Successful Vaginal Birth After Caesarean Section Research Articles

Frequency of uterine rupture after one successful vaginal birth after cesarean section (VBAC).

Objectives: To determine the frequency of uterine rupture after one successful vaginal birth after caesarean section. Study Design: Cross Sectional Study. Setting: Department of Obstetrics and Gynecology of Nishtar Hospital Multan. Period: From12-May-2017 to 11-May-2018. Material & Methods: Total number of 135 patients of 16-45 years with singleton pregnancies were admitted for 2nd Vagina Birth after cesarean Section at gestational age ≥ 28 weeks of gestation. Data in shape of parity, gestational age and BMI was taken. These patients were assessed for frequency of uterine rupture after one successful vaginal birth after caesarean section. Data was analyzed with statistical analysis program (SPSS version 21). Frequency and percentage was calculated for qualitative variables like parity and uterine rupture. Mean ± SD was calculated for quantitative variables like age, BMI and gestational age. Results: Mean age of patients was 29.88+5.34 years. Mean body mass index (BMI) of study patients was 25.17+4.88 kg/m2. Mean gestational age at the time of delivery was 39.01+2.54 weeks. Uterine rupture after vaginal birth occurred in 2 (1.48%) patients. There was no association of gestational age, parity and gestational age with the frequency of uterine rupture. Conclusion: Women with prior successful VBAC are at low risk of maternal and neonatal complications during subsequent trail of VBAC with lower risk of uterine rupture and perinatal complications.

Rates of vaginal birth after caesarean section: What chance do obese women have?

For women considering vaginal birth after caesarean section (VBAC), obesity has been associated with a lower rate of vaginal birth and a higher rate of uterine rupture. To enhance antenatal counselling, this study aimed to evaluate the success rates of morbidly obese women undergoing a trial of labour (TOL). A retrospective analysis was performed of women who birthed at our hospital who had previously had one caesarean section. Routinely collected data were reviewed for mode of birth for women who underwent a TOL. A number of maternal and neonatal outcomes were also gathered. The data were analysed according to those women with a body mass index (BMI) equal to or above 40, compared to those women with a BMI below 40. From 2011 to 2018, 2097 women gave birth at our hospital and had a caesarean section for a prior pregnancy. Of these women, 1234 (58.9%) had an elective caesarean section and 863 (41.1%) underwent a TOL. Of the women undertaking a TOL, 73.1% gave birth vaginally. Women with a BMI equal to or greater than 40 were less likely to have a successful VBAC compared to women with a BMI less than 40 (58.9% vs 74.1%, P=0.013). Only 50% of women with a BMI equal to or greater than 40 had a successful VBAC if they had not previously had a vaginal birth. Women with a BMI over 40 had lower rates of successful VBAC. Rates were even lower for those who had not had a prior vaginal birth.

Outcomes of Water Immersion During The Second Stage of Labor [11E

INTRODUCTION: Water immersion during labor and delivery has become popularized, resulting in questions regarding outcomes, safety, and efficacy. Our study analyzed neonatal and maternal outcomes of water immersion during the first and second stage of labor and delivery, and compared outcomes to land births as controls. METHODS: Retrospective cohort study of singleton, cephalic presentation term pregnancies between January 2013-March 2017. This study was IRB approved. Comparison groups included: labor and land birth, water immersion exposure, and all deliveries in the study period. Obstetrical and neonatal outcomes were reviewed and analyzed. Student t-test, Mann Whitney test, Test of Proportion and Chi square tests were utilized for analysis. Significance was set at P=<0.05. RESULTS: Vaginal delivery (P<.001) and vaginal birth after cesarean section (VBAC) (P<.001) rates were higher in the water immersion exposure group compared to land births. The cesarean (P<.001) and operative delivery (P<.001) rates were lower. The uterine rupture rate was not significant (P=.94) between water immersion exposure and land birth groups. NICU admission rates were not significantly different between the immersion exposure and land birth groups (P=.99). CONCLUSION: Water immersion has positive outcomes in terms of increased rates of vaginal delivery and successful VBAC, and decreased rates of cesarean section. Water immersion for the second stage of labor and delivery is similar, if not better, than land birth in terms of maternal outcomes. Neonatal outcomes after water immersion exposure were similar to land births.

