Strategies To Reduce Cesarean Birth in Low-Risk Women: Comparative Effectiveness Review Number 80
Strategies To Reduce Cesarean Birth in Low-Risk Women: Comparative Effectiveness Review Number 80
Overview
Thirty-two percent of pregnancies in the United States conclude with a cesarean birth. This record high rate reflects a relative increase of 53 percent in use of cesarean from 1991 to 2007. The pattern of increasing use of cesarean has been of concern for decades, with the last decline of 2 to 3 percent, occurring in the mid-1990s, being fully reversed by 1999, and the rate increasing over 50 percent from 1996 to 2007. Nearly one in three births by cesarean translates to a total of 1.4 million cesarean births each year, making cesarean the most commonly performed major surgery in the United States. Cesarean birth is not without consequences. In general, cesarean is more costly to the health care system, is associated with increased risk for both mother and infant, and has the potential to complicate subsequent pregnancies. Indeed, because the effects of these complications can be devastating and include fetal death, emergent hysterectomy, and maternal mortality from associated bleeding, labor and delivery units have increased the use of “code teams” that conduct practice drills to be prepared for such emergencies. Cesarean birth rates vary considerably by geographic region, ranging from 25 to 38 percent among States, with the highest rates in the southeastern United States. One research group examining differences across hospitals documented a span from 9 percent to 37 percent for primary cesarean births. While health care providers and health systems initially viewed such variation as a reflection of underlying differences in the risk profile of the women receiving care at the hospitals, it has become increasingly clear, through use of techniques such as risk adjustment, that a large proportion of variation is not explained by some facilities having much higher or lower risk patients than others. In medical care, when there is variation of the magnitude we see in use of cesarean after taking into account differences in patient characteristics, the conclusion is that provider preferences, and to a lesser extent patient preferences, are important drivers of variation. Nonetheless, relatively little focus has been placed on research specifically designed to assess strategies to reduce use of cesarean. The notable exception is a study of approaches to promote trial of vaginal birth after cesarean (VBAC). The state of general knowledge about evidence-based approaches to reduce cesarean overall is uncharted. In this review we aim to bring that literature to the forefront by systematically examining the outcomes of strategies intended to reduce use of cesarean among low-risk women. The goal of this systematic evidence review is to examine the effects of available strategies to reduce cesarean birth among low-risk pregnant women who have a singleton pregnancy, focusing on the following outcomes: route of birth, maternal morbidity and mortality, and neonatal morbidity and mortality. We synthesized evidence in the published literature to address these Key Questions (KQs): KQ1. What strategies during pregnancy are effective to reduce the use of cesarean birth among women with a singleton pregnancy who are intending a vaginal birth? KQ2. What strategies during labor are effective to reduce the use of cesarean birth among women with a singleton pregnancy who are intending a vaginal birth? KQ3. Where head-to-head comparisons are available, what strategies are shown to be superior in reducing the use of cesarean birth among women with a singleton pregnancy who are intending a vaginal birth? KQ4. What are the nature and frequency of adverse effects resulting from strategies used to reduce cesarean birth among women with a singleton pregnancy who are intending a vaginal birth?Description
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Depending on where you live, the time it may take for your exchanged product to reach you, may vary.
If you are shipping an item over $75, you should consider using a trackable shipping service or purchasing shipping insurance. We don’t guarantee that we will receive your returned item.
Overview
Thirty-two percent of pregnancies in the United States conclude with a cesarean birth. This record high rate reflects a relative increase of 53 percent in use of cesarean from 1991 to 2007. The pattern of increasing use of cesarean has been of concern for decades, with the last decline of 2 to 3 percent, occurring in the mid-1990s, being fully reversed by 1999, and the rate increasing over 50 percent from 1996 to 2007. Nearly one in three births by cesarean translates to a total of 1.4 million cesarean births each year, making cesarean the most commonly performed major surgery in the United States. Cesarean birth is not without consequences. In general, cesarean is more costly to the health care system, is associated with increased risk for both mother and infant, and has the potential to complicate subsequent pregnancies. Indeed, because the effects of these complications can be devastating and include fetal death, emergent hysterectomy, and maternal mortality from associated bleeding, labor and delivery units have increased the use of “code teams” that conduct practice drills to be prepared for such emergencies. Cesarean birth rates vary considerably by geographic region, ranging from 25 to 38 percent among States, with the highest rates in the southeastern United States. One research group examining differences across hospitals documented a span from 9 percent to 37 percent for primary cesarean births. While health care providers and health systems initially viewed such variation as a reflection of underlying differences in the risk profile of the women receiving care at the hospitals, it has become increasingly clear, through use of techniques such as risk adjustment, that a large proportion of variation is not explained by some facilities having much higher or lower risk patients than others. In medical care, when there is variation of the magnitude we see in use of cesarean after taking into account differences in patient characteristics, the conclusion is that provider preferences, and to a lesser extent patient preferences, are important drivers of variation. Nonetheless, relatively little focus has been placed on research specifically designed to assess strategies to reduce use of cesarean. The notable exception is a study of approaches to promote trial of vaginal birth after cesarean (VBAC). The state of general knowledge about evidence-based approaches to reduce cesarean overall is uncharted. In this review we aim to bring that literature to the forefront by systematically examining the outcomes of strategies intended to reduce use of cesarean among low-risk women. The goal of this systematic evidence review is to examine the effects of available strategies to reduce cesarean birth among low-risk pregnant women who have a singleton pregnancy, focusing on the following outcomes: route of birth, maternal morbidity and mortality, and neonatal morbidity and mortality. We synthesized evidence in the published literature to address these Key Questions (KQs): KQ1. What strategies during pregnancy are effective to reduce the use of cesarean birth among women with a singleton pregnancy who are intending a vaginal birth? KQ2. What strategies during labor are effective to reduce the use of cesarean birth among women with a singleton pregnancy who are intending a vaginal birth? KQ3. Where head-to-head comparisons are available, what strategies are shown to be superior in reducing the use of cesarean birth among women with a singleton pregnancy who are intending a vaginal birth? KQ4. What are the nature and frequency of adverse effects resulting from strategies used to reduce cesarean birth among women with a singleton pregnancy who are intending a vaginal birth?Description
Condition Guidelines
Books - New and Used
The following guidelines apply to books:
- New: A brand-new copy with cover and original protective wrapping intact. Books with markings of any kind on the cover or pages, books marked as "Bargain" or "Remainder," or with any other labels attached, may not be listed as New condition.
