Lithuania’s experience in reducing caesarean section rate

Abstract

Objectives To evaluate the change in the number of caesarean sections (CS) in Lithuania following a multifaceted intervention. Materials and Methods The information system was used for CS and perinatal mortality rate data collection. The multifaceted intervention took place in 2012 – 2019 and consisted of 1) implementation of the Robson’s classification (2012); 2) implementation of a CS audit system as the quality of care indicator (2012); 3) national professional training courses (2012-2014), and 4) regular audit of recommended CS rates at different levels of maternities (according to WHO) by National Committee of Integrated Perinatal Care was performed (2012). Results In the period covered by the study, 217 523 women gave birth in Lithuania. The national CS rate edged down from 26.01 % to 20.43 % in 2012-2019 (p<0.001). The reduction was gradual: from 26.01 % to 25.21 % in 2012- 2013, from 25.21 % to 21.64 % in 2013-2014, from 21.64 % to 22.17 % in 2014-2015, from 22.17 % to 20.9 % in 2015-2016, from 20.9 % to 20.2 % in 2016-2017, from 20.2 % to 20.56 % in 2017-2018, from 20.56 % to 20.43 % in 2018-2019. The perinatal mortality was 5.3‰ in 2012, 6.26 ‰ in 2013, 6.2 ‰ in 2014, 5.66 ‰ in 2015, 5.85 ‰ in 2016, 4.9 ‰ in 2017, 5.41 ‰ in 2018, 5.42 ‰ in 2019. Conclusions • The CS rate decreased with statistical significance from 26% (2012) to 20,4% (2019. • The change in CS did not have a negative impact on perinatal mortality.