Labour characteristics of women achieving successful vaginal birth after caesarean section in three European countries

ObjectiveKnowledge about labour characteristics of women achieving successful vaginal birth after caesarean section (VBAC) might be used to improve labour and birth management. This study examined sociodemographic and labour process-related factors regarding a) differences between countries, b) the comparison of successful VBAC with unplanned caesarean section, and c) predictors for the success of planned VBAC in three European countries. DesignWe analysed observational data collected within the OptiBIRTH trial, a cluster-randomised controlled trial. SettingFifteen study sites in Ireland, Italy and Germany, five in each country. Participants790 participants going into labour for planned VBAC. MeasurementsDescriptive statistics and random-effects logistic regression models were applied. FindingsThe pooled successful VBAC-rate was 74.6%. Italy had the highest proportion of women receiving none of the four intrapartum interventions amniotomy (ARM), oxytocin, epidural or opioids (42.5% vs Ireland: 26.8% and Germany: 25.3%, p < 0.001). Earlier performance of ARM was associated with successful VBAC (3.50 hrs vs 6.08 hrs, p = 0.004). A positive predictor for successful vaginal birth was a previous vaginal birth (OR=3.73, 95% CI [2.17, 6.44], p < 0.001). The effect of ARM increased with longer labour duration (OR for interaction term=1.06, 95% CI [1.004, 1.12], p = 0.035). Higher infant birthweight (OR per kg=0.34, 95% CI [0.23, 0.50], p < 0.001), ARM (reference spontaneous rupture of membranes (SROM), OR=0.20, 95% CI [0.11, 0.37], p < 0.001) and a longer labour duration (OR per hour=0.93, 95% CI [0.90, 0.97], p < 0.001) decreased the odds of a vaginal birth. Key conclusionWomen with a previous vaginal birth, an infant with a lower birth weight, SROM and a shorter labour duration were most likely to have a successful vaginal birth. If SROM did not occur, an earlier ARM increased the odds of a vaginal birth. Implication for practiceLabour progress should be accelerated by fostering endogenous uterine contractions. With slow labour progress and intact membranes, ARM might increase the chance of a vaginal birth.

Obstetric outcome of induction of labor using prostaglandin gel in patients with previous one cesarean section.

ObjectiveAfter globally acceptance of planned vaginal birth after cesarean section (VBAC), the mode of induction is still a matter of debate and requires further discussion. We aimed to study obstetric outcomes in post-cesarean patients undergoing induction of labor with prostaglandin gel compared with patients who developed spontaneous labor pains.MethodsAll patients at 34 weeks or more of gestation with previous one cesarean section eligible for trial of labor after cesarean section admitted in a labor room within one year were divided in 2 groups. Group one consisted of patients who experienced the spontaneous onset of labor pains and group 2 consisted of patients who underwent induction of labor with prostaglandin gel. They were analyzed for maternofetal outcomes. Descriptive statistics, independent sample t-test, and chi-square test were applied using SPSS 20 software for statistical analysis.ResultsBoth groups were comparable in maternal age, parity, and fetal weight, but different in bishop score, mode of delivery, and neonatal outcome. Admisson bishop score was 6.61±2.51 in group 1 and 3.15±1.27 in group 2 (P<0.005). In the patients who experienced spontaneous labor, 86.82% had successful VBAC. In the patients with induced labor, 64.34% had successful VBAC with an average dose of gel of 1.65±0.75. Both groups had one case each of uterine rupture. The neonatal intensive care unit admission rate was 4.1% in group one and 10.4% in group 2.ConclusionThis study reflects that supervised labor induction with prostaglandin gel in previous one cesarean section patients is a safe and effective option.

VBAC: antenatal predictors of success.

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)

Single prior caesarean section and risk of anal sphincter injury.