- Used - Good: All pages and cover are intact (including the dust cover, if applicable). Spine may show signs of wear. Pages may include limited notes and highlighting. May include "From the library of" labels. Shrink wrap, dust covers, or boxed set case may be missing. Item may be missing bundled media.
- Used - Acceptable: All pages and the cover are intact, but shrink wrap, dust covers, or boxed set case may be missing. Pages may include limited notes, highlighting, or minor water damage but the text is readable. Item may but the dust cover may be missing. Pages may include limited notes and highlighting, but the text cannot be obscured or unreadable.
Note: Some electronic material access codes are valid only for one user. For this reason, used books, including books listed in the Used – Like New condition, may not come with functional electronic material access codes.
Shipping & Delivery
Shipping Fees
- Stevens Books offers FREE SHIPPING everywhere in the United States for ALL non-book orders, and $3.99 for each book.
- Packages are shipped from Monday to Friday.
- No additional fees and charges.
Delivery Times
The usual time for processing an order is 24 hours (1 business day), but may vary depending on the availability of products ordered. This period excludes delivery times, which depend on your geographic location.
Estimated delivery times:
- Standard Shipping: 5-8 business days
- Expedited Shipping: 3-5 business days
Shipping method varies depending on what is being shipped.
Tracking
All orders are shipped with a tracking number. Once your order has left our warehouse, a confirmation e-mail with a tracking number will be sent to you. You will be able to track your package at all times.
Damaged Parcel
If your package has been delivered in a PO Box, please note that we are not responsible for any damage that may result (consequences of extreme temperatures, theft, etc.).
If you have any questions regarding shipping or want to know about the status of an order, please contact us or email to support@stevensbooks.com.
Returns & Refunds
You may return most items within 30 days of delivery for a full refund.
To be eligible for a return, your item must be unused and in the same condition that you received it. It must also be in the original packaging.
Several types of goods are exempt from being returned. Perishable goods such as food, flowers, newspapers or magazines cannot be returned. We also do not accept products that are intimate or sanitary goods, hazardous materials, or flammable liquids or gases.
Additional non-returnable items:
- Gift cards
- Downloadable software products
- Some health and personal care items
To complete your return, we require a tracking number, which shows the items which you already returned to us.
There are certain situations where only partial refunds are granted (if applicable)
- Book with obvious signs of use
- CD, DVD, VHS tape, software, video game, cassette tape, or vinyl record that has been opened
- Any item not in its original condition, is damaged or missing parts for reasons not due to our error
- Any item that is returned more than 30 days after delivery
Items returned to us as a result of our error will receive a full refund,some returns may be subject to a restocking fee of 7% of the total item price, please contact a customer care team member to see if your return is subject. Returns that arrived on time and were as described are subject to a restocking fee.
Items returned to us that were not the result of our error, including items returned to us due to an invalid or incomplete address, will be refunded the original item price less our standard restocking fees.
If the item is returned to us for any of the following reasons, a 15% restocking fee will be applied to your refund total and you will be asked to pay for return shipping:
- Item(s) no longer needed or wanted.
- Item(s) returned to us due to an invalid or incomplete address.
- Item(s) returned to us that were not a result of our error.
You should expect to receive your refund within four weeks of giving your package to the return shipper, however, in many cases you will receive a refund more quickly. This time period includes the transit time for us to receive your return from the shipper (5 to 10 business days), the time it takes us to process your return once we receive it (3 to 5 business days), and the time it takes your bank to process our refund request (5 to 10 business days).
If you need to return an item, please Contact Us with your order number and details about the product you would like to return. We will respond quickly with instructions for how to return items from your order.
Shipping Cost
We'll pay the return shipping costs if the return is a result of our error (you received an incorrect or defective item, etc.). In other cases, you will be responsible for paying for your own shipping costs for returning your item. Shipping costs are non-refundable. If you receive a refund, the cost of return shipping will be deducted from your refund.
Depending on where you live, the time it may take for your exchanged product to reach you, may vary.
If you are shipping an item over $75, you should consider using a trackable shipping service or purchasing shipping insurance. We don’t guarantee that we will receive your returned item.
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