A feasibility study and pilot randomised trial of an intervention designed to reduce unnecessary caesarean section in Ireland

ISRCTN ISRCTN50041378
DOI https://doi.org/10.1186/ISRCTN50041378
Secondary identifying numbers DIFA-2017-011
Submission date
12/02/2018
Registration date
25/02/2018
Last edited
15/05/2019
Recruitment status
Stopped
Overall study status
Stopped
Condition category
Pregnancy and Childbirth
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

Plain English summary of protocol

Background and study aims
Concern has been expressed globally at the rising caesarean section (CS) rate, and this has not resulted in a decrease in health problems for mothers and babies, indicating that many CSs are not necessary. Death and severe health problems are increased (3-fold) for women following CS compared with vaginal birth, and more newborn babies require oxygen after CS. This study aims to develop and test a package of care that is designed to reduce overall CS rates in Ireland, safely.

Who can participate?
Pregnant women aged over 18 years

What does the study involve?
Participants giving birth at one site receive the intervention, and those at the other site receive standard care. All participants complete three health and wellbeing surveys, one in pregnancy, one at 3 months after their baby is born and a final survey 6 months after their baby is born. Hospital records are accessed to gather information on their pregnancy, labour and birth (all information is kept strictly private and confidential). Participants in the intervention hospital also attend two antenatal classes where information specific to CS birth is presented and discussed.

What are the possible benefits and risks of participating?
The main benefit is that participants are helping to answer whether the information package is effective or not in reducing caesarean section rates overall. If their hospital has been allocated to test the new programme, it is possible that participants may find the information beneficial. There are no known risks to taking part in this study.

Where is the study run from?
1. The Coombe Women and Infants University Hospital (Ireland)
2. The Rotunda Hospital (Ireland)

When is the study starting and how long is it expected to run for?
September 2017 to September 2020

Who is funding the study?
Health Research Board (Ireland)

Who is the main contact?
Prof Cecily Begley (Public)
cbegley@tcd.ie

Contact information

Prof Valerie Smith
Scientific

School of Nursing and Midwifery
Trinity College Dublin
24 D'Olier Street
Dubliin
2
Ireland

ORCiD logoORCID ID 0000-0003-2249-6038
Phone +353 (0)1 896 4031
Email smithv1@tcd.ie