Injury to the anal sphincter at vaginal delivery remains the leading cause of faecal incontinence in women. Previous studies reported an increased incidence of obstetric anal sphincter injury (OASI) in women attempting vaginal birth after caesarean section (VBAC). The aim of the paper was to establish whether women in their second pregnancy, with one previous uterine scar, are at a higher risk of OASI compared with nulliparous women. All primiparous and secundiparous women with a previous caesarean section who delivered from 2008 to 2017 were analysed in a single-centre retrospective study. The primary endpoint was OASI. Labour characteristics in both groups were compared, and a multiple regression model was created. There were 8573 vaginal deliveries of nulliparous women and 3453 deliveries of women in their second pregnancy with a previous caesarean section, of whom 550 had a successful VBAC. There was no significant difference in the rate of OASI between primiparous women and those who had a successful VBAC: 3.5% (297/8573) versus 3.1% (17/550), P = 0.730). Foetal macrosomia (>4kg) and forceps delivery were risk factors for sphincter injury, while episiotomy and epidural anaesthesia were protective. VBAC does not confer an increased risk of OASI after a first delivery by caesarean section when compared with nulliparous women. The rate of successful VBAC may be contributory and suggests that the risk conferred by VBAC may be unit-specific. Unit and national-level audit is necessary to investigate this risk further.

Factors Associated with Success Rate of Vaginal Birth After Single Caesarean Section in Khartoum Maternity Hospital

Objectives- To determine success rate of VBAC (Vaginal birth after cesarean section) with reference to prognostic factors to predict successful VBAC in Khartoum Maternity Hospital- Sudan Methodology- It was descriptive, cross sectional and hospital based study conducted in a period of one year, involving 342 pregnant women with one previous C/S who were admitted in the labor room as emergency cases, were evaluated thoroughly, data collected through designed questionnaire include:- Socio-demographic characters, antenatal clinic follow up, previous C/S, variables affect success of VBAC and outcome of current pregnancy.

Mechanical induction of labor and ecbolic-less vaginal birth after cesarean section: A cohort study

ObjectiveDuring delivery counseling, some women with previous uncomplicated cesarean section (CS) wish mechanical induction of labor (IOL) but they are not accepting the added risk of using ecbolics to induce and/or augment labor. The objective of the study was to assess the safety and efficacy of the isolated use of transcervical Foley's catheter balloon as a mean of mechanical cervical ripening (CR)/IOL and successful ecbolic-less vaginal birth after cesarean section (VBAC). Materials and methodsA cohort study was conducted in two tertiary care maternity hospitals between October 2013 and July 2016 and recruited women with singleton pregnancy and cephalic presentation who had previous one uncomplicated CS and were scheduled for mechanical CR/IOL at term for routine obstetric indications. No ecbolics were used for induction or augmentation of labor as per patients' request. The primary outcome variable was the rate of successful VBAC. Results108 Women had a completed trial of mechanical CR/IOL without ecbolics till delivery. Active labor started in 94 women (87%), however only 43 women (39.8%) had successful VBAC. No woman in the study cohort had uterine rupture, scar dehiscence, uterine tachysystole, postpartum hemorrhage and/or puerperal sepsis. No cases were admitted to intensive care units and there were no maternal mortalities. Prior successful VBAC and post-expulsion BS were the only independent predictors for successful VBAC and shorter duration of labor after balloon expulsion. ConclusionMechanical IOL with the mere use of transcervical Foley's catheter is a safe and effective method of VBAC in women refusing use of ecbolics.

VBAC: Changes over Last 10 Years.

Vaginal birth after caesarean section (VBAC) has been historically studied to be a standard and a safe procedure with good successful results. This study was conducted to determine changes in pattern of VBAC by the same author over a period of 10years. Data for 1year between 2005-2006 and 2014-2015 were compared, and successful VBAC was found to be 74.46% in 2005-2006 period compared to only 34.42% in 2014-2015. Neonatal mortality and maternal morbidity were, however, much higher 10years ago. It was concluded that better diagnostic techniques, awareness of patients and medico legal fear have led to safer health of mother and child and lesser incidence of VBAC over the last 10years.

