Trial of labor or repeated cesarean section. The woman's choice

Roberts, Richard G.; Bell, Hannah; Wall, Erika; Moy, Julie Graves; Hess, G.; Bower, Hannah

doi:10.1001/archfami.6.2.120

Cited by 20 publications

(14 citation statements)

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“…This is the major morbidity resulting from a TOL that is of concern to physicians. The uterine rupture rate in women who laboured of 0.20%[95% CI 0.04, 0.60] was lower than, but not significantly different from, the 0.45%[95% CI 0.39, 0.56] quoted in a recent summary of data from observational studies 1 . In addition, the two‐thirds of the study population that did not labour did not have a uterine rupture.…”

Section: Discussionmentioning

confidence: 66%

“…Our study population differs from the above reports because it includes only women who had a Caesarean section in their penultimate delivery and excludes those who had a vaginal delivery. Some of these excluded women would have had a Caesarean delivery in an earlier pregnancy, and such women are known from other studies to be more likely to attempt a TOL and have a vaginal delivery at the following birth than women who had a Caesarean section at the penultimate birth 1 . 14 Exclusion of these women who have had a vaginal birth in the intervening pregnancy has contributed to our lower percentage of women undergoing a VBAC.…”

Section: Discussionmentioning

confidence: 99%

“…Some of these excluded women would have had a Caesarean delivery in an earlier pregnancy, and such women are known from other studies to be more likely to attempt a TOL and have a vaginal delivery at the following birth than women who had a Caesarean section at the penultimate birth. 1,14 Exclusion of these women who have had a vaginal birth in the intervening pregnancy has contributed to our lower percentage of women undergoing a VBAC. All things considered, however, the women with higher parity in our study were less likely to undergo a TOL (23% compared with 37%) or a VBAC (11% compared with 21%).…”

Section: Delivery Outcomesmentioning

confidence: 99%

“…Two influential factors are the risk of uterine rupture and the fear that in choosing to undergo labour (often referred to as a trial of labour or TOL), there is a chance that the woman will ultimately have to undergo a Caesarean anyway. Although two‐thirds of women in their third trimester are reported to prefer a TOL over a repeat Caesarean, a perception of a low chance of vaginal delivery increases the proportion opting for a repeat Caesarean 1 …”

Section: Introductionmentioning

confidence: 99%

“…Although twothirds of women in their third trimester are reported to prefer a TOL over a repeat Caesarean, a perception of a low chance of vaginal delivery increases the proportion opting for a repeat Caesarean. 1 The current proportion of women undergoing TOL, experiencing a vaginal birth after a previous Caesar-ean (VBAC) and, having undergone labour, actually having a vaginal birth (VBAC/TOL) may be known at an individual hospital level but is not readily available at an Australian state or national level. Method of delivery is not collected on birth certificates; thus, information on current or previous Caesareans is not available from that data source.…”

Section: Introductionmentioning

confidence: 99%

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Vaginal births after Caesarean (VBAC): a population study

Stone

Halliday

Lumley

et al. 2000

Paediatric Perinatal Epid

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This paper describes delivery outcomes for women from Victoria, Australia, who gave birth in 1995 and whose immediately previous (penultimate) delivery, within a 5-year search period, was a Caesarean section. Because of the large numbers of records involved, dedicated computer software for record linkage was used to identify the previous delivery and link it with the woman's current birth in 1995. Overall, 79% of the records from multiparous women were linked successfully. Approximately 15% were not linked because the previous birth was before the search period or was an abortion that would not have been reported to the Perinatal Data Collection Unit. Reasons for not being able to link the last 6% of the records include the previous pregnancy being overseas or interstate. Women who had a vaginal birth as the penultimate birth or a multiple birth at either event were excluded, resulting in a study population of 4663 linked records. More women (68%) had a repeat Caesarean than went into labour and, of the remaining women who laboured, 56% delivered vaginally. Overall, 18% of the women delivered vaginally. For the women who went into labour, the reported number experiencing a uterine rupture was two per 1000 births. Uterine rupture was not reported in the two-thirds who did not labour but had a repeat Caesarean. A review of the perinatal deaths identified only two deaths, one baby being born by elective Caesarean and one by a vaginal birth after a previous Caesarean (VBAC) where the choice of delivery methods may have contributed to the death. This large study is one of the few in the literature to provide population-based information on vaginal births after a previous Caesarean and related outcomes.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Delivery Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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