Birth after Caesarean Section: A Retrospective Audit of 10 Years of State-Wide Data

Rates of Caesarean Section (CS) have been increasing worldwide with varying rates of 5 percent in Sub-Saharan Africa to 43 percent in Latin America and the Caribbean 1. In Australia too rates have increased from 32 percent in 2011 to 38 percent in 20212. Attempts have been made to seek ways at slowing the rise in rates of CS but with little success 3. Women who have had a previous CS may elect to have a Elective Repeat CS (ERCS) or have an attempt at a Vaginal Birth (VBAC) in their subsequent pregnancy. A planned VBAC, considering the woman’s individual history and needs, is viewed as a safe option for many women with a single previous lower segment caesarean section 4. Studies have shown that a Trial of Labour (TOL) ending in a VBAC is most favourable for the mother, newborn, and the health service 5,6. Likelihood of success rates are reported to be between 60 and 80 percent 7. A recent meta-analysis 8 noted successful vaginal birth rates of 74.3 percent if labour was spontaneous and 60.7 percent if induced. Achieving successful VBAC has also been reported to be less expensive and more effective than undergoing an ERCS 9,10. There has recently been an international multi-centre trial that aims to increase the proportion of women having VBAC by increasing woman-centred care and facilitating women’s empowerment in their choice of birth in three countries – Germany, Ireland and Italy 1. An attempt at vaginal birth is also supported by various colleges across countries 4,7,12. One of the reasons for the preference of ERCS may be a concern of a failed trial at vaginal birth resulting in an emergency CS. In one study of 29 352 women who attempted a vaginal birth after CS compared to 169 377 women without previous CS, Odds Ratio (OR) for emergency CS was 3.65 (CI: 3.26-4.08) higher when compared to women without previous CS 13. The scibasejournals.org aim of this retrospective study however was to use a large dataset with a specific objective to report on the success and failure rate and to identify any specific predictors of a successful or an unsuccessful vaginal birth in women who are pregnant after one previous CS.