Outcome of the vaginal birth after cesarean section during the second birth order in West Kazakhstan.

Background:Vaginal birth after cesarean section (VBAC) increases the chance of subsequent vaginal deliveries and reduces the repeat cesarean section (CS) rate with subsequent postoperative morbidity.Objectives:To detect the outcome of VBAC during the second birth order in Aktobe region of West Kazakhstan.Patients and Methods:A total of 832 women eligible for trial of VBAC were included in this study. Women who signed the consent of VBAC were evaluated thoroughly and data such as maternal age, body mass index, height, gestational age at admission, indication of the previous CS, estimated fetal weight, engagement of the fetal head, condition of the membranes, and cervical dilatation were collected. Data collected after delivery include duration from active phase of labor, mode of delivery, fetal, and neonatal outcomes. The collected data analyzed to detect the outcome of trial of VBAC during the second birth order in Aktobe region of West Kazakhstan.Results:Logistic analysis and odds ratio (OR) showed that body mass index (BMI) ≤25 kg/m2 (OR 1.7; P = 0.0004), height ≥150 cm (OR 1.7; P = 0.002), gestational age ≤40 weeks (OR 2.3; P = 0.0001), and inter-delivery interval ≥2 years (OR 1.6; P = 0.008) were significantly associated with successful VBAC. In addition, <2/5 of the fetal head palpable abdominally, station <−2 (OR 1.7; P = 0.0009), cervical dilatation ≥4 cm (OR 1.7; P = 0.003), and duration of active phase of labor ≤7 h (OR 1.6; P = 0.01) were significantly associated with successful VBAC.Conclusion:VBAC is safe in properly selected cases. BMI ≤25 kg/m2, gestational age ≤40 weeks, inter-delivery interval ≥2 years, and fetal head <−2 station increase the success of VBAC. Prolonged active phase of labor >7 h and the need for labor augmentation decrease the chance of VBAC success.

Antenatal scoring system in predicting the success of planned vaginal birth following one previous caesarean section

This was a prospective observational study to determine the predictive factors for a successful vaginal birth after caesarean section (VBAC) and to develop a relevant antenatal scoring system. Patients with one previous caesarean section were included in this study. All data including maternal demographics, obstetric history, pregnancy progress and outcomes were collected and analysed. A total of 142 out of the 186 women (76.3%) had successful VBAC. History of previous vaginal delivery and non-recurrent indications for previous caesarean section were the significant predictive factors for a successful VBAC. Five variables for our scoring tool were selected. By using a proposed mean score of 4 out of 7, the scoring system had a sensitivity of 81.0%, specificity of 52.3% and a positive predictive value of 84.6%. VBAC antenatal scoring system was potentially a useful predictive tool in antenatal counselling.Impact statementWhat is already known on this subject: Planned vaginal birth after caesarean section (VBAC) is an important strategy to limit the overall caesarean section rate, which is related to maternal morbidities. However, trial of vaginal delivery does involve potential complications including scar dehiscence, postpartum haemorrhage and emergency hysterectomy.What the results of this study add: Clinical predictors of a successful VBAC include non-recurrent indications for the previous caesarean section, previous vaginal delivery, spontaneous onset of labour and birthweight less than 4kg. There were multiple screening tools developed to predict the likelihood of successful VBAC. These scoring systems involved various variables such as age, ethnicity, Bishop’s score and previous caesarean indication. We had prospectively developed an antenatal scoring system based on five variables. Our result showed that patient with a score of four and above will have around 85% chance of successful VBAC.What the implications are of these findings for clinical practice and/or further research: We have also found that, estimated foetal weight based on ultrasound scan is a potential predictor for successful VBAC. This simple scoring method will be useful in-patient counselling regarding mode of delivery after one previous caesarean section. A multicentre study involving large cohort of patients is ideal to validate our scoring system.

