Comparison of maternal and neonatal outcomes between vaginal birth after cesarean section and normal vaginal birth

Abstract

Objective This study aimed to compare the outcomes of vaginal birth after cesarean (VBAC) with those of normal vaginal birth (NVB) in a tertiary hospital in China. Methods This retrospective cohort study analyzed 1,024 women who birthed vaginally between January 2019 and December 2020. The VBAC group (n = 512) included women with one previous cesarean, while the NVB group (n = 512) had no previous caesareans. All women used epidural analgesia. We assessed maternal and neonatal complications using descriptive statistics, chi-square tests, and logistic regression. Statistical analysis was performed using SPSS version 25.0. Results The VBAC group had an 87.5% success rate for vaginal birth under epidural analgesia, whereas the NVB group had a 100% success rate. A primary focus of the study was uterine rupture. Vaginal birth after cesarean was associated with a higher incidence of uterine rupture (0.8% vs 0%, p = 0.031), postpartum hemorrhage (6.6% vs 3.5%, p = 0.021) and the need for blood transfusions (2.7% vs 0.8%, p = 0.012) compared with NVB. There were no substantial differences in maternal infections, wound infections or perineal lacerations between the groups. Although neonatal outcomes were generally similar, the VBAC group experienced higher rates of 5-minute Apgar scores <7 (2.3% vs 0.6%, p = 0.009) and admissions to neonatal intensive care units (3.1% vs 1.2%, p = 0.016 Even after adjusting for confounders, VBAC remained an independent risk factor for several complications. Conclusion Although VBAC is feasible and mostly safe, it is associated with a higher risk of specific complications compared with NVB. Careful selection of candidates and close monitoring are essential for optimizing outcomes in VBAC cases.