Problem:

Optimal, healthy pregnancy followed by normal birth is the ideal. Caesarean section (CS) doubles the risk of mortality and morbidity (hysterectomy, blood transfusion), and increases the risk of postnatal infection five times, compared with vaginal birth (WHO Global Survey on Maternal and Perinatal Health). The European Perinatal Health Report (2008) notes “widespread concern” over rising CS rates, which vary from 15% in the Netherlands to 38% in Italy. Much of the rise is due to routine CS following previous CS, despite calls for increased vaginal birth after caesarean (VBAC), which results in less mortality and morbidity and is the preferred option for the majority of women. VBAC rates in Ireland, Germany, and Italy are significantly lower (29-36%) than those in the Netherlands, Sweden, and Finland (45-55%), a difference equating to 160,000 unnecessary CSs per annum in Europe, at an extra direct annual cost of €156m.

Aim:

To improve maternal health service delivery, and optimise childbirth, by increasing vaginal birth after caesarean section (VBAC) through enhanced patient-centred maternity care across Europe.
Using a cluster randomised trial in Ireland, Germany and Italy, with 15 clusters of 94 women, the OptiBIRTH study will attempt to increase VBAC rates from 25 to 40% through increased women-centred care and women’s involvement in their care, making savings of €2m for every 100,000 births in future. The intervention involves evidence-based education of women, information for clinicians, introduction of communities of practice (women and clinicians sharing knowledge), opinion leaders, audit and peer review of CSs in each site, and joint decision-making by women and clinicians.

Expected results:

The project, through meaningful women-centred care, will influence EU health policymaking by increasing VBAC rates in at least three participating countries, Ireland, Italy and Germany. This project arose from the work of the TCD School of Nursing and Midwifery Maternity Research Group, COST Action ISO907 (Childbirth Cultures, Consequences: Creating a Dynamic EU Framework for Optimal Maternity Care), and the European Science Foundation workshop.