Interinstitutional variations in mode of birth after a previous caesarean section: a cross-sectional study in six German hospitals

Groß, Mechthild M.; Matterne, Andrea; Berlage, S; Kaiser, A.; Lack, Nicholas; Macher-Heidrich, Susanne; Misselwitz, Björn; Bahlmann, Franz; Falbrede, Jörg; Hillemanns, Peter; Kaisenberg, Constantin von; Koch, Franz Edler von; Schild, R. L.; Stepan, Holger; Devane, Declan; Mikolajczyk, Rafael

doi:10.1515/jpm-2014-0108

Cited by 15 publications

(13 citation statements)

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“…Multivariable analysis was used for the whole study group and for each country separately using random effects logistic regression models with the dependent variable "success of planned VBAC". Variations in labour and birth management for planned VBAC had been observed at the sites prior to the trial in Germany (Gross et al, 2015) and were accounted for by using a random effects term for all study sites. Multiple imputation (Stata "mi set" with fivefold imputation) was used for the variables "BMI", "married/living with partner", "health insurance", "cervical dilatation on admission" and "rupture of membranes" because of up to 14% missing data.…”

Section: Discussionmentioning

confidence: 99%

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Labour characteristics of women achieving successful vaginal birth after caesarean section in three European countries

et al. 2019

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Objective: Knowledge about labour characteristics of women achieving successful vaginal birth after caesarean section (VBAC) might be used to improve labour and birth management. This study examined sociodemographic and labour process-related factors regarding a) differences between countries, b) the comparison of successful VBAC with unplanned caesarean section, and c) predictors for the success of planned VBAC in three European countries. Design: We analysed observational data collected within the OptiBIRTH trial, a clusterrandomised controlled trial. Setting: Fifteen study sites in Ireland, Italy and Germany, five in each country. Participants: 790 participants going into labour for planned VBAC. Measurements: Descriptive statistics and random-effects logistic regression models were applied. Findings: The pooled successful VBAC-rate was 74.6%. Italy had the highest proportion of women receiving none of the four intrapartum interventions amniotomy (ARM), oxytocin, epidural or opioids (42.5% vs Ireland: 26.8% and Germany: 25.3%, p<0.001). Earlier performance of ARM was associated with successful VBAC (3.50 hrs vs 6.08 hrs, p=0.004). A positive predictor for successful vaginal birth was a previous vaginal birth (OR=3.73, 95% CI [2.17, 6.44], p<0.001). The effect of ARM increased with longer labour duration (OR for interaction term=1.06, 95% CI [1.004, 1.12], p=0.035). Higher infant birthweight (OR per kg=0.34, 95% CI [0.23, 0.50], p<0.001), ARM (reference spontaneous rupture of membranes (SROM), OR=0.20, 95% CI [0.11, 0.37], p<0.001) and a longer labour duration (OR per hour=0.93, 95% CI [0.90, 0.97], p<0.001) decreased the odds of a vaginal birth. Key conclusion: Women with a previous vaginal birth, an infant with a lower birth weight, SROM and a shorter labour duration were most likely to have a successful vaginal birth. If SROM did not occur, an earlier ARM increased the odds of a vaginal birth. Implication for practice: Labour progress should be accelerated by fostering endogenous uterine contractions. With slow labour progress and intact membranes, ARM might increase the chance of a vaginal birth.

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Section: Discussionmentioning

confidence: 99%

“…Euro-Peristat, 2018; Gross et al, 2015;Macfarlane et al, 2016;Mikolajczyk et al, 2013). A lack of consensus about optimal labour management methods may contribute to the variations (Gross et al, 2015). Scott et al (2014) recommended an intrapartum management similar to parturients without a c-section in history.…”

Section: Accepted Manuscript Introductionmentioning

confidence: 99%

Labour characteristics of women achieving successful vaginal birth after caesarean section in three European countries

et al. 2019

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“…The key features of note are that the publicly funded model of care is predominantly medically led and that the women give birth in a hospital setting. These factors are important when considering the national CS rate for any country, since significant variations in CS rates have been identified at the unit level, depending on whether the woman attends the public system or utilises health insurance to attend an obstetrician privately [5]. …”

Section: Methodsmentioning

confidence: 99%

“…In the absence of a robust justification of these increasing rates, an exploration of clinicians’ attitudes to CS as a mode of birth is required [2, 5–7], since an understanding of the non-medical factors associated with the decision to perform a CS are becoming more important. These factors include maternal requests [8] and provider attitudes [9].…”

