Vaginal Birth After Cesarean Section (VBAC) Model using Fuzzy Analytic Hierarch Process

There is an even more pressing need to address the issue of vaginal birth after cesarean section (VBAC), as an increase of cesarean deliveries (CDs) has been noticed. This increase however was temporarily overturned during the period 1989-1996, when some researchers tried to manifest the advantages of trial of labor after cesarean (TOLAC). Increased VBACs though raised the issue of scar ruptures, causing fear to women and guiding them once again towards the choice of cesarean deliveries. The numbers of Cesarean Sections (CS) still increase, despite the initiatives promoted by the World Health Organization (WHO) to reduce the rates of CS.

This research aims to construct two fuzzy models, the Fuzzy vaginal birth after cesarean (VBAC) model and the fuzzy CS model in order to assess the medical profile of pregnant women and to suggest the most suitable type of delivery.

A preliminary set of factors that affect VBAC or CS was identified after a comprehensive literature review. The final set of factors was used to develop a questionnaire and collect data regarding the identified factors, through a series of semi structured interviews with 29 highly experienced obstetricians. The Fuzzy Analytic Hierarchy Process (FAHP) method is utilized to develop the fuzzy VBAC and the fuzzy CS multicriteria decision models.

A set of 36 factors in total are identified as important to consider when judging the most suitable type of delivery. Results show that a subset of 27 factors support the decision to adopt CS, with top 5 most significant to be: vaginal delivery is contraindicated, prior uterine rupture, uterine incision, extensive transfundal uterine surgery and desire for sterilization at the time of delivery. A subset of 9 factors positively affects the decision towards VBAC. The top 5 of the most important factors that positively affect the decisions to adopt VBAC are: Maternal request for VBAC, Mother's personal values/preferences, Previous bladder injury, Health care providers recommendations, Family obligations, and Prior VBAC after CS.

The proposed approach addresses the multi-dimensional nature of judging the most appropriate type of delivery. By utilizing fuzzy logic analysis obstetricians and midwives are allowed to express their expertise and their intuition in a sound methodological approach to assess cases of pregnant women and suggest a valid route of intrapartum care.