Power to Push Campaign in British Columbia

Dr. Nicole ToddNicole J. Todd, MD, University of British Columbia resident

In 2010, as a response to increased cesarean delivery rates in British Columbia, the Power to Push Campaign was launched, providing information to women and encouraging them to know their options, advocate for their choices, and push for the safest births possible.

The British Columbia Women’s Hospital Cesarean Task Force, which includes ob-gyns, family doctors, midwives, nurses, researchers, and other health professionals, developed the campaign. Integrating medical consultation, an interactive website, and social media platforms, the campaign seeks to lower the overall cesarean birth rate at British Columbia Women’s Hospital in Vancouver.

The Best Birth Clinic, located in the diagnostic ambulatory program area at British Columbia Women’s Hospital, offers consultations with ob-gyns for women who have had previous cesarean deliveries, women with breech presentations for external cephalic version (ECV), and women who desire a vaginal breech delivery. In addition, counseling services are offered to women who are considering a primary elective cesarean delivery and women who have recently experienced a difficult or traumatic birth.

Labor support handouts are available in multiple languages at the clinic and on the
Power to Push Campaign website. For maternity care providers, protocols are available for early, active, and second-stage labor management, and informed consent forms are available for vaginal birth after cesarean delivery (VBAC), ECV, and vaginal breech delivery.

Task force research is ongoing, including a randomized controlled trial examining the effect of doulas on intrapartum outcome for VBAC. Upon review of the first 14 months of operation, consultation breakdown includes 53% VBAC, 39% ECV, and 8% vaginal breech delivery. The majority of consults were from midwives (59%), followed by family physicians (31%) and obstetricians (10%).

After counseling, 65% of women chose to attempt VBAC, and 60% of those women were successful. The success rate for ECV approached 33%, with 78% of those women achieving vaginal delivery. The success rate for vaginal breech delivery was 49%, with equal success between primiparous and multiparous women. Data regarding cesarean delivery rates are pending.

The Power to Push Campaign provides patients with information and options to assist with making the best choices surrounding their births. Further, it allows maternity care providers to provide consistent information and care to facilitate the safest births.