Hospital contribution to variation in rates of vaginal birth after cesarean

Triebwasser, Jourdan E.; Kamdar, Neil; Langen, Elizabeth S.; Moniz, Michelle H.; Basu, Tanima; Syrjamaki, John; Thomason, Alexandra C; Smith, Roger; Morgan, Daniel M.

doi:10.1038/s41372-019-0373-2

Cited by 22 publications

(25 citation statements)

References 18 publications

(34 reference statements)

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“…On the other hand, the mode of delivery in women with two previous CS is strongly associated with counseling of doctors. 22,25 This is the obvious consequence of the paucity of data in this field, so that obstetrical practice and counseling are mainly based on personal beliefs, rather than on solid evidence. The reluctance to offer a trial after two CS is likely to stem from concerns regarding scar rupture and medical-legal issues.…”

Section: Discussionmentioning

confidence: 99%

Vaginal Birth after Two Previous Cesarean Sections versus Elective Repeated Cesarean: A Retrospective Study

et al. 2020

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Objective Trial of labor after cesarean delivery (TOLAC) is a common practice worldwide but the evidence is still scant regarding this practice in women who underwent 2 previous cesareans. The purpose of this study is to retrospectively review our experience with vaginal birth after two previous cesarean sections (VBA2C), with specific attention to the indications for previous cesarean and to the women's motivation for attempting trial of labor. Study Design This was a retrospective cohort study conducted in a primary care hospital between January 2011 and December 2019. Inclusion criteria were: singleton pregnancies, absence of morphological abnormalities at ultrasonographic screening of the second trimester (or at any other stage of pregnancy), and two previous cesarean sections. Results The final analysis included 114 cases for maternal and neonatal outcomes. In total, 40.4% of women chose trial of labor after two cesarean delivery (TOLA2C group). TOLA2C was associated with a success rate of 76.1%, a higher gestational age at birth, and a shorter hospital stay, compared with elective repeated cesarean delivery group. There were no significant differences in the rate of Apgar scores at 5 minutes <7 between both groups. The percentage of successful TOLA2C in women with prior vaginal delivery was 92.8%. Factors related to failed TOLA2C included failure to progress (3/11, 27.3%), nonreassuring fetal heart rate (3/11, 27.3%), and no onset of spontaneous labor after premature rupture of membranes (5/11, 45.4%). In the group of TOLA2C, more than 70% accepted to travel more than 45 minutes to reach our hospital, with the aim to attempt VBA2C. Conclusion TOLA2C is a possible option for both mothers and neonates in selected cases. Adequate counseling about pros and cons of TOLA2C is mandatory. The woman's motivation represents a key element to determine the success of VBA2C. Key Points

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Section: Discussionmentioning

confidence: 99%

Vaginal Birth after Two Previous Cesarean Sections versus Elective Repeated Cesarean: A Retrospective Study

et al. 2020

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“…14,16 Although the safety of labor after cesarean has been well established, availability of labor after cesarean continues to be limited. [17][18][19] In the most recent 2013 Listening to Mothers survey, 46% of women interested in VBAC were unable to choose to labor after cesarean, and the most common reasons given were a health reason unrelated to their prior cesarean (45%), unwillingness of their caregiver (24%), or unwillingness of the hospital (15%). 20 These surveys indicate a need to more fully understand what facilitates or limits a woman's ability to access, choose, and collaboratively plan to labor aftercesarean with her health care provider in the United States.…”

Section: Introductionmentioning

confidence: 99%

Women's Perceptions of Barriers and Facilitators to Vaginal Birth After Cesarean in the United States: An Integrative Review

Ibrahim

Kennedy

Whittemore

2020

J Midwife Womens Health

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Introduction The purpose of this integrative review was to synthesize the literature on women's perceived barriers and facilitators to achieving a vaginal birth after cesarean. Methods A search of Scopus and PubMed databases and relevant citations from 2000 to 2018 was conducted to identify resources meeting inclusion criteria. Conclusion drawing and verification were completed using data displays, data analysis, and comparison. Results Sixteen resources met inclusion criteria. Factors identified by women with a history of cesarean that act as facilitators or barriers to achieving a vaginal birth after cesarean included (1) individual factors (knowledge, body, and psychological), (2) social factors (culture and social support), and (3) systemic factors (perinatal care provider, health system, and financial). Some factors related to barriers and facilitators reflected opposing aspects of the same phenomenon on a continuum. Discussion Enhancing facilitators identified by women, while addressing perceived barriers, may increase access to labor after cesarean for women in the United States. Increasing access to labor after cesarean may subsequently improve women's experiences of care and decrease the US cesarean rate, positively affecting individual health outcomes and overall health of childbearing women in the United States.

