SIMPLE: implementation of recommendations from international evidence-based guidelines on caesarean sections in the Netherlands. Protocol for a controlled before and after study

Sonja Melman, Ellen NC Schoorel, Carmen Dirksen, Anneke Kwee, Luc Smits, Froukje de Boer, Madelaine Jonkers, Mallory D Woiski, Ben Willem J Mol, Johannes PR Doornbos, Harry Visser, Anjoke JM Huisjes, Martina M Porath, Friso MC Delemarre, Simone MI Kuppens, Robert Aardenburg, Ivo MA Van Dooren, Francis PJM Vrouenraets, Frans TH Lim, Gunilla Kleiverda, Paulien CM van der Salm, Karin de Boer, Marko J Sikkema, Jan G Nijhuis, Rosella PMG Hermens, Hubertina CJ Scheepers

Caesarean section (CS) rates are rising worldwide. In the Netherlands, the most significant rise is observed in healthy women with a singleton in vertex position between 37 and 42 weeks gestation, whereas it is doubtful whether an improved outcome for the mother or her child was obtained. It can be hypothesized that evidence-based guidelines on CS are not implemented sufficiently. Therefore, the present study has the following objectives: to develop quality indicators on the decision to perform a CS based on key recommendations from national and international guidelines; to use the quality indicators in order to gain insight into actual adherence of Dutch gynaecologists to guideline recommendations on the performance of a CS; to explore barriers and facilitators that have a direct effect on guideline application regarding CS; and to develop, execute, and evaluate a strategy in order to reduce the CS incidence for a similar neonatal outcome (based on the information gathered in the second and third objectives).