OptiBirth is a project funded by EU, FP7, aiming to improve the organisation of maternal health service delivery, and optimising childbirth, by increasing vaginal birth after caesarean section (VBAC) through enhanced women-centred care.
The Caesarean section (CS)-rates has risen over time and varies in an international perspective; for example 15 % in Netherlands, 17 % in Sweden, 32 % in Germany and 38 % in Italy. Much of the rise is attributed to routine CS following a previous CS. VBAC is associated with lower maternal mortality than elective repeat CS, and less overall morbidity for mothers and babies. The VBAC-rates is also varying in an international perspective; significantly lower in Germany, Ireland and Italy (29-36%) than in the Netherlands, Sweden, and Finland (45-55%).
OptiBirth involves 12 research groups from eight EU member states, lead by five WG; management, intervention development, translation of intervention into online and ICT tools, cluster randomised trial, and economic analysis. Ingela Lundgren is scientific leader for WG2 intervention development. Focus group interviews with women, their partners, physicians and midwives will be carried out in three countries with high VBAC-rates (Finland, Sweden and Netherlands) and low VBAC-rates (Italy, Gemany, Ireland). Based on the interviews an innovative programme of evidence-based antenatal strategies, incentives and interventions will be designed to increase the empowerment, engagement and involvement of women. The programme will assist them to work in partnership with clinicians with the aim of increasing the VBAC-rates from 33% to 53%. The intervention will also be translated into an on-line, user-friendly format, including innovative Information Communication Technology solutions, an interactive website and 3-5 mobile phone applications, to assist women to achieve their optimal birth outcome. The clinical effectiveness of the intervention will be tested through a cluster randomised trial in 15 maternity units in three countries with low VBAC-rates (Germany, Ireland and Italy), in a variety healthcare settings (small, medium & large units, in both urban & rural sites). A full cost analysis will be conducted, and the team will engage with decision-makers throughout the project.