The leading practice consists in preventing iterative cesareans performed before 39 weeks of gestation in women at low risk coming to give birth at the Montfort Hospital’s Family Birthing Centre (FBC). According to the Society of Obstetricians and Gynaecologists of Canada (SOGC), elective iterative cesareans should be performed at 39 weeks of gestation and over to reduce the newborn morbidity rate. This leading practice prevents increased risks in newborns, such as morbidities and respiratory problems, an extended hospital stay and admissions to the neonatal intensive care unit or intermediate care unit for newborns. The objective of this leading practice is to create a safety net for mothers and newborns.
The FBC’s leadership is supporting the team in adopting a proactive approach. A team reviews the antenatal record of each woman at 37 weeks eligible for an elective cesarean. When a low-risk cesarean is scheduled before the 39th week of gestation, the head of the obstetric department performs a follow-up with the designated obstetrician. The record is reviewed by the obstetrician to confirm the postponement of the date of the cesarean to 39 weeks of gestation and over; the date is then determined in collaboration with the patient. This process meets the fourth performance indicator of the Better Outcomes Registry & Network (BORN) Ontario dashboard, and the monitoring of cesareans according to the Robson classification system, recognized by the World Health Organization