Vaginal birth after cesarean section—The world trend and local experience in Taiwan

ObjectiveThe trend of increasing cesarean section rates had evoked worldwide attention. Many approaches were introduced to diminish cesarean section rates. Vaginal birth after cesarean section (VBAC) is a route of delivery with diverse agreements. In this study, we try to reveal the world trend in VBAC and our experience of a 10-year period in a medical center in northern Taiwan. Materials and methodsThis is a retrospective study of all women who underwent elective repeat cesarean delivery or trial of labor after cesarean (TOLAC) following primary cesarean delivery by a general obstetrician–gynecologist in the Tamshui Branch of MacKay Memorial Hospital (Taipei, Taiwan) between 2006 and 2015. We excluded cases of preterm labor, two or more cesarean deliveries, and major maternal diseases. We compared the characteristics and outcomes between these groups. ResultsWe included 400 women with subsequent pregnancies who underwent elective repeat cesarean delivery or TOLAC during the study period. Among the study population, 112 women were excluded and 11 underwent repeat VBAC. A total of 204 (73.65%) cases underwent elective repeat cesarean delivery and 73 (26.35%) chose TOLAC. The rate of successful VBAC among the women who chose TOLAC was 84.93%. ConclusionWith respect to maternal and fetal safety, and success rates and adverse effects of VBAC, the results of this study are promising and compatible with the global data. It shows that a trial of VBAC can be offered to pregnant women without contraindications with high success rates.

An audit on the outcome of vaginal Birth after Caesarean Section (VBAC) in a Sri Lankan tertiary care setting and factors associated with failure

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.

VAGINAL BIRTH AFTER PREVIOUS ONE CAESAREAN SECTION IN A PRIVATE TEACHING HOSPSITAL

Objectives: The objective of the study was to assess the factors indicating success in vaginal delivery after previous one C-Section.&#x0D; Material and Methods: The study was carried out to assess the factors indicating successful VBAC ( vaginal birth after caesarean section). Over a period of two years from Jan 2011 to Dec 2012 at the department of Obstetrics and Gynecology Al-khidmat Teaching Mansoorah Hospital, Lahore affiliated with University College of Medicine and Dentistry&#x0D; Results: The frequency of normal vaginal delivery after previous 1 C-Section was 47.29% while 52.7% had repeat CSection. The only statistically significant factor which could favor successful vaginal delivery was history of previous vaginal delivery prior to previous C-Section. Patients who had previous C-section for bad obstetrical history were delivered by repeat caesarean section. Majority of the patients included in the study group were booked belonged to educated middle class families having awareness of the complications that may occur during trial of labor. Provision of adequate antenatal health care services, timely identification of high risk cases, use of electronic fetal monitoring, involvement of senior , skilled and experienced personnel in the management of obstetrical emergencies are responsible for successful trial of Labor i.e. almost 50% patients delivered vaginally after previous I C-Section. Thus in order to increase the rate of NVD frequency of trial of labor must be increased with the goal of vaginal delivery but without compromising maternal and fetal health.&#x0D; Conclusion: Almost 50% of the patients with previous one C-Section can be delivered normally especially if they had delivered vaginally previously. The decision of VBAC is complex and ultimately resides with the women and her Obstetrician after counseling the patient regarding all the risk - benefit profile.

Improving VBAC rates: the combined impact of two management strategies.

Caesarean section rates in Australia have risen to >30%, with repeat caesarean delivery the most common indication. One method of reducing caesarean delivery rates is to increase rates of vaginal birth after caesarean section (VBAC). To determine the combined effect of two management strategies on the rates of successful VBAC in women experiencing their first pregnancy following primary caesarean section. Prospective cohort study from May 2009 to October 2010 at a metropolitan Australian teaching hospital. The strategies studied were (i) allocating responsibility for VBAC candidates attempting labour to the hospital's three high-risk obstetric consultants and (ii) implementing a next birth after caesarean (NBAC) antenatal clinic designed to counsel and support women deciding on mode of birth for their next pregnancy after a primary caesarean section. Data were collected from Obstetrix, a NBAC logbook and medical records of 396 eligible women who gave birth during the study period. Overall VBAC rates improved from 17.2% in 2006 prior to implementation of the combined strategies, to 27.0% over the studied period (P<0.001). Of those women who desired and attempted a VBAC, the success rate was 64.4%. Regression analysis identified an increased likelihood of attempted vaginal birth where malpresentation was the indication for previous caesarean, while Eastern Asian ethnicity was associated with increased likelihood of choosing repeat caesarean. A dedicated NBAC clinic and more consistent approach to labour management can help improve VBAC rates. Further targeted counselling towards women with previous malpresentation and/or East Asian descent may further improve VBAC attempt rates.

