Do cesarean sections cause autism?
There have been a number of articles published about some new research that looks at the link between cesarean sections and autism. An article by ‘The Conversation’ highlights that whilst the study shows an association between cesarean section and autism and ADHD the study does not indicate there is a causal relationship.
Cesarean sections are more common in women who are obese, older or have history of immune conditions all of which have been linked with a child having increased risk of autism. These factors may therefore be also contributing to the study findings.
National Centre for Maternity Improvement
In the UK charity Tommys, The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists have joined together to launch ‘The Tommys National Centre for Maternity improvement’.
The alliance will work on 5 work streams:
There will be involvement from parents, midwives, doctors, the NHS and academic experts with the aim of preventing 600 stillbirths and 12,000 preterm births nationally.
NICE guidance – Preterm Labour and Birth updated
NICE have updated their Preterm labor and birth guidance which covers the care of women at increased risk of or with symptoms and signs of preterm labor. The guideline includes new and updated recommendations on:
The guidance in full is available here - https://www.nice.org.uk/guidance/ng25
Effectiveness of financial intervention strategies for reducing cesarean section rates
A systematic review has been conducted evaluating the effectiveness of financial interventions on reducing cesarean section rates. There were 9 studies included in the review with some focusing on provider interventions and some with provider and patient interventions.
The study concludes that risk adjusted payments may be an effective method to reduce cesarean section rates and considering stakeholder characteristics may also be important.
Association between rates of second-stage Caesarean section and instrumental delivery
A study from Hong Kong has looked at the trends in cesarean section and instrumental delivery rates. Records for cesarean sections and instrumental deliveries between 1997 and 2016 were examined. Over the period there were 87413 deliveries, 17600 (20.1%) of which were CS and 6502 (7.4%) instrumental deliveries.
Over the study period the cesarean section rate increased whilst the instrumental delivery rate decreased. The decline in instrumental delivery was replaced by second stage cesarean section.
Lack of confidence with instrumental delivery, medicolegal concerns and failed instrumental delivery may trigger a reluctance to attempt.
Training programs that include teaching on instrumental delivery skills as an alternative to cesarean section and having experience obstetricians involved are described as important for optimizing outcomes.
Read the full study here - https://www.hkjgom.org/sites/default/files/pdf/v19n2-89-association.pdf
This Week in Maternity - Tips to prevent stillbirth, Cesarean sections in women with high BMI and Second victim experience
Tips to provide best practice care to help prevent stillbirth
Safe Care Victoria is aiming to reduce the rate of stillbirths across Victoria, Australia. They have shared 6 tips to aid in providing best practice care for pregnant women:
They are also encouraging women to:
They share other support resources on their website - https://www.bettersafercare.vic.gov.au/news-and-media/six-tips-to-provide-best-practice-care-for-pregnant-women
Women with increased BMI could be having unnecessary cesarean sections
A study of 526 patients in Canada has found that patients with a higher BMI took up to 2.67 hours longer to reach a dilation of 10cm compared to women with a normal weight. A high BMI was also associated with increased oxytocin use.
The study highlights that care providers should take into consideration the time it takes for labor to progress in women with high BMI to help avoid undertaking premature cesarean sections.
Second victim experience is an underestimated problem
A study in the Netherlands has looked at the experiences of healthcare providers who have been involved in a patient safety incident during their careers.
4369 doctor and nurse respondents were involved, 462 of which had been involved in an incident in the last 6 months that caused permanent harm or death. Those who had experienced an incident were more likely to report symptoms including hyper-vigilance, they felt doubts about knowledge or skill, felt unable to provide quality care and felt uncomfortable within a team. Where the outcome of the incident was more severe these symptoms lasted longer.
The study concludes ‘Attention should be given to how to cope with these symptoms as they profoundly affect personal well-being, professional performance as well as teamwork-related efforts directly influencing patient safety and the provision of quality care.’