Reducing caesarean rates in Europe

According to the 2008 Perinatal Health Report, there is 'widespread concern' over rising CS rates. Furthermore, VBAC rates in Germany, Ireland and Italy are significantly lower (29–36 %) than they are in the Netherlands, Finland and Sweden (45–55 %). As a result, 160 000 unnecessary CSs are performed each year at an extra direct annual cost of EUR 156 million.

The project OPTIBIRTH brings together service users (women and their families), midwives and obstetricians with researchers from epidemiology, health economics and industry for a four-year project to be conducted at 15 sites in the 3 countries with low VBAC rates. The intervention has been designed to increase the empowerment, engagement and involvement of women with a history of at least one CS. The hope is that VBAC rates will increase, moving from 25 to 40 %.

The intervention is being tested through a cluster randomised trial. The team will conduct a full-cost analysis and engage with decision makers to enhance transfer of findings into mainstream practice.

To date, the intervention has been developed. It includes two antenatal education and support classes lasting two hours each that will form the basis for a community of practice. Other components include interactive web design/motivationally enhanced decision making tools for women; user-friendly apps, also to assist with decision making; and a one-hour information session for clinicians.

A two-month rolling pilot has been completed, accompanied by monthly meetings to share information. Toolkits to collect women's antenatal and postnatal uses of resources and economic data were developed and tested during the pilot phase.

It is expected that the intervention will result in a decrease in repeat CSs and an increase in VBAC rates in Germany, Ireland and Italy. Furthermore, the project has the potential to halt the trend of declining fertility.

OPTIBIRTH also may improve the organisation of maternity health systems and service delivery in Europe. This will be accomplished by enhancing patients' involvement in their care.