BACKGROUND:
Caesarean section (CS)-rates have increased to more than 50% in some low- and middle-income countries. CS can be a life-saving procedure, but unnecessary interventions may be harmful for both mother and child.

OBJECTIVES:
To investigate whether multi-professional simulation training on prolonged labour could reduce the CS-rate during active labour.

METHODS:
Simulation training on prolonged labour was carried out at a university hospital, Tanzania, using a quasi-experimental pre-post interventional design. Women admitted to the labour ward were included in the study after giving consent. Maternity staff consented before training participation. The contextual training involved maternity staff in small teams. Lectures and workshops on prolonged labour, foetal heart rate monitoring, respectful maternity care, shared decision-making, and teamwork, were followed by simulation training on prolonged labour. We collected baseline data seven months before the training and post-intervention data nineteen months after the training.

RESULTS:
The study population comprised 1159 mothers pre-intervention and 2256 mothers post-intervention. Among these, 54,5% and 51,6% mothers respectively, were delivered by CS pre- and post-intervention. Most CS were performed prelabour or during the latent phase. The CS-rate during the active labour phase was reduced from 7.4% pre-intervention to 2.7% post-intervention (p < 0.01). The frequencies of five minutes Apgar scores <7 and referrals to the neonatal intensive care unit, were similar in both periods.

CONCLUSIONS:
With emphasis on respectful maternity care and shared decision-making during simulation training on prolonged labour, we found a significant reduction in the CS-rate during active labour.

KEY MESSAGE:
Teamwork in maternity care with close follow-up during prolonged labour, might contribute to a reduction in the CS-rate during the active labour phase. Pregnancy - preparation