Impact of a specialised 'birth after caesarean section (BAC)' clinic

Abstract

Background Multiple caesarean sections (C/S) have an impact on maternal morbidity and are ‘resource hungry’. Previous audit data (April 2008–October 2009) in this unit had shown that 44% of elective C/S were performed for ‘maternal request’ after the woman had one previous C/S. Consequently a birth after caesarean (BAC) clinic was set up where the care of women was standardised. This is Consultant led with a specialised midwife and patient information leaflets. Aims To increase the percentage of women opting for Vaginal (V) BAC resulting in an increased percentage of successful VBAC's without increasing the overall complication rate from VBAC. To standardise an induction of labour (IOL) protocol for VBAC's to improve the success rate further. Standards The delivery register was reviewed for 6 months prior to the BAC clinic (November 2009–April 2010): 40% of women with one previous C/S aimed for VBAC with a 64% success rate. Results 93 women have delivered via the BAC clinic between May-December 2010. 73% opted for VBAC of which 68% were successful. 10 women chose IOL and 3 had emergency C/S. One woman had an incidental finding of scar dehiscence in spontaneous labour. Seven babies went to NICU – 6 after emergency C/S and 1 after SVD; 4 of these infants were preterm. Conclusions There was a significant improvement in the percentage of women opting for VBAC. There was a more modest improvement in VBAC success rates which we hope will be sustained as more data becomes available. We will continue monitoring complication rates.

Maternal and perinatal outcomes in women planning vaginal birth after caesarean (VBAC) at home in England: secondary analysis of the Birthplace national prospective cohort study

“…Trials of decision‐support aids for women choosing mode of birth after a prior CS have shown that these may help women to feel more sure about their birth choice, but have demonstrated varied impacts on rates of VBAC . Local small‐scale evaluations of specialist consultant‐led and midwife‐led (V)BAC clinics to support women's decision‐making have shown mixed results in terms of increasing the proportion of women who choose VBAC or have a successful VBAC . More research is required to establish whether specialist VBAC clinics are effective in supporting women to achieve a vaginal birth following a prior CS in a setting where there is easy access to obstetric, anaesthetic and advanced neonatal support if needed.…”