Women who deliver by cesarean recover slower after birth than women who deliver vaginally, and cesarean newborns are more likely to be admitted to neonatal intensive care units than babies delivered vaginally. Mother and baby outcomes can be improved by increasing vaginal birth rates. Unfortunately, our data shows that the vaginal delivery rate for first-time mothers (who account for nearly 40% of all deliveries in BC) has decreased from 73% in 2010/11 to 70% in 2014/15.
The Ministry of Health identified normalizing birth as a priority, with Perinatal Services BC leading a provincial committee of Ministry representatives, regional health authorities, care providers, and researchers to identify strategies to ensure pregnant women can be supported in normalizing the labour and birth process and experience, thus increasing vaginal birth rates.
The Normalizing Birth Committee had two sub-groups—Providing Quality Care and Vaginal Birth After Cesarean.
The mandate of this group was to provide advice to PSBC on how to support health authorities and maternity care providers to improve the implementation of clinical practice guidelines that support normal birth (with a focus on preventing cesarean section when it is not medically indicated).
The following recommendations were approved by the PSBC Steering Committee:
- Interdisciplinary fetal health surveillance education to become compulsory for all providers as part of privileging and basic competencies requirements.
- PSBC to support sites to implement documented ‘handover’ communication tools for maternal and fetal health surveillance.
- All sites to provide an experienced and trained professional to provide one-to-one support and education to women presenting in early labour prior to discharge home (or admission to site where discharge is not appropriate).
- PSBC to provide a series of tools to support quality improvement and adherence to existing clinical guidelines for the identification and management of dystocia.
- PSBC to support sites and health authorities to develop facility- and peer-level audit processes.
- PSBC to continue to report facility-level vaginal birth rates for eligible nulliparous women.
The VBAC group’s mandate was to provide advice to PSBC and the Ministry on education, communication, and system planning for strategies that will lead to an increase in VBAC rates.
The following recommendations were approved by the PSBC Steering Committee:
- PSBC to report facility-level attempted vaginal birth after cesarean rates for eligible parous women.
- PSBC to support sites and health authorities to develop facility- and peer-level audit regarding trial of labour for VBAC.
- PSBC to work with health authorities to support sites self-assessed as providing Tier 1b or higher maternity services to provide VBAC.
- Shared decision-making and educational resources to be developed and provided to health care providers and to women.
Work on implementing these recommendations will begin this spring to ensure pregnant women can be supported in normalizing the labour and birth process and experience, thus increasing vaginal birth rates.
