Normalising Choice: An Observational Study of Australian Clinicians' Perspectives on Written Informed Consent for Vaginal Birth.

BackgroundThe most common reason for caesarean section (CS) is repeat CS following previous CS. Vaginal birth after caesarean section (VBAC) rates vary widely in different healthcare settings and countries. Obtaining deeper knowledge of clinicians’ views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Interview studies with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of ‘OptiBIRTH’, an ongoing research project. The study reported here is based on interviews in high VBAC countries. The aim of the study was to investigate the views of clinicians working in countries with high VBAC rates on factors of importance for improving VBAC rates.MethodsIndividual (face-to-face or telephone) interviews and focus group interviews with clinicians (in different maternity care settings) in three countries with high VBAC rates were conducted during 2012–2013. In total, 44 clinicians participated: 26 midwives and 18 obstetricians. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country.ResultsThe findings are presented in four main categories with subcategories. First, a common approach is needed, including: feeling confident with VBAC, considering VBAC as the first alternative, communicating well, working in a team, working in accordance with a model and making agreements with the woman. Second, obstetricians need to make the final decision on the mode of delivery while involving women in counselling towards VBAC. Third, a woman who has a previous CS has a similar need for support as other labouring women, but with some extra precautions and additional recommendations for her care. Finally, clinicians should help strengthen women’s trust in VBAC, including building their trust in giving birth vaginally, recognising that giving birth naturally is an empowering experience for women, alleviating fear and offering extra visits to discuss the previous CS, and joining with the woman in a dialogue while leaving the decision about the mode of birth open.ConclusionsThis study shows that, according to midwives and obstetricians from countries with high VBAC rates, the important factors for improving the VBAC rate are related to the structure of the maternity care system in the country, to the cooperation between midwives and obstetricians, and to the care offered during pregnancy and birth. More research on clinicians’ perspectives is needed from countries with low, as well as high, VBAC rates.

Management of Breech Presentation: Green-top Guideline No. 20b.

BackgroundRising caesarean section (CS) rates are a global health concern. Contemporary data indicates that almost 50% of CS are electively performed, with a high proportion of these being a repeat procedure. Vaginal birth after caesarean (VBAC) is recognised as a safe way to give birth in developed countries. UK national maternity policy and worldwide professional guidance supports shared decision-making about mode of birth with women following CS. Evidence suggests that women want individualised information, particularly about their likeilihood of successful VBAC, to enable them to participate in the decision making process. This study aimed to identify characteristics that could inform a predictive model which would allow women to receive personalised and clinically specific information about their likelihood of achieving a successful VBAC in subsequent pregnancies.MethodsAn observational study using anonymised clinical data extracted from a detailed, comprehensive socio-demographic and clinical dataset. All women who attempted a singleton term VBAC between 2000 and 2012 were included. Data were analysed using both logistic regression and Bayesian statistical techniques to identify clinical and demographic variables predictive of successful VBAC.ResultsVariables significantly associated with VBAC were: ethnicity (p = 0.011), maternal obstetric complications (p < 0.001), previous vaginal birth (p = < 0.001), antepartum haemorrhage (p = 0.005), pre-pregnancy BMI (p < 0.001) and a previous second stage CS (p < 0.001).ConclusionsBy using current literature, expert clinical opinion and having access to clinically detailed variables, this study has identified a new significant characteristic. Women who had a previous CS in the second stage of labour are more likely to have a successful VBAC. This predictor may have international significance for women and clinicians in shared VBAC decision-making. Further research is planned to validate this model on a larger national sample leading to further development of the nomogram tool developed in this study for use in clinical practice to assist women and clinicians in the decision-making process about mode of birth after CS.