Study information

Study designFeasibility study and pilot cluster randomised trial
Primary study designInterventional
Secondary study designCluster randomised trial
Study setting(s)Hospital
Study typePrevention
Participant information sheet ISRCTN50041378_PIS_V1_23Feb18.pdf
Scientific titleReducing caesarean section rates in Ireland: a feasibility study and pilot randomised trial of an evidence-based intervention designed to reduce caesarean section safely
Study acronymREDUCE
Study objectivesA complex package of care, based on evidence, can reduce overall caesarean section rates
Ethics approval(s)1. Faculty of Health Sciences, Research Ethics Committee Trinity College Dublin, 19/12/2017, ref: 170501
2. Rotunda Hospital Research Ethics Committee Dublin, 15/12/2017, ref: REC-2017-026
3. The Coombe Women and Infants Hospital Research Ethics Committee Dublin, 10/10/2017, ref: 21-2017
Health condition(s) or problem(s) studiedLabour and delivery
InterventionThe study sites (n=2) are randomly allocated to the intervention or control by an independent statistician with no connection to the trial, using the R-software.
The intervention is developed, as part of the overall trial, using focus group interviews (FGIs) (4 with 3-6 women and their partners, 4 with 3-6 clinicians) in the hospital allocated randomly to the intervention arm. The FGIs ascertain views on, and barriers to, facilitating vaginal birth (FGIs will not be held in the control site so as to avoid contamination of the population in advance of the trial) and an overview of systematic reviews on antenatal and intrapartum interventions to identify those interventions that have shown to be effective for reducing CS. Based on existing evidence, the intervention will likely consist of an appointment of an obstetric and midwife opinion leader (OOL, MOL) who will facilitate women-centred, evidence-based antenatal classes (2 classes) and information session for clinicians, providing accurate information on the risks and benefits of both VBAC and repeat CS, second opinions for all CSs (other than category 1), peer-review of each CS and feedback, reducing induction of labour rates, support of clinicians and women to choose normal options over medical intervention (e.g. mobility instead of oxytocin, water-bath instead of pharmacological pain relief, reducing use of EFM in low-risk women). The protocol will be updated in Aug 2018 when the intervention is finalised.
Participants at the control site receive usual care as per current hospital practice.
Participants at both sites are followed through pregnancy, up to 6 months postpartum.
Intervention typeBehavioural
Primary outcome measureCaesarean section rate (overall per site) is measured using hospital birth records
Secondary outcome measures1. Labour interventions (e.g. induction and acceleration of labour, pain relief used, electronic fetal monitoring) are measured by reviewing women's hospital labour and birth records.
2. Maternal/neonatal morbidities (e.g. postpartum haemorrhage, perineal trauma, wound infection, need for neonatal resuscitation, neonatal admission to intensive care, readmission to hospital) are assessed using hospital records.
3. Mother and baby health problems are assessed using self-completion surveys (health and wellbeing questionnaires that include the SF-36 instrument) during pregnancy and at 3 and 6 months post natal.
4. Clinician attitudes to caesarean section are measured by a self-completion questionnaire adapted from the UK National Sentinel Caesarean Section Audit.
5. Feasibility and pilot outcomes (% eligible and participating, time to recruit, etc.) are assessed using trial screening and eligibility forms, numbers participating (consent forms) and time to recruit full sample size (months).
Overall study start date01/09/2017
Completion date30/09/2020
Reason abandoned (if study stopped)Objectives no longer viable

Eligibility

Participant type(s)Mixed
Age groupAdult
Lower age limit18 Years
SexFemale
Target number of participants2 clusters (400 participants in each cluster)
Key inclusion criteria1. Pregnant woman
2. Aged over 18
3. Speak either English or a language for which translation is available
4. Give informed consent
Key exclusion criteriaVaginal birth contraindicated at time of booking
Date of first enrolment01/03/2018
Date of final enrolment29/02/2020

Locations

Countries of recruitment

  • Ireland

Study participating centres

The Coombe Women and Infants University Hospital
Rialto
Dublin
8
Ireland
The Rotunda Hoapital
Parnell Strett
Dublin
1
Ireland

Sponsor information

Health Research Board
Research organisation

Grattan House
67-72 Lower Mount Street
Dublin
D02 H638
Ireland

Phone +353 (0)1 2345000
Email hrb@hrb.ie
Website http://www.hrb.ie/home/
ROR logo "ROR" https://ror.org/003hb2249

Funders

Funder type

Research organisation

Health Research Board (Ireland)

No information available

Results and Publications

Intention to publish date01/02/2021
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot expected to be made available
Publication and dissemination planOpen access peer reviewed Journals, conference presentations, research proceedings and maternity care representative and user Networks.
IPD sharing planThe datasets generated during and/or analysed during the current study are not expected to be made available due to a lack of ethical approval granting permission for this.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Participant information sheet version V1 23/02/2018 01/04/2019 No Yes

Additional files

ISRCTN50041378_PIS_V1_23Feb18.pdf
Uploaded 01/04/2019

Editorial Notes

15/05/2019: The study, in the original planned form of a pilot cluster randomised trial, has been stopped. This was because, in the first phase, a systematic review of 155 systematic reviews of studies where caesarean section was a primary or secondary outcome was conducted, which showed conclusively that although many interventions were known to decrease CS rates, they were not being implemented. A pilot implementation research study is therefore being conducted instead, which will test the feasibility and acceptability of an evidence-based intervention designed to reduce overall caesarean section rates in Ireland, using an implementation research approach.
01/04/2019: The participant information sheet has been uploaded.