Clinical Practice Guidelines

The resource entitled ‘Discussing Birth Options Following Cesarean Section in Nova Scotia: Vaginal Birth after Cesarean (VBAC) or Elective Repeat Cesarean Section’  (March 2015), and the accompanying two-page summary, are available to assist health professionals in discussions with women with a history of cesarean section as they consider their options for birth.

Small numbers have been removed from the posted versions for privacy reasons. Hard copy versions of the original resources are available by contacting RCP. Please note, these materials are intended for provider use.

This guideline presents care and investigative options for women (and their relatives) who experience intrauterine fetal demise (IUFD) or stillbirth. Material is grouped into standard and selective investigations classified by pregnancy timing and type of investigation: maternal, fetal or placental. The process for mother and family informed decision-making is outlined.

According to the Nova Scotia Atlee Perinatal Database (2015), the provincial stillbirth rate has remained virtually unchanged since 1988.

Our clinical guideline on Labour Analgesia is under revision. In the meantime, we are providing the attached table of recommended dosages for commonly used medications. For further information, consult our clinical guideline Fentany for Pain Relief in Labour and our two-part education module Supportive Care in Labour.

Intravenous (IV) Fentanyl is a suitable option for pharmacological pain management during labour. Because of the potential for adverse effects related to IV Fentanyl use, Registered Nurses, midwives, or physicians must demonstrate competency in its safe administration. RCP understands that all policies and procedures must be approved by the appropriate processes within each DHA/facility and that assessing initial and continuing competency is a local responsibility.

RCP recommends that the content of this Clinical Guideline be considered in revisions to your local policy and/or procedure to ensure optimal safety and competence.

Pre-term birth is a significant health issue in Canada. In an effort to avoid unnecessary antepartum admissions or maternal transfers, many jurisdictions have adopted Fetal Fibronectin (ƒFN) testing for women with symptoms of pre-term labour. To assist health-care professionals and planners with the implementation and monitoring of a testing program, a Working Group with representatives from across Canada developed the following resources: a clinical guideline, a presentation, and a list of key indicators. These documents are provided as templates and can be adapted based on local circumstances.
RCP worked in collaboration with regional hospitals across Nova Scotia in 2006 to implement fetal fibronectin (fFN) testing to diagnose preterm labour. Dr. Heather Scott, Obstetrical Co-Director of RCP, Rebecca Attenborough, Coordinator RCP, and Mike Mahaffa, Adeza Biomedical Representative gave a presentation via telehealth on the implementation and use of fFN in Nova Scotia.

From April 2007 to January 2009, the Reproductive Care Program of Nova Scotia conducted a series of quality assessment reviews on induction of labour in 3 District Health Authorities and at the IWK Health Centre. This report summarizes findings from these reviews and from the literature. Data from the Nova Scotia Atlee Perinatal Database is presented.

Between 1970 and 2006 the cesarean section rate in Canada more than quadrupled from 6% to 26%. Similar increases have occurred in every province, including Nova Scotia where the cesarean section rate in 2006 was 27%. As part of an effort to understand the reasons for increased interventions in childbirth in our province, the Reproductive Care Program of Nova Scotia conducted quality assessment reviews in four different centres. This report outlines the collective findings from these reviews, describes the factors that appear to support best practices in maternity care with respect to cesarean sections in Nova Scotia, and presents recommendations for local and provincial action.

Occasionally, women arrive in active labour in the Emergency or Outpatient area of a facility where a maternity service is unavailable. This document has been developed to support health care professionals who do not deliver babies as part of their usual practice. It is intended to provide guidance and support to safely and effectively assess and care for laboring/birthing women. Included are guidelines for:

  • Assessment of the labouring woman and her fetus
  • Indications for transfer and the transfer process, including a provincial directory of all facilities offering a maternity service and details regarding EHS LifeFlight
  • Care and documentation during labour and birth when transfer is not possible
  • Basic neonatal resuscitation skills
  • Assessment and care following birth
  • Equipment
  • Medications to keep in stock for obstetrical emergencies and routine birth
  • Laboratory tests

(This guideline was previously entitled "Labour and Birth in the Emergency Room")

There has been much discussion about the best approach to preventing neonatal Group B Streptococcal (GBS) infection. While there is still controversy about this issue, both the U.S. Centers for Disease Control (CDC) and the Society of Obstetricians & Gynaecologists of Canada (SOGC) recommend universal screening at 35-37 weeks gestation and treatment based on culture results or risk factors if the culture results are not known.