Quality Statement 7: Unplanned Labour - Health Quality Ontario (HQO)

Resources Quality Statements Advisory Committee About

Unplanned Labour

Pregnant people planning an elective repeat Caesarean section should have a documented discussion with their physician or midwife about the feasibility of vaginal birth after Caesarean if they go into unplanned labour. This discussion should take place during antenatal care and again if the person arrives at the hospital in labour.

Background

During antenatal care, physicians and midwives should discuss the possibility of unplanned labour occurring before the scheduled delivery date with people who are planning an elective repeat Caesarean section. Any preferences for attempting a vaginal birth after Caesarean (VBAC) in this situation should be documented in the person’s perinatal record.

People planning an elective repeat Caesarean section who experience unplanned labour should engage in shared decision-making with their physician or midwife about the feasibility of VBAC when they arrive at the hospital in labour. People’s preferences, clinical factors that may increase the risk of uterine rupture, and the clinical judgment of the physician or midwife should be considered when determining the mode of birth. Obstetrical care providers and pregnant people should continue to engage in shared decision-making during labour after Caesarean if there are any changes in maternal or fetal health status that may affect the risks associated with labour and the likelihood of vaginal birth.

What This Quality Statement Means

For Pregnant People

If you plan to have another Caesarean birth but you go into labour before your scheduled Caesarean, it may still be possible to have a vaginal birth. Talk to your physician or midwife about your options if you go into labour early.

For Clinicians

Engage people who plan an elective repeat Caesarean section in shared decision-making about the feasibility of VBAC if they go into unplanned labour.

For Health Services

Ensure systems, processes, and resources are available for physicians, midwives, and facilities to engage people in shared decision-making about the feasibility of VBAC if they go into unplanned labour.

Quality Indicators

Process Indicators

Percentage of pregnant people planning an elective repeat Caesarean section who have a documented discussion that includes shared decision-making with their physician or midwife during antenatal care about the feasibility of VBAC in the event of unplanned labour

Denominator: number of pregnant people planning an elective repeat Caesarean section
Numerator: number of people in the denominator who have a documented discussion that includes shared decision-making with their physician or midwife during antenatal care about the feasibility of VBAC in the event of unplanned labour
Data source: local data collection

Percentage of pregnant people planning an elective repeat Caesarean section who experience unplanned labour and have a documented discussion that includes shared decision-making with their physician or midwife about the feasibility of VBAC

Denominator: Number of pregnant people planning an elective repeat Caesarean section who experience unplanned labour
Numerator: Number of people in the denominator who have a documented discussion that includes shared decision-making with their physician or midwife about the feasibility of VBAC
Data source: Local data collection

Definitions Used Within This Quality Statement

Unplanned labour

When labour begins spontaneously, before the scheduled elective repeat Caesarean section.

Evidence to Improve Care