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Access to emergency obstetric care, including assisted vaginal birth and caesarean birth, is crucial for improving maternal and childbirth outcomes. However, although the proportion of births by caesarean section has increased during the last few decades, the use of assisted vaginal birth has declined. This is particularly the case in low- and middle-income countries, despite an assisted vaginal birth often being less risky than caesarean birth. We therefore conducted a three-step process to identify a research agenda necessary to increase the use of, or reintroduce, assisted vaginal birth: after conducting an evidence synthesis, which informed a consultation with technical experts who proposed an initial research agenda, we sought and incorporated the views of women's representatives of this agenda. This process has allowed us to identify a comprehensive research agenda, with topics categorized as: (i) the need to understand women's perceptions of assisted vaginal birth, and provide appropriate and reliable information; (ii) the importance of training health-care providers in clinical skills but also in respectful care, effective communication, shared decision-making and informed consent; and (iii) the barriers to and facilitators of implementation and sustainability. From women's feedback, we learned of the urgent need to recognize labour, childbirth and postpartum experiences as inherently physiological and dignified human processes, in which interventions should only be implemented if necessary. The promotion and/or reintroduction of assisted vaginal birth in low-resource settings requires governments, policy-makers and hospital administrators to support skilled health-care providers who can, in turn, respectfully support women in labour and childbirth. [ABSTRACT FROM AUTHOR]

The authors offer perspectives on the World Health Organization's (WHO) Robson classification system for assessing, monitoring and comparing caesarean section rates within and between maternity units worldwide. They cite various purposes of the data from the Robson platform and discusses its advantages such as easy access to data on caesarian section rates and associated perinatal outcomes, creation of customized charts and graphs, and sharing of data on clinical processes.

The article reports on the recommendations published by the World Health Organization in 2018 on non-clinical interventions to reduce unnecessary caesarean sections. Topics mentioned include factors that may hinder uptake and scale-up of the recommendations, the benefits of adhering to recommended practices, and development of protocols for obtaining and maintaining the stock of supplies.