6.6 Vaginal Birth after Caesarean Section (VBAC) Predictor Models: which is the best model and can it save money?

ObjectiveTo assess the performance of three different statistical models in predicting successful VBAC. The statistically most reliable model was subsequently subjected to validation testing in a local antenatal population and...

Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success

To investigate the demographic and obstetric factors associated with the uptake and success rate of vaginal birth after caesarean section (VBAC). Cohort study using data from Hospital Episode Statistics. English National Health Service. Women whose first birth resulted in a live singleton delivery by caesarean section between 1 April 2004 and 31 March 2011, and who had a second birth before 31 March 2012. Logistic regression to estimate adjusted odds ratios (OR). Attempted and successful VBAC. Among the 143,970 women in the cohort, 75,086 (52.2%) attempted a VBAC for their second birth. Younger women, those of non-white ethnicity and those living in a more deprived area had higher rates of attempted VBAC. Overall, 47,602 women (63.4%) who attempted a VBAC had a successful vaginal birth. Younger women and women of white ethnicity had higher success rates. Black women had a particularly low success rate (OR, 0.54; 95% confidence interval [CI], 0.50-0.57). Women who had an emergency caesarean section in their first birth also had a lower VBAC success rate, particularly those with a history of failed induction of labour (OR, 0.59; 95% CI, 0.53-0.67). In this national cohort, just over one-half of women with a primary caesarean section who were eligible for a trial of labour attempted a VBAC for their second birth. Of these, almost two-thirds successfully achieved a vaginal delivery.

Vaginal birth after caesarean section (VBAC) in women with spontaneous labour: Predictors of success

We evaluated the predictors of VBAC success in Jordanian women with a single previous low transverse caesarean section of a gestational age of at least 28 weeks, followed by a trial of spontaneous labour at two tertiary hospitals between January 2008 and February 2010. Among 207 women, 117 (57%) women achieved a successful VBAC. Multivariate analysis showed that a cervical dilatation of ≥ 7 cm at the time of previous caesarean section was an independent predictor of successful VBAC (with a success rate of 80%). Parity of ≥ 2 was significantly associated with increased odds of success (OR = 2.7, 95% CI: 1.2, 6.2). Compared with women who had no previous VBAC, those with previous VBAC had higher odds of success (OR = 3.8 (95% CI: 1.5, 9.5). We concluded that women with a previous caesarean section who achieved a cervical dilatation of ≥ 7 cm before caesarean, had a previous history of successful VBAC and had parity of ≥ 2, have the greatest likelihood of successful VBAC.

The use of water during the first stage of labour: Is this a safe choice for women undergoing VBAC?

The caesarean section rate is greatly influenced by the amount of elective repeat caesarean sections. By promoting successful vaginal birth after caesarean section (VBAC), the caesarean section rate could be reduced. Clinicians supporting VBAC labour are concerned about the risk of uterine scar rupture; therefore, continuous fetal monitoring is recommended ( Royal College of Obstetricians and Gynaecologists (RCOG), 2007 ). As a result, these women are not recommended to use water for pain relief in labour. Yet, with the support of confident midwives some women have had successful VBACs while labouring in water. The evidence suggests that both labouring in water and undergoing VBAC are both beneficial to women. With a competent confident midwife, the use of water in labour could promote VBAC success rates and reduce intervention. This could improve the experience for both women and midwives, and improve future health for women and babies. In conclusion, the use of water in labour could be a safe choice for women who wish to undergo VBAC.