed to reducing the section rate and it
is heartening to actually see how it can be achieved. As you will see
from the posting, the North Hampshire Hospital in Basingstoke (which is in
southern England) have reduced their rate from around 30% to 13% in a matter
of months.
The message was as follows:
The North Hampshire
Hospital, Basingstoke, has halved its caesarean section
rate!
>
The Head of the Labour Ward (Carol) is behind it,
supported by the Lead
Obstetrician (Claire). Carol was at the last
Rising Caesarean Rate
Conference in January and expressed her frustration
that it was all very well
but what *exactly* had to happen to get the rate
down.
>
> The Maternity Forum met last week, and since we have
just lost our
administrative support goodness knows when we'll get any
minutes so what
follows is from my memory:
>
> The graph
showed that the csr peaked in Dec/Jan at around 28-30%. There
was
lots of talk about how they could get the rate down. From May there has
been a steady decline in the rate reaching 15% in October, and 13% over
the
first couple of weeks in November. They are hoping to be able to
maintain
this. They are really excited by their success, but it was
clear they wanted
to maintain it for a few more months before they feel
confident to start
shouting about it. The year end csr won't show
the dramatic improvement
although they are expecting it to end up at
around 20% overall as opposed to
25% last year.
>
> So, how
have they done it. Well it is multifactorial.
>
> 1.
Feb/March saw the annual change of registrars. Two female registrars
joined who are very pro vaginal birth.
> 2. VBAC - women with a
history of caesarean section are encouraged to
labour.
> 3. Breech -
Despite results of the Term Breech Trial, they are still
supporting those
women who wish to give birth vaginally to breech presenting
babies to do
so. In 1991 3% of breech babies were born vaginally, currently
15%
of breech babies are born vaginally.
> 4. CTG training package - Last
year they had a doctor who was very
interested in this and who put
together a very good training package for the
midwives resulting in better
interpretation of EFM traces.
> 5. Carol was given a small amount of
money to spend on improving things for
women. She decided the beds
in the labour rooms looked very clinical and
spent the money on nice duvet
covers and pillow cases (no, wait, keep
reading). She then moved the
beds so they are along the wall, with a chair
in front of bed. Male
partners are encouraged to sit on bed with the
labouring woman using the
chair. Women then generally stand up and move for
contractions, the
more upright position being better for labour. She has had
to fight
to keep those beds along the walls. Auxillary staff keep moving
them
back to the middle and it sounded like she has had a bit of a set to
with
them. Her and Claire have had to be very persistent in moving the beds
back! But she has won.
> 6. Induction - There has been a
change of induction procedure. Epidurals
are no longer fitted before
induction but are available afterwards if and
when needed. Women are
finding that they can cope with induced labour and
midwives are
gaining confidence that women can cope. More inductions are
being carried out since it is now policy to induce at 10 days (due to NICE
guidelines) rather than 12 days as previously, but more are resulting in
spontaneous vaginal deliveries.
> 7. Midwife ventouse practitioners
- Basingstoke now have four midwives
trained to do ventouse
deliveries. In 55% of cases where a midwife is called
to carry out a
ventouse delivery, a spontaneous vaginal birth is achieved.
But more
important are the opportunities this gives for experienced midwives
to
pass on their skills to less experienced midwives.
>
> What these
measures have succeeded in doing is changing the attitude of
the unit as a
whole. It is early days yet, but they have high hopes of being
able
to sustain the change. They have recently taken on a new obs and Carol
says she made it very clear to him at their first meeting that this is how
things are going to be run and that he will have to fit
in.
>
> There was another graph too. Just in case anyone
thinks they are doing
less cs and more forceps/ventouse that is not the
case. The forceps/ventouse
deliveries have remained unchanged.
The number of caesareans has gone down
and the number of svd's has gone
up.
>
> I am so please this has happened anywhere, but for it to
happen on my patch
> is great - although I can claim absolutely no
credit whatsoever!
>
How about trying this here?
Debbie
Slater
Perth, WA
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