Background The national Caesarean Section (CS) rate in the UK is almost 25%, having increased by 5.7% in the last 10 years; primary CS is a significant contributory. There are two standard care pathways following primary CS; Vaginal Birth After Caesarean (VBAC) or Elective Repeat CS (ERCS). Currently 70.8% of women who have experienced a primary CS will choose ERCS despite evidence supporting VBAC.

Aim to identify if focused ante-natal counselling sessions impact upon pathway choice.

Method A pilot two-armed RCT was undertaken. Pregnant women who had experienced a primary lower segment CS in the previous pregnancy were recruited, consented, and electronically randomised. Participants in the intervention group attended two ante-natal counselling appointments with the research midwife; the control group followed the Trusts routine ante-natal pathway. Primary outcome was the woman's choice of VBAC versus ERCS. Postnatally both groups completed a questionnaire.

Results 49 invitations were posted to potential participants. 18 women responded and 12 agreed to be randomised. There were 8 participants in the intervention group and 4 in the control. Antenatally, 87.5% (n=7) from the intervention group chose VBAC, compared to 75% (n=3) in the control. However, as a result of intrapartum events and obstetric guidance only 50% in each group delivered by VBAC.

Conclusion Focused antenatal counselling sessions advocating VBAC may impact upon the pathway a woman chooses; they may also contribute by supporting her throughout the antenatal and intrapartum periods. However, the impact of intrapartum events and obstetric guidance affects a woman's capacity to deliver by VBAC.