Researchers from the University of Technology, Sydney were eager to find out if medical as well as non-clinical interventions can increase the success rate of vaginal births after cesarean sections (VBAC). Based on reviews posted in the August copy of Journal of Advanced Nursing, there are several factors, clinical and non-clinical, that influence VBAC.  

Evaluations from 60 studies that were published spanning more than 24 years and involving 700,000 adult women from numerous hospitals in about 13 countries have investigated the factors which can affect VBAC like private health insurance, cervical ripening agents, induction, scoring systems, and local guidelines. The percentage of women who undergo cesarean deliveries has increased over the past 20 years. A large part of the increase can be attributed to women who had previous caesareans who went through the same delivery procedure with their subsequent pregnancy.  Research shows 33% of UK women have VBAC; Australia had a lower VBAC rate of just below 17%.  Another US study shows 73% of women had a safe vaginal delivery after having cesarean section

Non-clinical reviews have found that the attitude of the clinician has an effect on the success rate of VBAC and the implementation of its guidelines. The reviews also show that giving details regarding cesarean sections and VBAC can give women more delivery options. But there isn’t sufficient evidence to show the connection of private medical insurance to lower VBAC uptake.

Clinical reviews, on the other hand, concluded that VBACs induced with artificial rupture of the membranes are less likely to be successful. The use of prostaglandins and oxytocin infusion or a combination of the two also showed unfavourable VBAC results. Compared to pregnant women who labour spontaneously, using prostaglandin and Foley catheters in cervical ripening and inducing labor had lower success. Furthermore, women who went through X-ray pelvimetry examination had lower VBAC uptake and higher chances of C-section. Scoring systems organized to foresee the success of VBAC are mostly not helpful.

The reviews have verified a high percentage of women worldwide decided to give birth through cesarean section. There is also a considerable difference in how VBAC is viewed and accepted. Most women, including some experts from the medical society, believe that after having a cesarean section the subsequent babies should also be born in the same way. Vaginal delivery after having a C-section is possible. However, due to the health hazards of a C-section both on the mother and her baby, more research is needed to decrease the percentage of repeat cesarean sections and to give mothers the choice to experience the process of giving birth. 

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