VBAC or elective CS? An exploration of decision-making process employed by women on their mode of birth following a previous lower segment caesarean section

BackgroundWith the development of China’s two-child-policy, vaginal birth after cesarean section (VBAC) has aroused public concern. It is important to understand the labour characteristics and intrapartum management of women attempting VBAC to enhance the rates of successful VBAC. The purpose of our research was to investigate the differences in the characteristics of labor, intervention measures and perinatal outcomes between women who had a VBAC and primiparas or multiparas not undergoing VBAC, providing clinical references of intrapartum management for women who are planning a VBAC.Material and methodsThis observational retrospective study enrolled all women who laboured spontaneously and who had a VBAC (n = 139) at the Second Affiliated Hospital of Wenzhou Medical University in China between 2016 and 2019. They were allocated into VBAC group A (the previous cesarean section was performed before dilation of the cervix) and VBAC group B (the previous cesarean section was performed after dilation of the cervix). The primipara control group included 149 primiparae, and the multipara control group included 155 multiparae with second vaginal birth. Durations of labor, intervention measures and perinatal outcomes were compared among the groups.ResultsThe durations of labor, intrapartum interventions and maternal and neonatal outcomes in VBAC group A were similar to those of the VBAC group B. However, all women who had a VBAC and those in VBAC group A had shorter first, second and the total stages of labor than primiparae. All women with VBAC and those in VBAC group B had longer second stage of labor, but shorter third stage of labor than multiparae. Oxytocin, labor analgesia and artificial rupture of membranes were administered less often in women with VBAC than in primiparae, while phloroglucinol was administered more often in women with VBAC than in multiparae. Women who had a VBAC were more likely to receive episiotomy and had higher incidences of postpartum hemorrhage than primipara and multipara women.ConclusionsLabor characteristics, intrapartum interventions and perinatal outcomes in women who had a VBAC with cervical dilation were similar to those in women who had a VBAC without cervical dilation before the previous cesarean section, but differed significantly from those of multiparae and primiparae who did not undergo VBAC.

Preference of birth mode and postnatal health related quality of life after one previous caesarean section in three European countries

ABSTRACTBackground: Caesarean section (CS) rates are continuing to rise worldwide. Elective repeat CS (ERCS) greatly contribute to the rising rate which increases unnecessary risks of maternal and neonatal morbidity and mortality. Vaginal birth after caesarean (VBAC) is a safe mode of birth for most women; however, uptake remains low. Our objective is to find the factors that influence women’s decision-making to support informed choices for the mode of next birth after caesarean section (NBAC).Methods: A literature search was conducted in CINAHL, Maternity and Infant Care, Embase, EmCare, Cochrane Library and Medline databases. Primary, qualitative, peer reviewed, English language research articles were assessed according to inclusion/exclusion criteria. Articles were systematically assessed for inclusion or exclusion. Included studies were assessed using the Critical Appraisal Skills Programme qualitative studies checklist, Noblit and Hare’s seven-step meta-ethnography approach synthesised themes.Results: Fourteen primary research articles were included. Six studies on 287 women focused on VBAC, and eight studies examined both VBAC and ERCS with 1861 women and 311 blogs.Thematic analysis yielded four primary themes: Influence of health professionals, impact of previous birth experience, optimal experience, and being in control.Conclusion: This meta-ethnography highlights health professionals’ influence on women’s decision making. To assist in decision-making, women need supportive health professionals who provide the current evidence-informed information about risks and benefits of each mode of birth. Health professionals need skills to provide supportive shared decision-making, debrief women regarding indications for their primary caesarean, and address issues of safety, fear, and expectations of childbirth.

BackgroundCaesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians’ views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of “OptiBIRTH”, an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates.MethodsFocus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country.ResultsThe findings are presented in four main categories with several sub-categories: 1) “prameters for VBAC”, including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) “organisational support and resources for women undergoing a VBAC”, meaning a successful VBAC requires clinical expertise and resources during labour; 3) “fear as a key inhibitor of successful VBAC”, including understanding women’s fear of childbirth, clinicians’ fear of VBAC and the ways that clinicians’ fear can be transferred to women; and 4) “shared decision making – rapport, knowledge and confidence”, meaning ensuring consistent, realistic and unbiased information and developing trust within the clinician–woman relationship.ConclusionsThe findings indicate that increasing the VBAC rate depends on organisational factors, the care offered during pregnancy and childbirth, the decision-making process and the strategies employed to reduce fear in all involved.

