Promising Measures to Reduce the Use of a Avoidable Obstetrical Interventions with Low-risk Women

The use of obstetrical interventions is widespread in Québec. Québec’s 2008–2018 perinatal policy, along with its 2008–2012 policy implementation plan, places priority on promoting physiological delivery and reducing obstetrical interventions. These policy directions prompted the mandate entrusted to the Institut national d’excellence en santé et en services sociaux (INESSS) by the Ministère de la Santé et des Services sociaux (MSSS).

INESSS was asked two questions. What measures could be taken in Québec to reduce the use of the following obstetrical interventions: epidural analgesia, continuous electronic fetal monitoring, labour induction, labour augmentation, and caesarean delivery. What factors affect the use or not of these procedures? The first objective of this study was to retrieve, assess and synthesize the scientific evidence supporting the concept of “avoidable intervention,” defined as a procedure that can be replaced with a less invasive option, including no intervention, and that yields comparable outcomes in terms of quality of care and maternal and perinatal health. The second objective was to submit this evidence to obstetric practitioners for review in order to identify measures and courses of action aimed at reducing the number of avoidable obstetrical interventions in Québec.

Upon completing this work, INESSS, backed by scientific evidence and the opinions of experts and partners in obstetric care, finds that physiological or vaginal birth for women with low-risk pregnancies seems desirable. This report proposes 10 general measures, 19 measures related to the five obstetrical interventions covered in this report, and 37 possible courses of action to reduce avoidable procedures in women with low-risk pregnancies. These measures do not replace the existing practice guidelines.