Prevalence Trends and Factors Associated with Vaginal Birth after Cesarean Section Among Women with One Previous Scar Delivered at Kilimanjaro Christian Medical Centre, Northern Tanzania, 2020-2023

Background: As cesarean section rates continue to surpass the WHO’s recommendations, the understanding of vaginal birth after cesarean section (VBAC) should be a worldwide health priority to decrease maternal mortality and morbidity. VBAC’s success rate ranges from 47% to 88% worldwide. However, it remains underutilised due to certain concerns, including the risk of uterine rupture. While the global VBAC evidence base is well established, its applicability to Sub-Saharan Africa remains limited, creating a significant research gap, particularly in Tanzania, where context-specific studies are critically lacking. Objective: To determine the prevalence, trends, and factors associated with VBAC among women with one previous scar delivered at Kilimanjaro Christian Medical Centre, Northern Tanzania, between the years 2020-2023. Methods: A facility-based analytical cross-sectional study was conducted at KCMC in Northern Tanzania. Medical records of all women with a history of one previous scar and above 28 weeks of gestation who delivered at KCMC during the study period were included. The data collected was anonymised, computerised and then analysed by SPSS and STATA. A bivariate analysis (chi-square) was used, followed by a multivariate analysis to adjust for confounders. All statistical tests were considered significant when the p-value is less than 0.05. Results: The overall VBAC prevalence was 14.8%, with annual fluctuations. Higher parity [aOR(95%CI) = 2.71 (1.75–4.19)], induced labour [aOR(95% CI) = 2.11 (1.21–6.06)], and history of prior vaginal delivery [aOR(05%CI)= 6.82 (1.37–14.23)] were significantly associated with an increased VBAC likelihood. Post-term gestation was associated with reduced odds [aOR(95%CI)= 0.09 (0.02-0.59)]. Conclusion: Despite its benefits, VBAC remains underutilised in Tanzania. Key predictors included a history of prior vaginal delivery and induced labour, thus highlighting the critical role of careful patient selection. The implementation of standardised clinical guidelines and good antenatal counselling is therefore essential to safely increase VBAC rates.