BACKGROUND:
Caesarean section (CS) rates are rising around the world. C-Safe aims to optimise both safe, positive vaginal and CS births. It includes a training and intervention package with three components: C-Non, underpinning labour support and vaginal birth C-Why, a classification system for CS indications, and C-Op, strengthening the safety and quality of surgical procedures.

OBJECTIVES:
To pilot the implementation and field-testing of the C-Safe intervention ahead of a planned cluster randomised trial.

METHODS:
Piloting occurred in two sites (India and Tanzania). Data were collected from healthcare professionals (HCPs) and service users. Methods included readiness for change assessments, case report forms, surveys, interviews/focus groups, documentary reviews, and clinical practice observations. Analysis included descriptive statistics and thematic analysis. This paper reports C-Non results.

RESULTS:
Facilitators of vaginal births included multidisciplinary teamwork, shared decision making, respectful care per the WHO Labour Care Guide, and training on vacuum procedures. Barriers included misalignment between C-Safe training and local guidelines (or lack of local guidelines), perceived lack of institutional and government support for vacuum births, and challenges in balancing women’s’ preference for CS with clinical indications. HCPs suggested that enhancing antenatal education would support spontaneous labour and birth and reduce non-medically indicated CSs.

CONCLUSIONS:
To promote safe, positive labour and vaginal birth, training should be adaptable to local clinical and social contexts, enhance confidence in vacuum techniques, and build HCPs’ skills in decision-making. Antenatal education for women in these communities needs further exploration

KEY MESSAGE:
Adaptable, context-sensitive training combined with strengthened antenatal education has the potential to reduce unnecessary CSs and promote safer, more supported vaginal births in LMIC settings Poster session 2 (Group A)