Rūta J. Nadišauskienė MD, PhD
Professor and Head of the Department of OB/GYN LUHS
Presentation Title: Efforts to control CS rate: Lithuanian experience
The caesarean section (CS) rate had been increasing for several decades worldwide. In Lithuania it has increased from 9.49% in 1995 to 24.71% in 2010. Similar rates were reported in Canada (27%), the USA (33%), Brazil (50%) or Australia (31%). On the other hand, northern European countries, such as Finland (16%) or Norway (17%), are known for lower rates. CS not only increases societal economic burden but also has huge impact on the future fertility potential of the woman. This has led to debate among OB/GYN, health care policy makers and service users to define strategies in order to reduce the rate CSs.
In 2012, the Robson classification was implemented in Lithuanian hospitals. This was encouraged by the Lithuanian Society of Obstetricians and Gynaecologists. This intervention has led to the reduction of the CS rate from 26.01% in 2012 to 21.65% in 2014. After finding out that this classification can work as audit system and it helps to identify the groups of women who are responsible for the increasing CS rate the most, the Lithuanian Ministry of Health (MoH) has decided to make this classification compulsory since 2016.
In 2015, a national quality improvement course (QIC) for obstetrical skills improvement was organized for obstetric staff. A part of it was an intra-partum care. This course was a part of the Lithuanian–Swiss Cooperation Programme. This intervention has led the decrease of the CS rate from 21.65% in 2014 to 20.81% in 2016.
Specialists OB/GYN Integrated Perinatal Care Committee (IPCC) with the support from the MoH has initiated CS rate as a quality indicator. Since 2018 all the hospitals will get financial incentives if the number of CS will not exceed certain numbers. In the 3rd level hospitals (2 Perinatal Centers) the recommended CS number is 23 – 25%, in the 2nd level of District hospitals – 18 – 20% and in the level of regional hospitals – 10 – 12%.
Regular meetings of the IPCC at the MoH are organised since 2012. They are held every 3 months and attendees of those meetings are representatives from 5 Lithuanian Regions responsible for women’s health care policy, representatives of Sick Fund and non-governmental organizations, etc. During the meetings besides other national perinatal care issues the CS rates in different hospitals overall and in different Robson groups are discussed.
Chief OB/GYN specialists in the MoH of Lithuanian Republic
WHO/Euro Temporary advisor, member of European Advisory Committee on Health Research
Board member of Lithuanian Society of Obstetricians and Gynaecologists (LSOG)
Editor in Chief of the journal “Lithuanian Obstetrics and Gynecology”
Areas of clinical and research interests: quality and safety issues in OB/GYN, public health issues related to maternal health, infection in OB/GYN, modern education of clinical skills.