Abstract
Introduction: The rate of primary cesarean section is on the rising trend. Vaginal birth after cesarean section can be an alternative to reduce cesarean section worldwide. Antenatal examination and intrapartum monitoring are the most important factors for a vaginal birth after a cesarean section. This study aims to determine the acceptance of vaginal birth after cesarean section trial in a tertiary care hospital in Nepal.
 Methods: This is a descriptive cross-sectional study carried out in Shree Birendra Hospital, Kathmandu, Nepal, from March 2019 to March 2020. All pregnant women with a previous history of cesarean section meeting Royal College of Obstetrics and Gynecology criteria were included. A trial of labor was conducted on the patients who accepted vaginal birth after cesarean section.
 Results: A total of 85 cases with previous lower section cesarean section were included in the study. Out of which, 75 (88.2%) refused vaginal birth after cesarean section, and only 10 cases (11.8%) accepted to undergo a trial of labor. Five women (50%) had a successful vaginal birth. Complications were less among the vaginal birth after cesarean section group than the repeat cesarean section group. There was no maternal and neonatal mortality.
 Conclusions: The acceptance of vaginal birth after cesarean section is very low in this study. No complications were observed among vaginal birth after cesarean section in our study.
Highlights
The rate of primary cesarean section is on the rising trend
Complications were less among the vaginal birth after cesarean section group than the repeat cesarean section group
The acceptance of vaginal birth after cesarean section is very low in this study
Summary
The rate of primary cesarean section is on the rising trend. This study aims to determine the acceptance of vaginal birth after cesarean section trial in a tertiary care hospital in Nepal. Vaginal birth after cesarean section (VBAC) trial is an alternative to repeated Caesarean sections (CS). It peaked during the mid-1990s, along with a lower rate of CS. The evidence is inconsistent, and the effect on VBAC is unclear. This decline has been a response to new evidence on VBAC's risks and clinician's fear of professional liability.[1,2]. The dictum now is "once a cesarean section, always an institutional delivery in a well-equipped hospital." This decline has been a response to new evidence on VBAC's risks and clinician's fear of professional liability.[1,2] In 1916, Cragin popularized the dictum "once a cesarean section, always a cesarean section." That was the era of classical CS.[3,4,5]
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