In the face of an increasing C-section rates, Markham Stouffville Hospital created a Caesarean Reduction Strategy (MSH-CARES) which was comprised of evidence based interventions to decrease existing C-Sections rates. The strategy included targeted interventions for the patients, the health care providers and the maternity care unit policies.

One of the unique interventions was the introduction of the "Birth Options Following Caesarean Section Sessions". All women who have had a previous Caesarean Section (C-Section) are invited to attend (along with their partner) the “Options for Birth after Caesarean” group counseling information session (“Birth Options”). This session ensures that all women receive consistent information about their options for birth following a previous C-Section, regardless of their type of maternity care provider. The content is based on best practice guidelines, and agreed upon by all maternity care providers at the hospital. Sessions are held in a group format where women have the opportunity to discuss the reasons for their previous C-Sections and to explore options for their upcoming birth. The decision to have a repeat elective C-Section or a Vaginal Birth after C-Section (VBAC) is made with their care provider at their next visit following this counselling session.

Researchers from the University of Ottawa and McMaster University collaborated with us to develop an in-depth process evaluation of the Birth Options sessions at MSH. A pre and post survey questionnaire is completed by clients (ethics approval obtained). Results to date demonstrate that these sessions are highly valued by clients, 97.7% were very satisfied or satisfied, 95% felt the amount and type of information was just right and 100% of respondents would recommend the sessions to another client.

The sessions were one component of the larger CS reduction strategy. Despite good evidence that vaginal birth after caesarean (VBAC) is a safe option for the majority of women, prior to this strategy only 15% of MSH clients were choosing to do so. This was despite a 77% success rate. Today (based on YTD April to June data), the VBAC rate has more than doubled to 34.33% with the same high success rate. Our overall CS rate has been reduced from 29.6% to 22%.

These sessions and our overall approach to CS and evidenced based quality care in now incorporated into the culture of the maternal child program. Staff and providers have immense pride in this program. Our expertise is regularly sought by other hospitals who are facing a rising CS rate and looking for solutions.

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