The Effect of Implementing Guidelines and Changing Practices on Caesarean Section Rates in A Tertiary Care Hospital in Islamabad

Objective: To evaluate the effect of implementation of guidelines and changing practices on caesarean sections rates at Al Nafees Medical College Hospital without compromising fetal or neonatal morbidity and mortality. Study Design: Prospective Analytical study. Place and Duration of Study: Department of Obstetrics, Al- Nafees Medical College Islamabad, Pakistan, Jan 2012 to Jan 2017. Methodology: All 1593 patients who underwent cesarean sections during the study period were enrolled. Data was divided into yearly periods for comparison and analysis. Sampling technique used is convenient sampling. New labor management guidelines were implemented along with regular audit and feedback in Jan 2014. Delivery statistics were compared before and after implementation of these guidelines. Results: Rate of caesarean sections decreased from 36.4% (94 out of 258 births) in 2013 to 24.5% (125 out of 510 births) in 2016 after changing practices and implementation of guidelines. Primary cesarean section rate decreased from 54% (84 out of 155 births) in 2013 to 22% (70 out of 310 births) in 2016. Vaginal birth after cesarean section increased from 17.3% (11 out of 62 births) in 2013 to 68% (62out of 90 births) in 2016. There was no increase in fetal, or neonatal morbidity or mortality during this period. Conclusion: Caesarean section rate was safely lowered our teaching hospital when we changed the clinical practices of the doctors and paramedical staff using supervision, audits, feedbacks and clear clinical guidelines.