Quality Statement 2: Discussion After Caesarean Birth

Resources Quality Statements Advisory Committee About

Discussion After Caesarean Birth

After a Caesarean birth, people have a discussion with their physician or midwife and receive written information about the reasons for their Caesarean birth and their options for future births.

Background

Preferences for future births are usually established between pregnancies. Therefore, vaginal birth after Caesarean should be presented as an option for future births at discharge from hospital and again at the 6-week postnatal visit. It is important to discuss the reasons for the initial Caesarean birth so that the person and their family can use that information for family planning and future births. Discussion should also include the association between a delivery interval of less than 18 to 24 months and increased risk of uterine rupture. The physician or midwife should ask about the person’s emotional state and well-being and encourage them to ask questions.

Information should be provided during the discussion and also in written form so that it can be retained and shared. Written information facilitates communication with care providers from one birth to the next, because the clinical context and factors involved in the previous Caesarean birth are then clear, not only to the physician or midwife but also to the pregnant person and their family. This information can support shared decision-making during the next pregnancy, and this discussion should be repeated for each subsequent Caesarean birth.

What This Quality Statement Means

For Pregnant People

Before you leave the hospital, your physician or midwife should talk with you about why you had a Caesarean birth and what your options are for future births. They should give you this information in a written report (see Definitions section). They should also talk about this at your 6-week follow-up appointment.

For Clinicians

Have a discussion with people who have had a Caesarean birth and provide written information about the reasons for their Caesarean birth and their options for future births.

For Health Services

Ensure that systems, resources, and training are available for physicians and midwives to have discussions and provide written information about the reasons for Caesarean births and options for future births.

Quality Indicators

Process Indicators

Percentage of people who have had a Caesarean birth and who have a discussion with their physician or midwife about the reasons for their Caesarean birth and their options for future births at discharge

Denominator: number of people who have had a Caesarean birth
Numerator: number of people in the denominator who have a discussion with their physician or midwife about the reasons for their Caesarean birth and their options for future births at discharge
Data source: local data collection

Denominator: Number of people who have had a Caesarean birth
Numerator: Number of people in the denominator who have a discussion with their physician or midwife about the reasons for their Caesarean birth and their options for future births at the 6-week postnatal visit
Data source: local data collection

Percentage of people who have had a Caesarean birth and who receive written information after a discussion with their physician or midwife about the reasons for their Caesarean birth and their options for future births at discharge and at the 6-week postnatal visit

Denominator: Number of people who have had a Caesarean birth and who have a discussion with their physician or midwife about the reasons for their Caesarean birth and their options for future births at discharge and at the 6-week postnatal visit
Numerator: Number of people in the denominator who receive written information about the reasons for their Caesarean birth and their options for future births at discharge and at the 6-week postnatal visit
Data source: local data collection

Definitions Used Within This Quality Statement

Discussion

A conversation between the person who had a Caesarean birth, their family, and a physician or midwife to provide accurate information about the reason for the Caesarean birth, including the clinical situation, recurring and non-recurring indications for Caesarean birth, and how it might affect options for future births. This conversation should happen before the person is discharged from hospital and should be reviewed at the 6-week postnatal visit. It should take place after each Caesarean birth.

Written information

Written information could be in the form of an operative report, but should be in a format that is easy to read and includes the following:

Gestational age
Reason for Caesarean section
Fetal position and presentation
Length of labour and dilation before Caesarean section
Whether labour was induced or augmented
Type of uterine incision, extension of the incision, and closure
Any contraindication to future vaginal birth

Evidence to Improve Care