The current management of vaginal birth after previous caesarean delivery

Abstract

Key content Judicious promotion of vaginal birth after caesarean section (VBAC) is a reasonable strategy to counter the rising caesarean section rate. VBAC can achieve cost savings along with greater patient satisfaction. Appropriate augmentation of labour with oxytocin is not associated with an increase in scar rupture rate. Induction of labour with prostaglandin should be approached with caution as it is associated with an increased risk of scar rupture. With careful selection and monitoring, VBAC can be considered in twin pregnancy. Learning objectives To be aware of the specific level of risk of common complications associated with VBAC (including scar rupture) to facilitate appropriate counselling of women. To become familiar with evidence‐based tools that can help predict the outcome of planned VBAC. To know the signs and symptoms indicating impending or acute scar rupture in order to be able to manage women undergoing VBAC safely in the intrapartum period. Ethical issues Should society be concerned about the trend towards normalising caesarean birth? To what degree should women be able to choose repeat caesarean section in the absence of a medical indication? Research confirms that the majority of women can safely achieve a vaginal delivery after one caesarean section. Should units with low rates of successful VBAC be expected to review and justify their outcomes? Please cite this article as: Ball E, Hinshaw K. The current management of vaginal birth after previous caesarean delivery. The Obstetrician & Gynaecologist 2007;9:77–82.