At the University of Technology, Sydney, researchers have embarked on a journey to uncover how both medical and non-clinical strategies can enhance the likelihood of a successful vaginal birth after a cesarean section (VBAC). From reviews published in the Journal of Advanced Nursing, multiple factors – both clinical and non-clinical – play crucial roles in influencing VBAC outcomes. Let's dive into these empowering insights together!

In evaluating 60 studies over 24 years with 700,000 women across 13 countries, several determinants affecting VBAC have been identified: private health insurance, cervical ripening agents, induction protocols, scoring systems, and hospital guidelines. Over the last two decades, cesarean delivery rates have markedly increased, notably among women with prior cesarean sections choosing the same route in subsequent pregnancies. While 33% of women in the UK experience VBAC, the rate stands at just below 17% in Australia. Encouragingly, a US study highlighted that 73% of women safely achieved vaginal delivery following a previous cesarean, showcasing the potential for success with VBAC.

Shifting our focus to non-clinical aspects, clinician attitudes have been shown to significantly impact the success and implementation of VBAC guidelines. Equipping women with comprehensive information about cesarean sections and VBAC empowers them to make informed choices. However, the evidence is inconclusive regarding the influence of private medical insurance on VBAC rates, suggesting areas for further exploration.

From a clinical standpoint, inducing VBAC with artificial rupture of membranes has proven less successful. The use of prostaglandins, oxytocin infusions, or their combination has also been linked to less favorable results. In contrast, spontaneous labor tends to yield higher VBAC success. Methods such as prostaglandin and Foley catheters for cervical ripening and labor induction showed lower success rates, while X-ray pelvimetry often led to reduced VBAC uptake and increased cesarean occurrences. Additionally, prediction scoring systems for VBAC success have been largely unhelpful, underscoring the need for a personalized and evidence-based approach.

The evidence resonates with global patterns, reflecting a significant number of women opting for cesarean deliveries. However, there exists variability in the perception and acceptance of VBAC, both among women and within the medical community. It is crucial to dispel the myth that subsequent births must mimic prior cesarean deliveries. Given the potential health implications of repeat cesareans for both mother and child, striving towards decreasing these numbers is paramount. Equipping mothers with more choices and fostering a safe environment for vaginal birth after a cesarean is not only possible but beneficial.

With these insights, I encourage you to engage in informed discussions with your healthcare provider, weigh your options, and feel empowered in your birthing journey. Whether you're considering VBAC or exploring other birthing methods, remember that the most important thing is that you feel confident, supported, and in control of your birthing experience. Let's work together to unlock the potential for safe and fulfilling deliveries.

Source: Journal of Advanced Nursing. Christine Catling-Paull, Rebecca Johnston, Clare Ryan, Maralyn J. Foureur, Caroline S. E. Homer. 27 July 2011.