icddr,b’s new intervention package can help cut C-sections

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DHAKA, Oct 26, 2018 (BSS/UNICEF FEATURE)-Newly invented intervention
package of icddr,b (International Centre for Diarrhoeal Disease Research,
Bangladesh) could be the key to reducing C-sections (caesarean deliveries) as
most of these deliveries take place in Bangladesh without considering any
risk of both mothers and their babies.

The intervention package includes regular monitoring of the vital signs
that need to be performed, maintaining the woman’s preferred birthing
position, providing support for using the spontaneous pushing technique, the
presence of a trained healthcare provider, and a support person for the
pregnant woman throughout the whole process.

According to the researchers of icddr,b, all the components combined
greatly increases the likelihood of a successful delivery with minimal
complications.

At icddr,b’s Matlab hospital, all physicians, nurses and midwives were
trained on the various labour positions, pushing techniques and the need for
support persons during delivery.

Implementing the package saw a sharp increase – 76 percent from just 1
percent – in adopting the lateral or upright positions, which has more
advantages than the dorsal position in reducing complications.

The spontaneous pushing technique, which is considered to be more
comfortable for the woman and results in fewer complications, rose in favour
from 77 percent to 97 percent.

In addition, the results show, engaging a support person for the woman
significantly increased from 2.5 percent to 91.4 percent. The combination of
all these factors is poignant, with maternal and neonatal complications
decreasing by 46 percent between the pre-intervention and post-intervention
periods.

Caesarean section, also known as C-section, or caesarean delivery, is the
use of surgery to deliver babies. A caesarean section is often necessary when
a vaginal delivery would put the baby or mother at risk. This may include
obstructed labour, twin pregnancy, high blood pressure in the mother, breech
birth, or problems with the placenta or umbilical cord.

Once upon a time, caesarean delivery was considered a last resort in giving
birth due to high-risk pregnancies or complications during labour. Now, there
is an alarming upstream trend of C-sections where one in five women globally
will have a caesarean birth.

The World Health Organization (WHO) recommends that caesarean section be
performed only when medically necessary. But, some C-sections are performed
here without a medical reason, upon request by someone, usually the mother.

In Bangladesh, about one million caesarean deliveries are performed each
year, rising from 12 percent in 2010 to 31 percent in 2016. According to the
WHO, countries should maintain their rate of C-sections to 10-15 percent and
every effort should be utilised to ensure it is carried out of medical
necessity given the risk it poses to the mother and the baby.

Researchers say reducing the rate of caesarean births requires a shift in
normalising vaginal deliveries among healthcare practitioners and providing
and availability of quality care.

They said misconceptions and complications surrounding vaginal births are
other reasons for women opting for C-sections, including fear of labour pain,
post-partum haemorrhage, episiotomy, cervical and perineal tears, and birth
asphyxia, among others.

“Ours is the first study to assess the effects of using this package of
interventions and we were greatly heartened by the positive results.
Episiotomies, perineal and cervical tears were considerably reduced, as well
as median blood loss during birth. This signifies that the intervention
package can immensely benefit women during the second stage of labour,
providing both physical and emotional comfort,” principal investigator of the
study Dr Jesmin Pervin said on a webpost.

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