Identifying barriers and facilitators towards implementing guidelines to reduce caesarean section rates in Quebec
Nils Chaillet, Eric Dubé, Marylène Dugas, Diane Francoeur, Johanne Dubé, Sonia Gagnon, Lucie Poitras, Alexandre Dumont
Volume 85, Number 10, October 2007, 791-797
Table 2. Identified barriers to the implementation of practical guidelines
| Topics |
|---|
| • Induction of labour before 41 complete gestation weeks |
| • Maternal request for induction at term |
| • Possible complications insufficiently discussed with women when planning an induction |
| • Medico-legal concerns |
| • Adoption of a proactive approach to reduce potential risks of lawsuits |
| • Unavailability of induction during the weekend |
| • Not having a one-to-one nurse–patient ratio |
| • Use of a central monitoring system |
| • Anaesthesia department preferences for the use of continuous electronic fetal monitoring |
| • Availability of equipment (i.e. pH metre) |
| • Limited use of fetal scalp blood sampling |
| • Fear of lawsuits |
| • Availability of experienced nurses |
| • Maternal preferences for the use of continuous electronic fetal monitoring |
| • Conclusions of the term breech trial of Marie Hannah et al. |
| • Need of more evidence about maternal and neonatal morbidity |
| • Not having a blended remuneration mode |
| • Lack of skills or unwillingness to offer instrumental vaginal birth |
| • Maternal refusal to attempt an external cephalic version |
| • Need of a high-level infrastructure necessary to offer a safe vaginal birth after caesarean section |
| • Availability of an anaesthetist at all times |
| • Use of a conditional verb tense “should be offered to a woman” in the guideline |
| • Fear of lawsuits in case of uterine rupture |
| • Women’s preference for a repeat caesarean section |