Current Dutch practice on caesarean sections: Identification of barriers and facilitators for optimal care.

Caesarean (CS) delivery rates continue to increase worldwide. In the past 20 years the CS rate in the Netherlands increased from 5 to 15%. CS have no clear benefit for overall neonatal outcome and are associated with higher maternal complications and high costs. Dutch guidelines offer clear recommendations on factors that have a direct effect on the decision to perform a CS. This study aims to provide insight into current adherence of Dutch gynaecologists to these guideline recommendations. Moreover, facilitators and barriers for guideline (non)-adherence are studied and a tailored implementation strategy will be developed and tested in a feasibility study.



The current Dutch care will be studied in 20 hospitals (N=80 gynaecologists). After the development of quality indicators 1000 files on the performed CS are analyzed regarding the adherence to the guideline recommendations. To get insight into Dutch practices compared to international data, basic obstetrical data will be extracted from the delivery database. A barrier analysis will be carried out based on the results of the current care study. Two groups of hospitals will be identified in the upper and lower extremes of the 'adherence distribution': 5 hospitals with the lowest and 5 hospitals with the highest adherence scores. Factors that determine the decision to perform a CS or not (barriers and facilitators) will be analyzed in both groups using semi-structured interviews among 15-20 health care professionals and 15-20 patients. A questionnaire will be used to study the 'prevalence' of these factors among all obstetric gynaecologists in the Netherlands and among 200 experienced patients.



Based on the outcomes of the current care study and the barrier analysis, an implementation strategy will be developed and tested. The study will be performed in 4 hospitals where the effect of the implementation strategy; the adherence to the developed indicators will be measured. A process evaluation will be performed to study the experiences of the clinicians and patients with this strategy. A cost analysis of the tested implementation strategy will take place.

There is incomplete adherence to the recommendations from the guidelines on caesarean section among Dutch gynaecologists.

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Current care study: retrospective observational study.



Barrier and facilitatos analysis: focus group interviews among healthcare professionals and caesarean section patients.