Introduction The Midwife Led VBAC clinic was established in Blackpool Victoria Hospital in 2008 as part of the Caesarean Section toolkit developed by NHS Institute in response to a rising caesarean section rate. Following its implementation the caesarean rate reduced from 28% to 22%. Since its introduction, its effectiveness has not been reviewed. As part of a 360 degree review of caesarean sections within the trust the outcomes of the clinic have been reviewed.
Method A retrospective review of 100 women who attended the midwife led VBAC clinic. Data collected included the desired mode of delivery and the actual mode delivery.
Results At the initial visit, 22% were undecided about mode of delivery, 59% desired a VBAC and 19% asked for planned elective repeat Caesarean section. The actual delivery mode was 33% successful VBAC, 26% emergency caesarean section and 41% planned repeat section. Of those who planned a VBAC, 50% achieved a vaginal birth, 25% had an emergency section and 25% a planned section. Of those women who were undecided 9% had a successful VBAC and 54% had a planned section.
Conclusion There is a definite discrepancy between those planning a VBAC compared to those who undertake it. Whilst our results do not implicate the midwife led VBAC clinic as being ineffective, they highlight the need for a holistic approach to management of caesarean section and subsequent deliveries. This includes ‘getting it right first time’, an immediate debrief and 6 week follow-up and consultant led management plan in subsequent pregnancies.
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