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Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success
H E Knight1, I Gurol-Urganci, J H van der Meulen
1Office for Research and Clinical Audit, Lindsay Stewart R&D Centre, Royal College of Obstetricians and Gynaecologists, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Objectives:
To investigate the demographic and obstetric factors associated with the uptake and success rate of vaginal birth after caesarean section (VBAC).
Design:
Cohort study using data from Hospital Episode Statistics.
Setting:
English National Health Service.
Population:
Women whose first birth resulted in a live singleton delivery by caesarean section between 1 April 2004 and 31 March 2011, and who had a second birth before 31 March 2012.
Methods:
Logistic regression to estimate adjusted odds ratios (OR).
Main Outcome Measures:
Attempted and successful VBAC.
Results:
Among the 143,970 women in the cohort, 75,086 (52.2%) attempted a VBAC for their second birth. Younger women, those of non-white ethnicity and those living in a more deprived area had higher rates of attempted VBAC. Overall, 47,602 women (63.4%) who attempted a VBAC had a successful vaginal birth. Younger women and women of white ethnicity had higher success rates. Black women had a particularly low success rate (OR, 0.54; 95% confidence interval [CI], 0.50-0.57). Women who had an emergency caesarean section in their first birth also had a lower VBAC success rate, particularly those with a history of failed induction of labour (OR, 0.59; 95% CI, 0.53-0.67).
Conclusion:
In this national cohort, just over one-half of women with a primary caesarean section who were eligible for a trial of labour attempted a VBAC for their second birth. Of these, almost two-thirds successfully achieved a vaginal delivery.
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