After the code act, what's next?

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AFTER THE CODE ACT, WHAT’S NEXT?

ศ. ภิเศก ลุมพิกานนท์

ประธานราชวิทยาลัยสูตินรีแพทย์แห่งประเทศไทย

14 December 2017

Pisake Lumbiganon, President, RTCOG 1

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CONFLICT OF INTEREST

• N ^ONE

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RTCOG PLANS

1. M ILK CODE

2. R EDUCING UNNECESSARY CESAREAN SECTION

3. C OMPANION OF CHOICE DURING LABOR

4. R EPRODUCTIVE HEALTH LITERACY

5. จิตประภัสสร

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CAESAREAN SECTION:

WHO RECOMMENDATIONS AND APPROACH TO REDUCING

UNNECESSARY CAESAREANS

M ÊTIN G ^ÜLMEZOGLU , A ^NA P ÎLAR B ÊTRAN

P ^ISAKE L ^UMBIGANON , RTCOG

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CS TRENDS WORLDWIDE SINCE 1990

Source: Betrán et al: The increasing trend in Caesarean section rates. PLoS ONE 2016

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CS RATES WORLDWIDE

Source: Betrán et al: The increasing trend in Caesarean section rates. PLoS ONE 2016

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CAESAREAN SECTION – WHO STATEMENTS

1985 S TATEMENT

 T HERE IS NO JUSTIFICATION FOR ANY REGION TO HAVE A CS RATE HIGHER THAN 10-15%

2015 S TATEMENT

 A ^T ^POPULATION ^LEVEL , CS ^RATES ^HIGHER ^THAN 10% ARE NOT ASSOCIATED WITH REDUCTIONS IN MATERNAL AND NEWBORN MORTALITY RATES

 WHO PROPOSES THE USE OF THE R OBSON (10-

GROUP ) CLASSIFICATION

ศ ภิเศก ลุมพิกานนท์

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2015 WHO STATEMENT ON CAESAREAN SECTION KEY MESSAGES

 CS are effective in saving maternal and infant lives, but only when they are required for medically

indicated reasons.

 CS can cause significant complications, disability or death (mothers and babies).

 CS increases unnecessary health care cost.

 CS should ideally only be undertaken when

medically necessary

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CHALLENGE: MOST RECURRENT QUESTION!

How can we reduce the unnecessary

caesarean deliveries in our countries?

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ภิเศก ลุมพิกานนท์ RTCOG 11

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WHAT SHOULD WE DO?

Interventions By

1. Reproductive health literacy 1. DOH, PSO, University, RTCOG

2. Monitoring C/S rates 2. DMS, PSO, RHO, University, RTCOG

3. Implement interventions 3. DMS, PSO, NHSO, HA, University, RTCOG 4. Monitoring and evaluation 4. DMS, PSO, NHSO, RTCOG

5. Implementation Research 5. HSRI, University, RTCOG

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POSSIBLE INTERVENTIONS

1. C LINICAL INTERVENTIONS

1. A PPROPRIATE INDUCTION OF LABOUR

2. ECV

3. A PPROPRIATE INDICATION FOR C/S 4. VBAC

5. P AIN RELIEF DURING LABOUR

2. N ON CLINICAL INTERVENTIONS

1. H EALTH LITERACY

2. C OMPANION OF CHOICE DURING LABOUR

3. A UDIT AND FEEDBACK

4. F INANCIAL STRATEGIES

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COMPANION OF CHOICE DURING LABOUR AND CHILDBIRTH FOR IMPROVED QUALITY OF CARE

Ӧ ZGE T UNÇALP , MD P H D, P ISAKE L UMBIGANON , MD, MS

D EPARTMENT OF R EPRODUCTIVE H EALTH AND R ESEARCH , RTCOG

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EVIDENCE BASE – COCHRANE REVIEW

• C ONTINUOUS SUPPORT IN LABOUR INCREASED THE CHANCE OF A SPONTANEOUS VAGINAL BIRTH AND WOMEN WERE MORE SATISFIED .

• E NHANCING PHYSIOLOGICAL PROCESS OF LABOUR

• A ^DDITIONAL ^ADVANTAGES ^OF ^LABOUR COMPANIONSHIP INCLUDE :

• LESS ANALGESIA REQUIRED AT LABOUR ,

• LESS EMERGENCY CESAREAN SECTIONS ,

• L ESS BIRTH ASPHYXIA AND

• LESS VULNERABLE TO MISTREATMENT .

Hodnett et al, 2013

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COMPANIONSHIP IN WHO GUIDELINES – 1

RECOMMENDATION 12:

C ONTINUOUS COMPANIONSHIP DURING LABOUR IS RECOMMENDED FOR IMPROVING

LABOUR OUTCOMES .

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COMPANIONSHIP IN WHO GUIDELINES – 2

RECOMMENDATION 8:

C ONTINUOUS COMPANIONSHIP DURING LABOUR AND BIRTH IS RECOMMENDED

FOR IMPROVING WOMEN ’ S SATISFACTION WITH SERVICES .

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WHO CAN ACT AS A COMPANION?

• A NY PERSON CHOSEN BY THE WOMAN TO PROVIDE HER WITH CONTINUOUS SUPPORT

 W OMAN ' S FAMILY AND SOCIAL NETWORK

 S POUSE / PARTNER , FEMALE FRIEND OR RELATIVE ,

COMMUNITY HEALTH WORKER , TBA

 D ^OULA ( ^SPECIALTY ^TRAINING ^IN ^LABOUR

SUPPORT )

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BARRIERS TO IMPLEMENTATION

• T HE ABSENCE OF NATIONAL OR INSTITUTIONAL POLICIES ALLOWING WOMEN TO HAVE A COMPANION OF CHOICE DURING LABOUR AND CHILDBIRTH

• T HE PHYSICAL INFRASTRUCTURE OF HEALTH CARE FACILITIES , WHICH LIMITS PRIVACY AND CONTRIBUTES TO OVERCROWDING IN LABOUR WARD AND DIFFICULTIES IN MAINTAINING HYGIENE STANDARDS

• L IMITED KNOWLEDGE AMONG HEALTH - CARE PROVIDERS AND MANAGERS ABOUT THE BENEFITS AND NEGATIVE ATTITUDES

Kabakian et al, 2015

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Prof Pisake Lumbiganon, RTCOG 22

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Prof Pisake Lumbiganon, RTCOG 23

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Professor Pisake Lumbiganon Faculty of Medicine, KKU 24

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Professor Pisake Lumbiganon Faculty of Medicine, KKU 25

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After the code act, what's next?