957: Women with one cesarean: Views on VBAC, ERCD and future RCT regarding mode of delivery

Abstract

After one cesarean delivery (CD) the options for future delivery include vaginal birth after cesarean (VBAC) or elective repeat cesarean delivery (ERCD), albeit practice regarding this is controversial and varied worldwide. The aims of this study were: 1. to assess women’s views of their birth experience after their first CD; 2. to compare the findings between women who had an elective CD (ECD) and those who had an emergency CD (EmCD); 3. to evaluate their views on a potential future delivery; and 4. to investigate whether they would be willing to join a clinical trial of VBAC vs ERCD in a future pregnancy. This was a prospective questionnaire survey of woman who had their first CD between January and August 2018 in Galway University Hospital. Eligible participants were contacted by telephone for consent and postal surveys sent out, with review board approval (Ref No. 1804). Survey results were collected, and statistical analysis performed using Chi-Square test. There were 297 eligible women consented to participate, of which 242 (81.5%) did, and 154 (64%) surveys were returned complete. EmCD n=104 (67.5%); ECD N= 50 (32.5%) (Table 1). Satisfaction levels for mode of delivery in both groups are shown (Table 1). Women in the EmCD group were less satisfied with the information received prior to the delivery (P<0.05). Both groups were less satisfied with the postnatal counseling provided, and a similar difference observed (P <0.05). Regarding VBAC in a future pregnancy, 45 (43.3%) and 17 (34%), in the EmCD and ECD groups respectively, expressed a preference for VBAC. A lower rate of women in the EmCD expressed a preference for ERCD than those in the ECD group. Approximately 80% of women in both groups said they would consider randomization in a future pregnancy. Debriefing and counselling women after a CD is an important part of pregnancy care and can have a significant impact on a woman’s overall birth experience, as well as her view on mode of delivery in a subsequent pregnancy. A significant proportion of women in this cohort were considering VBAC for future delivery, and a majority of women stated they would consider randomization in a future RCT. These data indicate that an RCT of VBAC versus ERCD would be viewed positively by women with one previous CD in our population.