{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T16:20:38Z","timestamp":1790439638023,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,3,15]],"date-time":"2016-03-15T00:00:00Z","timestamp":1458000000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2016,5]]},"abstract":"Abstract<\/jats:title>\n \n Introduction<\/jats:title>\n \n In 2006 the overall rates of instrumental deliveries (10%) and cesarean sections (\n CS<\/jats:styled-content>\n ) (20%) were high in our unit. We decided to improve quality of care by offering more women a safe and attractive normal vaginal delivery. The target group was primarily nulliparous women at term with spontaneous onset of labor and cephalic presentation.\n <\/jats:p>\n <\/jats:sec>\n \n Material and methods<\/jats:title>\n Implementation of a \u201cnine\u2010item list\u201d of structured organizational and cultural change in Link\u00f6ping 2006\u201315. The nine items include monitoring of obstetric results, recruitment of a midwife coordinator, risk classification of women, introduction of three different midwife competence levels, improved teamwork, obstetrical morning round, fetal monitoring skills, obstetrical skills training, and public promotion of the strategy.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The\n CS<\/jats:styled-content>\n rate in nulliparous women at term with spontaneous onset of labor decreased from 10% in 2006 to 3% in 2015. During the same period the overall\n CS<\/jats:styled-content>\n rate dropped from 20% to 11%. The prevalence of children born at the unit with umbilical cord\n pH<\/jats:styled-content>\n <7 and Apgar score <4 at 5 min were the same over the years studied. At present, 95.2% of women delivering at our unit are satisfied with their delivery experience.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The\n CS<\/jats:styled-content>\n rates have declined after implementing the nine items of organizational and cultural changes. It seems that a specific and persistent multidisciplinary activity with a focus on the Robson group 1 can reduce\n CS<\/jats:styled-content>\n rates without increased risk of neonatal complications.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/aogs.12872","type":"journal-article","created":{"date-parts":[[2016,2,12]],"date-time":"2016-02-12T10:40:01Z","timestamp":1455273601000},"page":"580-586","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Avoiding the first cesarean section\u2013results of structured organizational and cultural changes"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4679-550X","authenticated-orcid":false,"given":"Marie","family":"Blomberg","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine Link\u00f6ping University Link\u00f6ping Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,3,15]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13284"},{"key":"e_1_2_7_3_1","unstructured":"Official Statistics of Sweden.Statistics \u2013 Health and Medical Care Pregnancies Deliveries and Newborn Infants. 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