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 and McCormick, Felicia (2015) Evaluating the ‘Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme’: A mixed method study in England. Midwifery, 31 2: 332-340. doi:10.1016/j.midw.2014.10.005

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Author Marshall, Joyce L.
Spiby, Helen
McCormick, Felicia
Title Evaluating the ‘Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme’: A mixed method study in England
Journal name Midwifery   Check publisher's open access policy
ISSN 0266-6138
1532-3099
Publication date 2015-02
Year available 2015
Sub-type Article (original research)
DOI 10.1016/j.midw.2014.10.005
Open Access Status Not Open Access
Volume 31
Issue 2
Start page 332
End page 340
Total pages 9
Place of publication London, United Kingdom
Publisher Churchill Livingstone
Collection year 2016
Language eng
Formatted 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.
Keyword Caesarean rates
Service improvement programme
Normal birth
Mixed methods
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Nursing, Midwifery and Social Work Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 3 times in Thomson Reuters Web of Science Article | Citations
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Created: Tue, 03 Nov 2015, 11:30:20 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work