Next birth after caesarean - Why are women not choosing to trial labour?

Vaginal birth after Caesarean section (VBAC) is a safe and appropriate choice for the majority of women after a previous lower segment caesarean section (LSCS) (1,2). The overall reported VBAC success rates are 72-75%. However, despite the safety and high success rates, VBAC rates in Ireland remain low, with rates of 18.9% and 20.7% in 2019 and 2020 respectively (3).

This was a retrospective, cross-sectional study of all eligible women attending a regional obstetric unit in Ireland between January and December 2022. Data was accessed via accessed through the Hospital In-Patient Enquiry (HIPE) system.

210 women were identified from the 12 month period. At booking, over half of these women, 112 (53 %) chose to have a planned, repeat LSCS. Of those who choose a VBAC (n = 98) only 41.8 % had a trial of labour after caesarean. In total, this gives a total of 169 or 80 % of women who chose to have a repeat caesarean.

While VBAC success rates are high, our study shows that the majority of women in our unit did not wish to attempt a VBAC. This data is important, because as the rate of primary LSCS increases internationally, so too will rates of repeat caesareans. Women's concerns and barriers to choosing VBAC should be explored in order to reduce morbidity associated with repeat LSCS.