Unlike previous U.S. guidelines, consensus statements, position papers, and tool kits developed to reduce the high rate of cesareans, the Toolkit to Support Vaginal Birth and Reduce Primary Cesarean Delivery was developed by a multidisciplinary task force of over fifty expert writers and advisers representing physicians, midwives, nurses, lactation experts, childbirth educators, doulas, patient advocates, public health experts, policymakers, and health care purchasers. It is a comprehensive, evidence-based, how-to guide to support vaginal birth and reduce the first cesarean in low-risk mothers.
Developed by the California Maternal Quality Care Collaborative (CMQCC) of the Stanford School of Medicine, the Toolkit includes strategies to lower the odds for a cesarean during labor. The strategies can be implemented by women and clinicians as early as the first trimester. The Task Force acknowledged that most women do not have evidence-based information about labor and birth or about the potential risks of frequently used interventions that increase the risk for a cesarean. So it is critical that communications between providers and pregnant women be frank and comprehensive during prenatal care to help women make informed decisions about how they want to give birth.
“ By identifying the major decision points that most impact the risk for cesarean delivery, “ the Task Force found that, “providers can markedly improve patient decision making and improve knowledge deficit.”
The underlying principles of the recommendations include respect for childbearing women’s values, choices, and cultural background. The Toolkit strongly recommends that women should be treated with dignity, respect, and cultural sensitivity throughout pregnancy, labor and birth, and postpartum.
The Task Force has included guidelines and recommendations for all stakeholders in maternity care from hospital administrations to healthcare insurance payers. The strategies that focus on hospital-based care encourage nursing skills which focus on promoting freedom of movement, fetal positioning, intermittent auscultation instead of continuous fetal monitoring, labor support techniques, and non-medical options of pain relief. Doulas are recommended as part of the collaborative healthcare team’s support for vaginal birth and reducing cesareans.
Although the main focus of the CMQCC Toolkit is on low-risk first births, nulliparous, at term, with a single fetus in a vertex position (NTSV), the philosophical principles and specific recommended strategies can be applied to all women giving birth.
While the Toolkit is meant to guide individual hospitals and provider level change in California it also includes guidance for state, county, and hospital system-level change. Hopefully, this game-changer Toolkit will eventually be adopted by maternity care stakeholders across the U.S.