To determine antenatal factors that may predict successful vaginal birth after Caesarean section (VBAC), to develop a relevant antenatal scoring system and a nomogram for prediction of vaginal birth after caesarean delivery. A non recurring indication for previous Caesarean section (CS), such as breech presentation or foetal distress, is associated with a much higher successful VBAC rate than recurrent indications, such as cephalopelvic disproportion (CPD). Prior vaginal deliveries are excellent prognostic indicators of successful VBAC, especially if the vaginal delivery follows the prior CS. A low vertical uterine incision does not seem to adversely affect VBAC success rates as compared to a low transverse incision. Maternal obesity and diabetes mellitus adversely affect VBAC outcomes. Foetal macrosomia does not appear to be a contraindication to VBAC, as success rates exceeding 50% are achieved and uterine rupture rates are not increased. An inter-pregnancy interval of <24 months is not associated with a decreased success of VBAC. Success rates decrease when interval increases. Twin gestation does not preclude VBAC. Post-dates pregnancies may deliver successfully by VBAC in greater than two-thirds of cases. There are few absolute contraindications to attempted VBAC. Attempted VBAC will be successful in the majority of attempted cases. (www.actabiomedica.it)

Vaginal birth after caesarean section (VBAC) is regarded as an effective option to reduce rapidly increasing C-section rates. The aim of the descriptive and cross-sectional study was to reveal opinions of women with experiences of prior C-section about VBAC and the factors affecting their opinions. The study included 283 pregnant women whit a history of previous C-section and followed up in a research and training hospital in İstanbul. Study data were collected by face-to-face interview method through The Personal Information Form and The Opinions about VBAC Form. Obtained data were analyzed with Number Cruncher Statistical System 2007 and evaluated with percentages, mean, standard deviation and Chi-square test. The statistical significance was set at p<0,05. According to the study results, 74.6% of the participants wanted to have a vaginal birth (VB) in their first pregnancy, whereas 56.9% were satisfied with the result of their first pregnancy with a C-section. The rate of those who are satisfied with the current pregnancy being planned as a repeat C-section is 66.8%. Also of all the women, 66.4% found VBAC acceptable, 44.5% wanted to give birth through VBAC, and 73.1% believed it should be promoted in the country. Women thoughts about VBAC were not affected by sociodemographic and obstetric features (p>0.05). On the other hand dissatisfaction with previous C-section had positive effects on finding VBAC acceptable (p=0.000), willingness to have VBAC (p=0.000), and wanting its promotion in the country (p=0.007). Also dissatisfaction with repeated C-sections plans had positive effects on finding VBAC acceptable (p=0.000) and willingness to have VBAC (p=0.000). Similarly, an increased frequency of antenatal visits was found to increase the thoughts about the promotion of VBAC in the country (p=0.015), and asking to have C-section in the first pregnancy was found to decrease the willingness to have VBAC in the current pregnancy (p=0.000). The study results showed that although the pregnant women participating in this study had positive perceptions about VBAC, they abstained from preferring this method. Also opinions of pregnant women about VBAC were shaped by women's birth experiences and the care services they received.

Trends in birth choices after caesarean section in Japan: A national survey examining information and access to vaginal birth after caesarean

Caesarean delivery: truths and consequences.

&amp;lt;i&amp;gt;Background;&amp;lt;/i&amp;gt; Vaginal Birth After cesarean section (VBAC) is considered a viable and safe option for many women who have previously undergone a cesarean section, particularly when the initial cesarean section was performed for a non-recurring indication. Studies indicates that VBAC can lead to lower rates of maternal complications and faster recovery times with success rate of 60-80% compared to elective repeat cesarean deliveries. &amp;lt;i&amp;gt;Objective;&amp;lt;/i&amp;gt; to assess success rate of vaginal birth after cesarean section and factors associated with VBAC in woman who gave birth at AHMC in 2024. &amp;lt;i&amp;gt;Method;&amp;lt;/i&amp;gt; institutional based cross-sectional study was conducted at AHMC involving 208 mothers who had undergone one previous cesarean section. Data were collected using a structured checklist that was pretested prior to the study. The collected data were entered and cleaned using Epi-data version 3.7 and analyzed with SPSS version 24 to determine frequency distributions, means, and standard deviations. Bivariate and Multivariate logistic regression analyses were performed to evaluate the success rate of vaginal birth after cesarean section and to identify factors associated with VBAC. A 95% confidence interval and 5% level precision were used to determine the presence of associations between and independent variables in the final model. &amp;lt;i&amp;gt;Result;&amp;lt;/i&amp;gt; the total number of mothers with one previous cesarean section who were offered trial of labor and included in this study were 208. Out of these 86 (41.3%) with CI (34.59%-48.09%) had successful vaginal birth. Independent variables history of pervious VBAC (AOR=6.306 [1.143-34.802]), rupture of membrane at admission [AOR=5.758 [2.588-12.812] and Low station at admission [AOR=6.807 [2.34-19.796] are highly associated with VBAC. &amp;lt;i&amp;gt;Conclusion;&amp;lt;/i&amp;gt; The study concluded that the overall success rate of Vaginal Birth after Cesarean (VBAC) in this research is consistent with findings from earlier studies conducted in Ethiopia. Key factors identified as predictors of VBAC success include a prior history of vaginal delivery following a cesarean section (C/S) scar, low fetal station, and membrane rupture. These elements play a significant role in determining the likelihood of a successful VBAC.

