FIGO good practice recommendations for vaginal birth after cesarean section

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine

Background:

• Global cesarean section (CS) rates are increasing.
• Vaginal birth after cesarean (VBAC) is a viable alternative to repeat CS.
• FIGO provides evidence-based guidelines for VBAC care.

Purpose of the Study:

• To review the safety and effectiveness of VBAC.
• To outline best practices for VBAC implementation.
• To inform patient selection and counseling for VBAC.

Main Methods:

• Review of existing literature and guidelines.
• Analysis of VBAC success rates and risk factors.
• Comparison of maternal and neonatal outcomes for VBAC versus repeat CS.

Main Results:

• VBAC success rates range from 60% to 80%.
• Key factors for success include prior vaginal birth, non-recurrent CS indications, longer interbirth intervals, lower BMI, and spontaneous labor.
• Uterine rupture risk is low (0.3%-0.7%) after one low transverse CS.
• VBAC offers similar or better maternal/neonatal outcomes than planned repeat CS, including reduced mortality and shorter hospital stays.

Conclusions:

• VBAC is a safe and effective option for appropriately selected women.
• Proper patient counseling, facility preparedness, and continuous fetal monitoring are crucial for VBAC success.
• Implementing VBAC can reduce unnecessary repeat CS and improve maternal and neonatal health outcomes.