Cesarean Delivery and Vaginal Birth After Cesarean Delivery Rates in a First Nations Community-Based Obstetrical...

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Public Health

Background:

• Rural obstetrical practices face unique challenges, including higher prevalence of risk factors like substance use and diabetes.
• Cesarean delivery (CD) rates vary significantly, and vaginal birth after cesarean delivery (VBAC) is a key consideration for maternal health.
• Understanding VBAC rates and patient profiles in diverse settings is crucial for optimizing obstetric care.

Purpose of the Study:

• To compare cesarean delivery (CD) and vaginal birth after cesarean delivery (VBAC) rates in a rural community practice against provincial and comparable data.
• To analyze the patient profile of women undergoing VBAC at the Sioux Lookout Meno Ya Win Health Centre (SLMHC).
• To evaluate the safety and feasibility of VBAC in a rural setting with specific demographic and clinical characteristics.

Main Methods:

• Retrospective analysis of data from 2012-2017 at SLMHC, compared with 30 similar hospitals and provincial data.
• Inclusion of maternal demographics, comorbidities, CD, VBAC, neonatal birth weight, and Apgar scores.
• Specific comparison of SLMHC VBAC patients with the general SLMHC obstetrical population.

Main Results:

• SLMHC had lower CD rates (25% vs. 28%) and significantly higher VBAC rates (31% vs. 16%) than comparable programs.
• The SLMHC population exhibited higher rates of alcohol, tobacco, opioid use, and diabetes.
• VBAC patients were older and of higher parity; their neonates had similar Apgar scores but lower birth weights and macrosomia rates.

Conclusions:

• Despite prevalent risk factors, SLMHC achieved lower CD and higher VBAC rates than anticipated.
• This study demonstrates that VBAC can be safely performed in well-screened and monitored patients in a rural setting.
• The findings support the successful implementation of VBAC programs in community-based rural obstetrical practices with emergency CD capacity.