Section: Introductionmentioning

confidence: 99%

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

Lundgren

Healy

Carroll

et al. 2016

BMC Pregnancy Childbirth

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BackgroundCaesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians’ views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of “OptiBIRTH”, an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates.MethodsFocus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country.ResultsThe findings are presented in four main categories with several sub-categories: 1) “prameters for VBAC”, including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) “organisational support and resources for women undergoing a VBAC”, meaning a successful VBAC requires clinical expertise and resources during labour; 3) “fear as a key inhibitor of successful VBAC”, including understanding women’s fear of childbirth, clinicians’ fear of VBAC and the ways that clinicians’ fear can be transferred to women; and 4) “shared decision making – rapport, knowledge and confidence”, meaning ensuring consistent, realistic and unbiased information and developing trust within the clinician–woman relationship.ConclusionsThe findings indicate that increasing the VBAC rate depends on organisational factors, the care offered during pregnancy and childbirth, the decision-making process and the strategies employed to reduce fear in all involved.

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“…Such information is not available in our registry, but may often be obtained directly from the pregnant woman, or from her medical records. Gross et al performed a study on variations in mode of delivery after a previous CS in six German hospitals, and found a substantial variation between institutions, in addition to a variation in regional patterns. In our previous study on VBAC prediction, we found that delivery ward characteristics (emergency CS in TOL, and elective repeat CS rates, respectively) significantly influenced VBAC rates.…”

Section: Discussionmentioning

confidence: 99%

Third‐trimester prediction of successful vaginal birth after one cesarean delivery—A Swedish model

Fagerberg

Källén

2019

Acta Obstet Gynecol Scand

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| INTRODUC TI ONCounseling women and their partners about preferable delivery mode after one cesarean section (CS) is a difficult task. There are medical as well as personal and emotional factors to discuss, and the specific delivery ward's tradition of handling births after CS has to be considered. The choice is between a trial of labor (TOL), hopefully ending in a vaginal birth after cesarean (VBAC), and an elective repeat CS. It has been shown that, in all, a TOL ending in a VBAC is the most favorable scenario for the health of mother and child, followed by an elective repeat CS and, last, a TOL ending in an emergency CS. 1,2 Abstract Introduction: The objective was to create a clinically useful prediction model for vaginal birth in trial of labor after one cesarean section, appropriate for a third trimester consultation. Material and methods:Women with one cesarean section and at least one following delivery (N = 38 686) in the Swedish Medical Birth Register, 1998-2013, were studied. The women were randomly divided into one development and one validation data set. From the development data set, variables associated with vaginal birth after cesarean (VBAC) were identified by univariable logistic regression. Stepwise backward selection was performed until all variables were statistically significant. From the final fitted multivariable logistic model, likelihood ratios were calculated, in order to transpose odds ratios into clinically useful measurements. A constant, based on the delivery ward VBAC in trial of labor rate, was used. By applying the likelihood ratios on the validation data set, the VBAC chance for each woman was estimated with the Bayesian theorem, and the ability of the model to predict VBAC was explored using receiver operating characteristics (ROC) curves. Results:A previous VBAC, and a previous cesarean section for non-cephalic presentation, were the strongest VBAC predictors. The lowest chances were found for a previous cesarean section due to dystocia, and among women with <18 months since the last cesarean section. The area under the ROC curve was 0.67. Conclusions:The new model was satisfactory in predicting VBAC in trial of labor.Developed as a software application, it would become a clinically useful decision-aid. K E Y W O R D S cesarean section, decision aid, elective repeat cesarean section, prediction model, trial of labor, vaginal birth after cesarean | 661 CARLSSON FAGERBERG ANd KÄLLÉNSince 2011, about 17% of women in Sweden have given birth by CS-with large differences between hospitals. Hence, decisions concerning delivery mode in pregnancies following one CS are made every day. In Sweden, about 70% of women would choose, or be eligible for, a TOL after cesarean (TOLAC). Among these women, about 75% would reach a successful VBAC. 3 Previously, we have performed a validation and adaptation of the widely used US prediction model from 2007 by Grobman et al, to fit a Nordic setting. 3,4 In the present study, we wanted to add several factors of importance to create an even more accur...

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Interinstitutional variations in mode of birth after a previous caesarean section: a cross-sectional study in six German hospitals

Abstract: There is substantial interinstitutional variation in mode of birth following previous caesarean section. This variation is in addition to regional patterns.

Cited by 15 publications

References 35 publications

Labour characteristics of women achieving successful vaginal birth after caesarean section in three European countries

Labour characteristics of women achieving successful vaginal birth after caesarean section in three European countries

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

Third‐trimester prediction of successful vaginal birth after one cesarean delivery—A Swedish model

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