Does continuity of care impact decision making in the next birth after a caesarean section (VBAC)? a randomised controlled trial

Abstract

BackgroundCaesarean section (CS) has short and long-term health effects for both the woman and her baby. One of the greatest contributors to the CS rate is elective repeat CS. Vaginal birth after caesarean (VBAC) is an option for many women; despite this the proportion of women attempting VBAC remains low. Potentially the relationship that women have with their healthcare professional may have a major influence on the uptake of VBAC. Models of service delivery, which enable an individual approach to care, may make a difference to the uptake of VBAC. Midwifery continuity of care could be an effective model to encourage and support women to choose VBAC.Methods/DesignA randomised, controlled trial will be undertaken. Eligible pregnant women, whose most recent previous birth was by lower-segment CS, will be randomly allocated 1:1 to an intervention group or control group. The intervention provides midwifery continuity of care to women through pregnancy, labour, birth and early postnatal care. The control group will receive standard hospital care from different midwives through pregnancy, labour, birth and early postnatal care. Both groups will receive an obstetric consultation during pregnancy and at any other time if required. Clinical care will follow the same guidelines in both groups.DiscussionThis study will determine whether midwifery continuity of care influences the decision to attempt a VBAC and impacts on mode of birth, maternal experiences with care and the health of the neonate. Outcomes from this study might influence the way maternity care is provided to this group of women and thus impact on the CS rate. This information will provide high level evidence to policy makers, health service managers and practitioners who are working towards addressing the increased rate of CS.Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611001214921

Caring for women wanting a vaginal birth after previous caesarean section: A qualitative study of the experiences of midwives and obstetricians

“…They saw midwifery care as being integral to the decision to attempt and ultimately achieve a VBAC. This finding is supported by other studies that show types of provider have an effect on the outcome of care for women 14,19,38 with midwifery led care associated with higher rates of VBAC 15,20,39 compared with obstetric led care. 14,19,40 Provider attitudes during care 21 have been shown to have an impact on the woman's desired mode of birth.…”

Clinicians’ views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a qualitative study from countries with high VBAC rates

“…The importance of support is verified by a meta-analysis showing that continuous support during labour by professionals and non-professional positively influences both the delivery outcome and the woman’s satisfaction with her care [ 29 ]. A planned study from Australia will answer the question of whether continuity of midwifery care through pregnancy, labour, birth and the early postnatal period impacts decision-making in the next VBAC [ 30 ]. Furthermore, the clinicians pointed out the importance of strengthening the woman’s trust in giving birth vaginally.…”

Women-centred interventions to increase vaginal birth after caesarean section (VBAC): A systematic review

“…These studies demonstrate that successful women-centred interventions do exist, extend beyond just supporting women in their decision-making, and need to be researched. In addition, an on-going study from Australia will show if continuity of care during pregnancy and childbirth will impact decision making in the next birth after caesarean section (Homer et al, 2013); this will provide information on a women-centred intervention during birth, which at present is lacking.…”