Quality Statement 6: Timely Access to Caesarean Birth

Resources Quality Statements Advisory Committee About

Timely Access to Caesarean Birth

Pregnant people planning a vaginal birth after Caesarean are aware of the resources available and not available at their planned place of birth, including physician, midwifery, nursing, anesthesiology, and neonatal care, and the ability to provide timely access to Caesarean birth.

Background

In an emergency, the risk to the person and the newborn is increased if a Caesarean birth is delayed. Therefore, the physician or midwife should advise that the safest place for a vaginal birth after Caesarean (VBAC) is in hospital, where there is access to continuous fetal monitoring and timely access to Caesarean birth. Physicians and midwives must be aware of the availability of physician, midwifery, nursing, anesthesiology, and pediatric staff for people in labour in their hospital. This information should be shared with people planning a VBAC as part of shared decision-making (Quality Statement 3). Hospitals should have written policies and protocols to promote and ensure access to VBAC that include how physicians are notified or consulted to provide timely Caesarean birth if needed. Maternal factors that may increase the potential risk of uterine rupture should be discussed and considered when planning birth location, and referral to a more comprehensive service that includes supports for planned VBAC may be appropriate.

What This Quality Statement Means

For Pregnant People

If you choose to plan a vaginal birth after Caesarean, your physician or midwife should tell you about the expertise available and not available where you plan to give birth, and what would happen if you needed an unplanned Caesarean birth. If you’re planning to have a vaginal birth after Caesarean, the safest place to have it is in hospital.

For Clinicians

Inform pregnant people planning a VBAC about the physician, midwifery, nursing, anesthesiology, and neonatal resources available and not available at their planned place of birth in case they need an unplanned Caesarean birth. If an out-of-hospital birth is planned, inform people about plans for transport and timely transfer to hospital.

For Health Services

Ensure that physicians and midwives and other relevant staff in the health service have the knowledge to inform pregnant people planning a VBAC about the resources available and not available at their planned place of birth. Practice should be supported by a written policy, protocol, or guideline.

Quality Indicators

Process Indicator

Percentage of pregnant people planning a VBAC who have a documented discussion about the resources available and not available at their planned place of birth, including obstetric, nursing, anesthesiology, neonatal care, and the ability to provide timely access to Caesarean birth

Denominator: number of pregnant people planning a VBAC
Numerator: number of people in the denominator who have a documented discussion about the resources available and not available at their planned place of birth, including obstetric, nursing, anesthesiology, neonatal care, and the ability to provide timely access to Caesarean birth
Data source: local data collection

Definitions Used Within This Quality Statement

Timely access

When there is an indication for Caesarean section, it should occur promptly, as delay in surgery could result in serious maternal and/or neonatal harm.

Evidence to Improve Care