Faculty Members Revise Guidelines for Assisted Vaginal Birth

This month, the Journal of Obstetrics and Gynaecology Canada released the newly revised guidelines on Assisted Vaginal Birth, including input from four faculty members with the University of Toronto's Department of Obstetrics and Gynaecology. Drs Sebastian Hobson (Assistant Professor) and Rory Windrim (Professor) co-authored the guidelines that focus on the safe and appropriate use of forceps, with input from Drs John Kingdom (Chair of ObGyn Department) and Jackie Thomas (Assistant Professor). The new guideline has been the first update in 15 years and it brings together the latest evidence-based care for women and babies who encounter difficulties in the second stage of labour.

"The rates of cesarean section are steadily rising throughout North America while the incidence of forceps and vacuum birth are concurrently falling," said Dr. Hobson. "Although caesarean sections during the second stage of labour (at full cervical dilation) are sometimes required, they are associated with several short and long term risks including future uterine rupture, placenta accreta spectrum disorders and subsequent preterm birth. Due to this, members of the Department of Obstetrics & Gynaecology at the University of Toronto have begun to work together on several initiatives to promote safe and skilled assisted vaginal birth."

According to Dr. Hobson, the guideline highlights the importance of strong clinical examination skills and safely optimizing the fetal head position to encourage vaginal birth. The guideline also emphasizes the important role of comprehensive resident training in assisted vaginal birth to achieve expert levels of skill and safety.

In December, Drs Hobson and Thomas attended the Regional Society of Obstetricians and Gynaecologists Canada Meeting in Toronto to present a workshop focusing on operative vaginal delivery to a large crowd of obstetricians. This presentation and the guidelines have helped to develop a Safe Forceps Initiative, which is an inter-hospital group currently working to promote safe assisted vaginal birth techniques through knowledge translation workshops across the country. This group is also in the early stages of developing a high-fidelity training model which will improve the simulation experience for all types of forceps birth.

You can read more about these guidelines in the Journal of Obstetrics and Gynaecology Canada.

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