Mandatory second opinion to reduce caesarean section rate among low-risk pregnant women at a private tertiary hospital, a pre and post intervention study: an analysis using WHO Robson classification.

Background: Caesarean section rate has increased globally even among low-risk obstetric deliveries. Therefore, more mothers and babies are subjected to potential complications associated with caesarean section. Hence, World Health Organization introduced measures to reduce unnecessary caesarean section, including worldwide accepted means of classifying all deliveries by the Robson's classification system and recommended safe non-medical interventions, such as mandatory second opinion prior caesarean section. Thus, this study aimed at comparing caesarean section rate pre and post introduction of mandatory second opinion prior caesarean section among low-risk pregnant women at a private hospital using Robson classification.

Methodology: This was a pre and post intervention study design, conducted at tertiary private hospital. Data were collected from all deliveries before intervention period from May 2022 to December 2022 and after intervention from May 2023 to December 2023. The intervention was mandatory second opinion prior caesarean section for deliveries in group one and two. The relative risk was calculated to compare caesarean section rate before and after mandatory second opinion at the 95% confidence interval. T-test and Chi-square were used to compare the pregnancy outcome in pre and post intervention periods. Statistical significance was determined at p-value of < 0.05.

Results: Total deliveries were 941 and 1107 before and post intervention period respectively. Caesarean section rate was 45.5% and 41.3% among low-risk groups (group one and two) in pre intervention and post intervention periods, relative risk of 0.921(95% CI: 0.75-1.11). There was no statistical significance regarding pregnancy outcome.

Conclusion: This study illustrated high caesarean section rate in all Robson's groups. Mandatory second opinion alone had no statistical significance in reducing the Caesarean Section rate and impact on the pregnancy outcomes. Therefore, to reduce the rate of caesarean section interventions targeting patients, health care workers and health system may effectively tackle the drivers of elevated caesarean section rates, leading to substantial reductions at both the facility and national levels.