Introduction: Caesarean section is a major surgical operation and its rate is on the rise in Sri Lanka as well as in the world. It is recommended to lower the Caesarean section rate due to the risk of potential complications and burden on the health care system. Previous Caesarean is a common indication for planned Caesarean section and vaginal birth after Caesarean section (VBAC) is considered a safe alternative for many women. This audit study was aimed at determining the success rate of VBAC in a local setting and to identify the factors that are associated with failure in this study population. Method: An audit study was carried out in two obstetric units if South Colombo Teaching hospital, Kalubowila and De Soysa hospital for women, Colombo 8 to assess the success rate among women who underwent VBAC. The unit policies included patient choice for decision to undergo VBAC and non-usage of medication either for induction or augmentation of labour. The audit standards were set as a VBAC success rate of 72% (RCOG Green-top guidelines) and a low APGAR (<7) in less than 2% of neonates (set by clinical experience). The demographic and past obstetric factors were compared between groups to determine significant associations. Results: A total of 161 women (37.8% of those with a previous one Caesarean) had opted to undergo VBAC during the study period. It was successful in 69.6% of the total study sample and 84.6% who has had a previous vaginal delivery. Low APGAR scores at 5 minutes was observed in two neonates (1.2%) and both these were in the group with a successful VBAC. The factors associated with failed VBAC in this study population included not having had a previous vaginal delivery (Odds ratio 2.99), poor progress of labour being the indication for previous section (OR 2.32), a cervical dilatation of <2cm at onset of labour (OR 4.43), malpositions in early labour (OR 12.24), and a birth weight of more than 3000g (OR 2.11). Other preciously described factors such as a high BMI and inter-delivery interval failed to show a significant association in this study group. Discussion and recommendations: The take up rate of VBAC in our study population seems to be low. However, the study did not study the reasons contributing to this low rate hence no recommendations can be made. The success rate of VBAC on our group (69%) was very close to the set standards (72%) and the rate of low APGAR at 5 minutes was 1.2% and was achieving the set standard. These figures along with the factors identified to be associated with the failure at VBAC should be used for patient counseling in our local setting. Other units also should carry out such audit projects to find out the success rate of VBAC in their respective units. More in-depth studies should be carried out to find causes for low rate of undergoing VBAC and to determine effective ways to improve it.

Women with a history of previous Cesarean Sections (CS) are faced with two choices during their pregnancy: Vaginal Birth After Cesarean (VBAC) or Elective Repeat Cesarean Delivery (ERCD). VBAC refers to vaginal delivery in women who have previously undergone a CS. Despite limited studies on VBAC in Saudi Arabia, this research aims to assess the knowledge and awareness of Saudi women regarding VBAC. This cross-sectional study was conducted among adult females in Western Saudi Arabia utilizing a convenient snowball sampling technique. The total number of participants was 901 females. The participants completed a self-administered questionnaire, which covered general information, knowledge about VBAC, and factors influencing their decision. Statistical analysis employed Chi-squared, Independent T-Test, and ANOVA. Our findings revealed that 67.5% of participants had inadequate knowledge about VBAC. Only 45.6% of participants were familiar with the term VBAC. The primary reason for choosing CS over VBAC was medical necessity, as reported by 36.3% of participants. The most common reasons for rejecting VBAC were fear for their child's safety and the fact that a CS was recommended, both reported by 35.1%. The lowest reported reason was external interference from family or spouses, at 10.5%. Although the majority of our sample consisted of highly educated women, most exhibited poor knowledge regarding VBAC. Therefore, raising awareness about VBAC, especially through healthcare professionals and their clinics, is essential.