Six out of ten births in our country are by caesarean section. Accordingly, according to a study published in 2021. World Health Organization, in Northern, Western and Eastern Europe, the rate of caesarean section is about 25%. The reasons for the high rate of caesarean sections are many, from the “easy delivery” mentality of many expectant mothers, and in some cases doctors, to the conditions prevailing in maternity hospitals. “There are public hospitals where there is no possibility of an epidural injection or, as it is also called, a painless delivery, due to a lack of anesthesiologists, and when a woman experiences pain during childbirth, she herself asks for a caesarean section. There is usually one midwife per pregnant woman. That is, in a delivery room where five births take place, there should be five midwives. You will not find such a hall in the public sector of Greece.” refers to “K” Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, EKPA Nikolaos Vrachnis.

In order to strengthen vaginal delivery in our country Greek Society of Obstetrics and Gynecology And EKPA in collaboration with researchers from foreign universities such as St. George and King’s College London and British Columbia Vancouver have been running the ENGAGE study since June 2021, which captures the reality of caesarean section, maternal and neonatal morbidity, and examines whether tailored interventions can reduce the number of caesarean sections. The ongoing study involves 22 obstetric and gynecological clinics in the public and private sectors. It is estimated that more than 5,500 births will be included at the end of the study.

From the first registration, it was seen that in the participating clinics, only 58% of births are carried out by caesarean section, with a percentage variation depending on the clinic from 47% to 70%. The current high rate of caesarean sections in Greece is an accumulated pathogenesis of many decades and is due to many causes. As Mr Vrachnis points out, “insufficient staffing of the public sector in all categories of obstetric care cannot provide the best continuous obstetric care. As part of my research, I found that many public clinics do not offer epidural services for vaginal births around the clock. In some clinics, there is almost no round-the-clock service.”

understaffing

“Another reason is the understaffing of state maternity hospitals with obstetrician-gynecologists and midwives. The training of healthcare professionals involved in childbirth is also a challenge and I believe the next generation of OB/GYNs need more training in vaginal delivery, such as assisted vaginal delivery where the use of a soft suction cup on the baby’s head could in some cases prevent caesarean section. ”, says Mr. Vrachnis. An additional reason is that caesarean section may be perceived as a safe option both by physicians and by pregnant women themselves and their family environment. “Fear of lawsuits and lawsuits, as well as pressure on the obstetrician from the environment of the pregnant woman to immediately complete labor when it exceeds eight to twelve hours, leads to the decision to caesarean section,” he explains.

The study selected ten interventions that were proposed for implementation by obstetrician-gynecologists and polyclinic staff. Among these are the implementation of the Hellenic Society of Obstetrics and Gynecology guidelines for childbirth, staff training and the organization of the delivery room in a way that serves vaginal delivery. In addition, reminders of good obstetric practice in the form of short text messages promoting vaginal birth have been posted in delivery rooms, on tables for nurses and in operating room sinks. Corresponding messages are sent in the form of SMS to the mobile phones of participating obstetricians.

Mr Vrachnis emphasizes that “the goal is to reduce the rate of primary caesarean sections per clinic. That is, each clinic competes with itself. We would be happy if participating clinics reduce the number of caesarean sections by 5% by the end of the program in June. However, the problem is multifactorial and I believe that it cannot be solved only by the will of obstetricians. We need to work together with the government and the Department of Health to bring about a reduction in the number of caesarean sections within five years, or better within a decade.”

Numbers

58%-60% cesarean section rate in Greece.

21.1% cesarean section rates worldwide, according to WHO.

29% expected by 2030.

25.7% on average across European countries.