Shaping practice to promote vaginal birth in BC

This team will host a provincial workshop to bring together maternity care clinicians who have demonstrated their ability to reduce or maintain low cesarean section rates, with a goal of developing and implementing best practices for minimizing cesarean section rates across BC. Cesarean section is a high volume intervention associated with considerable resources and more recently, with elevated risk for mortality and severe morbidity among women and their newborns. In 2013/14, the Canadian cesarean section rate was 27.3 percent, an absolute increase of 17 percent since the 1990s. Nationally, BC is among the highest, at 32.9 percent. In 2015, the WHO recommended that optimal country-wide cesarean section rates should be 19 percent. This meeting will begin the process to develop evidence-based strategies to work towards this goal in BC.

BC’s rising cesarean section rate arguably illustrates a failure to narrow the gap between best evidence and clinical practice. To mitigate this problem, the workshop will address four objectives:

1. Review rates of cesarean section stratified by Robson criteria (categories of risk) over the previous five years among hospitals represented at the meeting.
2. Identify broad categories of clinical practice that clinicians from these hospitals believe have promoted vaginal birth among healthy women.
   • Detail specific protocols developed to support these changes.
   • Discuss transferability of these protocols to other settings in BC.
   • Identify resources needed in hospitals to support these changes.
   • Develop a plan for health authorities to standardize practice in relation to targeted areas for change.
   • Identify an evaluation strategy for targeted practice change.
3. Establish a forum for ongoing collaboration/mentorship within health authorities by practice leaders in hospitals that have successfully initiated change with sustained results.
4. Define key research questions to be the basis of a vaginal birth research program, and to plan for follow-up meetings or developing research proposals arising from these questions;