Abstract
Background: caesarean section plays an important role in ensuring safety of mother and infant but rising rates are not accompanied by measurable improvements in maternal or neonatal mortality or morbidity. The 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' was a facilitative initiative developed to promote opportunities for normal birth and reduce caesarean section rates in England. Objective: to evaluate the 'Focus on Normal Birth and Reducing Caesarean section Rates' programme, by assessment of: impact on caesarean section rates, use of service improvements tools and participants[U+05F3] perceptions of factors that sustain or hinder work within participating maternity units. Design: a mixed methods approach included analysis of mode of birth data, web-based questionnaires and in-depth semi-structured telephone interviews. Participants: twenty Hospital Trusts in England (selected from 68 who applied) took part in the 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' initiative. In each hospital Trust, the head of midwifery, an obstetrician, the relevant lead for organisational development, a supervisor of midwives, or a clinical midwife and a service user representative were invited to participate in the independent evaluation. Methods: collection and analysis of mode of birth data from 20 participating hospital Trusts, web-based questionnaires administered to key individuals in all 20 Trusts and in-depth semi-structured telephone interviews conducted with key individuals in a sample of six Trusts. Findings: there was a marginal decline of 0.5% (25.9% from 26.4%) in mean total caesarean section rate in the period 1 January 2009 to 31 January 2010 compared to the baseline period (1 July-31 December 2008). Reduced total caesarean section rates were achieved in eight trusts, all with higher rates at the beginning of the initiative. Features associated with lower caesarean section rates included a shared philosophy prioritising normal birth, clear communication across disciplines and strong leadership at a range of levels, including executive support and clinical leaders within each discipline. Conclusions: it is important that the philosophy and organisational context of care are examined to identify potential barriers and facilitative factors.
| Original language | English |
|---|---|
| Pages (from-to) | 332-340 |
| Number of pages | 9 |
| Journal | Midwifery |
| Volume | 31 |
| Issue number | 2 |
| Early online date | 6 Nov 2014 |
| DOIs | |
| Publication status | Published - 1 Feb 2015 |
| Externally published | Yes |
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Evaluating the 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' : A mixed method study in England. / Marshall, Joyce L.; Spiby, Helen; McCormick, Felicia.
In: Midwifery, Vol. 31, No. 2, 01.02.2015, p. 332-340.Research output: Contribution to journal › Article
TY - JOUR
T1 - Evaluating the 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme'
T2 - A mixed method study in England
AU - Marshall, Joyce L.
AU - Spiby, Helen
AU - McCormick, Felicia
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Background: caesarean section plays an important role in ensuring safety of mother and infant but rising rates are not accompanied by measurable improvements in maternal or neonatal mortality or morbidity. The 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' was a facilitative initiative developed to promote opportunities for normal birth and reduce caesarean section rates in England. Objective: to evaluate the 'Focus on Normal Birth and Reducing Caesarean section Rates' programme, by assessment of: impact on caesarean section rates, use of service improvements tools and participants[U+05F3] perceptions of factors that sustain or hinder work within participating maternity units. Design: a mixed methods approach included analysis of mode of birth data, web-based questionnaires and in-depth semi-structured telephone interviews. Participants: twenty Hospital Trusts in England (selected from 68 who applied) took part in the 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' initiative. In each hospital Trust, the head of midwifery, an obstetrician, the relevant lead for organisational development, a supervisor of midwives, or a clinical midwife and a service user representative were invited to participate in the independent evaluation. Methods: collection and analysis of mode of birth data from 20 participating hospital Trusts, web-based questionnaires administered to key individuals in all 20 Trusts and in-depth semi-structured telephone interviews conducted with key individuals in a sample of six Trusts. Findings: there was a marginal decline of 0.5% (25.9% from 26.4%) in mean total caesarean section rate in the period 1 January 2009 to 31 January 2010 compared to the baseline period (1 July-31 December 2008). Reduced total caesarean section rates were achieved in eight trusts, all with higher rates at the beginning of the initiative. Features associated with lower caesarean section rates included a shared philosophy prioritising normal birth, clear communication across disciplines and strong leadership at a range of levels, including executive support and clinical leaders within each discipline. Conclusions: it is important that the philosophy and organisational context of care are examined to identify potential barriers and facilitative factors.
AB - Background: caesarean section plays an important role in ensuring safety of mother and infant but rising rates are not accompanied by measurable improvements in maternal or neonatal mortality or morbidity. The 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' was a facilitative initiative developed to promote opportunities for normal birth and reduce caesarean section rates in England. Objective: to evaluate the 'Focus on Normal Birth and Reducing Caesarean section Rates' programme, by assessment of: impact on caesarean section rates, use of service improvements tools and participants[U+05F3] perceptions of factors that sustain or hinder work within participating maternity units. Design: a mixed methods approach included analysis of mode of birth data, web-based questionnaires and in-depth semi-structured telephone interviews. Participants: twenty Hospital Trusts in England (selected from 68 who applied) took part in the 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' initiative. In each hospital Trust, the head of midwifery, an obstetrician, the relevant lead for organisational development, a supervisor of midwives, or a clinical midwife and a service user representative were invited to participate in the independent evaluation. Methods: collection and analysis of mode of birth data from 20 participating hospital Trusts, web-based questionnaires administered to key individuals in all 20 Trusts and in-depth semi-structured telephone interviews conducted with key individuals in a sample of six Trusts. Findings: there was a marginal decline of 0.5% (25.9% from 26.4%) in mean total caesarean section rate in the period 1 January 2009 to 31 January 2010 compared to the baseline period (1 July-31 December 2008). Reduced total caesarean section rates were achieved in eight trusts, all with higher rates at the beginning of the initiative. Features associated with lower caesarean section rates included a shared philosophy prioritising normal birth, clear communication across disciplines and strong leadership at a range of levels, including executive support and clinical leaders within each discipline. Conclusions: it is important that the philosophy and organisational context of care are examined to identify potential barriers and facilitative factors.
KW - Caesarean rates
KW - Mixed methods
KW - Normal birth
KW - Service improvement programme
UR - http://www.scopus.com/inward/record.url?scp=84921300157&partnerID=8YFLogxK
U2 - 10.1016/j.midw.2014.10.005
DO - 10.1016/j.midw.2014.10.005
M3 - Article
C2 - 25467600
AN - SCOPUS:84921300157
VL - 31
SP - 332
EP - 340
JO - Midwifery
JF - Midwifery
SN - 0266-6138
IS - 2
ER -