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“…They cautiously recommended TOLAC in these facilities, and sometimes recommended women deliver in hospitals with better access to timely emergency CS. This finding may partly explain the regional variation in repeat CS across Ontario, ranging from 69.8 to 88.2% [2], and why VBAC rates are higher in hospitals where emergency CS are readily available [74,75]. Interestingly, Munro and colleagues [37] found that providers in two rural British Columbia, Canada communities believed that they provided safe access to emergency CS even though surgical staff were not always on site.…”

Section: Discussionmentioning

confidence: 99%

“…In the United States, despite the evidence supporting the safety of TOLAC for eligible women [3,7,76], many hospitals and providers are unsupportive [22,64,[77][78][79][80]. Reasons given for non-support of TOLAC include unsupportive hospitals, public vs. private insurance, lack of obstetricians, obstetricians' preferences, and lack of anesthesiologists [22,77,80,81]. Additionally, provider liability is often identified as a reason for lack of TOLAC support [22].…”

Section: Discussionmentioning

confidence: 99%

“…Professional VBAC guidelines may also contribute to the lack of provider and hospital support for TOLAC. Triebwasser and colleagues [80] identified that the American College of Obstetricians and Gynecologists' (ACOG) VBAC guidelines [82] requiring 'immediate' availability of emergency CS was an important factor in some United States hospitals' refusal to allow TOLAC. The SOGC's new 2019 VBAC guidelines [21] recommends 'immediate' availability of CS, a change from previous wording, i.e., 'timely' access, which was often interpreted as within 30 min [9,48].…”

Section: Discussionmentioning

confidence: 99%

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Factors obstetricians, family physicians and midwives consider when counselling women about a trial of labour after caesarean and planned repeat caesarean: a qualitative descriptive study

Landy

Sword

Kathnelson

et al. 2020

BMC Pregnancy Childbirth

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Background: Repeat caesarean sections (CSs) are major contributors to the high rate of CS in Canada and globally. Women's decisions to have a planned repeat CS (PRCS) or a trial of labour after CS (TOLAC) are influenced by their maternity care providers. This study explored factors maternity care providers consider when counselling pregnant women with a previous CS, eligible for a TOLAC, about delivery method. Methods: A qualitative descriptive design was implemented. Semi-structured, one-to-one in-depth telephone interviews were conducted with 39 maternity care providers in Ontario, Canada. Participants were recruited at 2 maternity care conferences and with the use of snowball sampling. Interviews were audio recorded and transcribed verbatim. Data were uploaded into the data management software, NVIVO 10.0 and analyzed using qualitative content analysis. Results: Participants consisted of 12 obstetricians, 13 family physicians and 14 midwives. Emergent themes, reflecting the factors maternity care providers considered when counselling on mode of delivery, were organized under the categories clinical/patient factors, health system factors and provider preferences. Maternity care providers considered clinical/patient factors, including women's choice … with conditions, their assessment of women's chances of a successful TOLAC, their perception of women's risk tolerance, women's preferred delivery method, and their perception of women's beliefs and attitudes about childbirth. Additionally, providers considered health system factors which included colleague support for TOLAC and time needed to mount an emergency CS. Finally, provider factors emerged as considerations when counselling. They included provider preference for PRCS or TOLAC, provider scope of practice, financial incentives and convenience related to PRCS, past experiences with TOLAC and PRCS and providers' perspectives on risk of TOLAC. Conclusion: The findings highlight the multiplicity of factors maternity care providers consider when counselling women. Effectively addressing clinical, health care system and personal factors that influence counselling may help decrease nonmedically indicated PRCS.

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Hospital contribution to variation in rates of vaginal birth after cesarean

Cited by 22 publications

References 18 publications

Vaginal Birth after Two Previous Cesarean Sections versus Elective Repeated Cesarean: A Retrospective Study

Vaginal Birth after Two Previous Cesarean Sections versus Elective Repeated Cesarean: A Retrospective Study

Women's Perceptions of Barriers and Facilitators to Vaginal Birth After Cesarean in the United States: An Integrative Review

Factors obstetricians, family physicians and midwives consider when counselling women about a trial of labour after caesarean and planned repeat caesarean: a qualitative descriptive study

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