Vaginal Birth after Caesarean section – Acceptability and outcome in an East London University Hospital
Barts Health NHS Trust - Whipps Cross University Hospital – Whipps Cross Road, Leytonstone, London E11 1NR
Objectives
Women’s choice of a vaginal
birth after caesarean section
(VBAC) will help reduce the
increasing lower segment
caesarean section (LSCS) rates.
Counselling for VBAC is
important and a dedicated clinic
was set up to address this. The
objective of this audit was to
determine the acceptability and
outcome of VBAC in our setting.
Methods
200 consecutive women over a
4-month period (July to
November 2011) with previous
LSCS were identified and the
outcomes of their pregnancies
were obtained by using the birth
register.
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Results
The age range was 16-47
(average 32.6) years. Parity
ranged from 1-8. 118 women
were Para 1, 45 were Para 2, 26
were Para 3 while 11 women
were Para 4 or above. 116
women had one previous LSCS
with five women having a
previous vaginal birth. In this
group, 66 (60%) women
accepted a VBAC with 38 (58%)
women achieving it. VBAC was
achieved in all women with
previous vaginal birth. 12 women
(10%) had labour induced – only
2 had a successful VBAC. 31
women had 2 previous LSCS, of
which 7 women had a previous
vaginal birth. Six women (19%)
opted for a VBAC with only one
woman (17%) achieving it.
It was surprising that all 7
women with a previous vaginal
delivery declined VBAC. Uterine
rupture was seen in two women
but with normal maternal and
fetal outcomes. 18 women (9%)
had postpartum haemorrhage.
Surprisingly 45% were in women
with a normal vaginal delivery.
Five babies (four for abnormal
cord pH) were admitted to
SCBU. There were 20 babies
with a birth weight over 4 Kg.
The VBAC success rate in this
group was 80%.
Conclusions
A 58% success rate is far less
than the 72-76% RCOG quoted
figure but did not account for
factors such as high BMI and
previous LSCS for dystocia which
can reduce this figure to 40%.
Our counselling involves quoting
an increased incidence of
haemorrhage for LSCS but this
was not borne out by our results.
We also did not see a higher
failure rate with a birth weight
greater than 4Kg. This may be
explained by regional and unit
variations. Women with previous
vaginal births did better (in line
with current figures) but again
there were high numbers that
declined VBAC. We now wish to
study reasons for women
declining VBAC in an attempt to
evaluate if we can improve our
uptake rates of 60%.
References
Birth After Previous Caesarean Birth. Green-top guideline No. 45
Feb. 2007. Royal College of Obstetrician and Gynaecologiists.