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Is vaginal birth after previous caesarean section (VBAC) becoming a thing of the past?
  1. A J W Kendrick,
  2. C Hicks,
  3. D Roberts
  1. Liverpool Women's NHS Foundation Trust, Liverpool, UK

Abstract

Background Vaginal birth after caesarean (VBAC) and promoting normal birth is on the Quality Agenda of most UK maternity units.

Aim To compare the rates of VBAC in women with one previous caesarean section (CS) at our unit with findings from audit outcomes recorded between 2000 and 2001.

Methods Retrospective audit of 4272 women from August 2002 to December 2008. Computerised hospital records provided delivery details.

Standards The standards were based on the 2001 audit findings and the National Sentinal Caesarean Section Audit. These included the rate of VBAC (previously 58%); the rate of successful VBAC (previously 81%); the rate of induction of labour (previously 26%) and vaginal delivery (previously 72%) in women with one previous CS.

Results The rate of VBAC was 41.5%; a nearly 20% decline since 2001. The overall rate of successful VBAC was 71%; 75% in spontaneous labourers. 25% of women were induced. 61% of them achieved a vaginal delivery. Overall the dehiscence rate was 1.5%.

Conclusion Many factors contribute to the reduction in VBAC rate as well as the likelihood of achieving a vaginal delivery if induced. It is interesting to note the reduction at a time when antenatal care moved to the more normality driven agenda outlined by NICE and the RCOG. The Quality Agenda needs to address the indications for induction and its lack of success in this group if VBAC is to remain a viable option for the future.

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