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

Nilsson, Christína; Lundgren, Ingela; Smith, Valerie; Vehviläinen‐Julkunen, Katri; Nicoletti, Jane; Devane, Declan; Bernloehr, Annette; Limbeek, Evelien van; Lalor, Joan; Begley, Cecily

doi:10.1016/j.midw.2015.04.003

Cited by 34 publications

(21 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A number of interventions may be adopted to facilitate this process of change: education of staff/patients by opinion leaders; introduction of a second opinion for all CS; prenatal counselling for women and partners [82][83][84][85]112 . Although, clinical audits, financial penalties and rewards to maternity centres could also be considered.…”

Section: Discussionmentioning

confidence: 99%

Understanding Factors Leading to Primary Cesarean Section and Vaginal Birth After Cesarean Delivery in the Friuli-Venezia Giulia Region (North-Eastern Italy), 2005–2015

Cegolon

Mastrangelo

Maso

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Although there is no evidence that elevated rates of cesarean sections (cS) translate into reduced maternal/child perinatal morbidity or mortality, cS have been increasingly overused almost everywhere, both in high and low-income countries. the primary cesarean section (pcS) has become a major driver of the overall cS (ocS) rate, since it carries intrinsic risk of repeat cS (RcS) in future pregnancies. in our study we examined patterns of pcS, pl compared with planned toLAc anned PCS (PPCS), vaginal birth after 1 previous CS (VBAC-1) and associated factors in Friuli Venezia Giulia (FVG), a region of NorthEastern Italy, collecting data from its 11 maternity centres (coded from A to K) during 2005-2015. By fitting three multiple logistic regression models (one for each delivery mode), we calculated the adjusted rates of pcS and ppcS among women without history of cS, whilst the calculation of the VBAC rate was restricted to women with just one previous CS (VBAC-1). Results, expressed as odds ratio (OR) with 95% confidence interval (95%CI), were controlled for the effect of hospital, calendar year as well as several factors related to the clinical and obstetric conditions of the mothers and the newborn, the obstetric history and socio-demographic background. in fVG during 2005-2015 there were 24,467 OCS (rate of 24.2%), 19,565 PCS (19.6%), 7,736 PPCS (7.7%) and 2,303 VBAC-1 (28.4%). We found high variability of delivery mode (DM) at hospital level, especially for pcS and ppcS. Breech presentation was the strongest determinant for pcS as well as ppcS. Leaving aside placenta previa/abuptio placenta/ante-partum hemorrhage, further significant factors, more importantly associated with pcS than ppcS were non-reassuring fetal status and obstructed labour, followed by (in order of statistical significance): multiple birth; eclampsia/pre-eclampsia; maternal age 40-44 years; placental weight 600-99 g; oligohydramios; pre-delivery LoS 3-5 days; maternal age 35-39 years; placenta weight 1,000-1,500 g; birthweight < 2,000 g; maternal age ≥ 45 years; pre-delivery LoS ≥ 6 days; mother's age 30-34 years; low birthweight (2,000-2,500 g); polyhydramnions; cord prolaspe; ≥6 US scas performed during pregnancy and pre-term gestations (33-36 weeks). Significant factors for PPCS were (in order of statistical significance): breech presentation; placenta previa/abruptio placenta/ante-partum haemorrhage; multiple birth; pre-delivery LoS ≥ 3 days; placental weight ≥ 600 g; maternal age 40-44 years; ≥6 US scans performed in pregnancy; maternal age ≥ 45 and 35-39 years; oligohydramnios; eclampsia/pre-eclampsia; mother's age 30-34 years; birthweight

show abstract

Section: Discussionmentioning

confidence: 99%

Understanding Factors Leading to Primary Cesarean Section and Vaginal Birth After Cesarean Delivery in the Friuli-Venezia Giulia Region (North-Eastern Italy), 2005–2015

Cegolon

Mastrangelo

Maso

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Women require evidence-based information about the positive aspects of VBAC and their body’s ability to birth normally [42] if they are to be supported in making truly informed decisions regarding the mode of birth following CS. Clinicians should be sensitive to the fact that in addition to appraising hard data based on risk, women are frequently influenced by the obstetrician’s personal values, attitudes, experiences and expectations of birth when making decisions.…”

Section: Discussionmentioning

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…Sites randomised to the intervention group received a complex, innovative programme of evidence-based antenatal strategies, developed following three systematic reviews [17,20,21], and four qualitative studies with clinicians and women in both high and low VBAC countries [18,19,24,25]. Technology-assisted learning resources were also developed using motivational systems and instructional design theory [26].…”

Section: Interventionsmentioning

confidence: 99%

“…Information sessions and decision-aids for women during pregnancy did not increase VBAC but did significantly decrease their decisional conflict and increase their knowledge of mode of birth [20]. Therefore, the promotion of VBAC requires the provision of evidencebased information to women on the benefits and limitations of VBAC [21] and the options open to them [22].…”

Section: Introductionmentioning

confidence: 99%

OptiBIRTH: a cluster randomised trial of a complex intervention to increase vaginal birth after caesarean section

Clarke

Devane

Gross

et al. 2020

BMC Pregnancy Childbirth

Self Cite

View full text Add to dashboard Cite

Background: Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are low in many countries. Methods: OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC rates through an unblinded cluster randomised trial in 15 maternity units with VBAC rates < 35% in Germany, Ireland and Italy. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education of clinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review, and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annual hospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October 2015, 2002 women were recruited (intervention 1195, control 807), with mode-of-birth data available for 1940 women. Results: The OptiBIRTH intervention was feasible and safe across hospital settings in three countries. There was no statistically significant difference in the change in the proportion of women having a VBAC between intervention sites (25.6% in 2012 to 25.1% in 2016) and control sites (18.3 to 22.3%) (odds ratio adjusted for differences between intervention and control groups (2012) and for homogeneity in VBAC rates at sites in the countries: 0.87, 95% CI: 0.67, 1.14, p = 0.32 based on 5674 women (2012) and 5284 (2016) with outcome data. Among recruited women with birth data, 4/1147 perinatal deaths > 24 weeks gestation occurred in the intervention group (0.34%) and 4/782 in the control group (0.51%), and two uterine ruptures (one per group), a rate of 1:1000.(Continued on next page)

show abstract

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

Cited by 34 publications

References 34 publications

Understanding Factors Leading to Primary Cesarean Section and Vaginal Birth After Cesarean Delivery in the Friuli-Venezia Giulia Region (North-Eastern Italy), 2005–2015

Understanding Factors Leading to Primary Cesarean Section and Vaginal Birth After Cesarean Delivery in the Friuli-Venezia Giulia Region (North-Eastern Italy), 2005–2015

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

OptiBIRTH: a cluster randomised trial of a complex intervention to increase vaginal birth after caesarean section

Contact Info

Product

Resources

About