Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov 21;18(1):452.
doi: 10.1186/s12884-018-2065-x.

Adjunct clinical interventions that influence vaginal birth after cesarean rates: systematic review

Aireen Wingert  1 , Cydney Johnson  1 , Robin Featherstone  1   2 , Meghan Sebastianski  2 , Lisa Hartling  1   2 , R Douglas Wilson  3
Affiliations

Adjunct clinical interventions that influence vaginal birth after cesarean rates: systematic review

Aireen Wingert et al. BMC Pregnancy Childbirth. .

Abstract

Background: Rates of cesarean deliveries have been increasing, and contributes to the rising number of elective cesarean deliveries in subsequent pregnancies with associated maternal and neonatal risks. Multiple guidelines recommend that women be offered a trial of labor after a cesarean (TOLAC). The objective of the study is to systematically review the literature on adjunct clinical interventions that influence vaginal birth after cesarean (VBAC) rates.

Methods: We searched Ovid Medline, Ovid Embase, Wiley Cochrane Library, CINAHL via EBSCOhost; and Ovid PsycINFO. Additional studies were identified by searching for clinical trial records, conference proceedings and dissertations. Limits were applied for language (English and French) and year of publication (1985 to present). Two reviewers independently screened comparative studies (randomized or non-randomized controlled trials, and observational designs) according to a priori eligibility criteria: women with prior cesarean sections; any adjunct clinical intervention or exposure intended to increase the VBAC rate; any comparator; and, outcomes reporting changes in TOLAC or VBAC rates. One reviewer extracted data and a second reviewer verified for accuracy. Two reviewers independently conducted methodological quality assessments using the Mixed Methods Appraisal Tool (MMAT).

Results: Twenty-three studies of overall moderate to good methodological quality examined adjunct clinical interventions affecting TOLAC and/or VBAC rates: system-level interventions (three studies), provider-level interventions (three studies), guidelines or information for providers (seven studies), provider characteristics (four studies), and patient-level interventions (six studies). Provider-level interventions (opinion leader education, laborist, and obstetrician second opinion for cesarean sections) and provider characteristics (midwifery antenatal care, physicians on night float call schedules, and deliveries by family physicians) were associated with increased rates of VBAC. Few studies employing heterogeneous designs, sample sizes, interventions and comparators limited confidence in the effects. Studies of system-level and patient-level interventions, and guidelines/information for providers reported mixed findings.

Conclusions: Limited evidence indicates some provider-level interventions and provider characteristics may increase rates of attempted and successful TOLACs and/or VBACs, whereas other adjunct clinical interventions such as system-level interventions, patient-level interventions, and guidelines/information for healthcare providers show mixed findings.

Keywords: Systematic review; Trial of labor after cesarean; Vaginal birth after cesarean.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

This is a systematic review of previously published data and as such does not require ethics approval.

Consent for publication

Not applicable.

Competing interests

All authors declare funding from MNCY SCN of AHS and Alberta SPOR SUPPORT Unit KT Platform; LH, MS and RF are employed in part or whole by the Alberta SPOR SUPPORT KT Platform; LH was funded in part by a New Investigator Salary Award from CIHR; there are no other relationships or activities that could appear to have influenced the submitted work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
PRISMA flow of study selection
See this image and copyright information in PMC

References

    1. Canadian Institute of Health Information. Inpatient hospitalizations, surgeries and childbirth indicators in 2010–2013. https://secure.cihi.ca/estore/productFamily.htm. Accessed 5 May 2017.
    1. Kelly S, Sprague A, Fell DB, Murphy P, Aelicks N, Guo Y, et al. Examining caesarean section rates in Canada using the Robson classification system. J Obstet Gynaecol Can. 2013;35(3):206–214. doi: 10.1016/S1701-2163(15)30992-0. - DOI - PubMed
    1. Canadian Institute for Health Information . Health indicators 2014: caesarean section. 2014.
    1. World Health Organization . WHO statement on caesarean section rates. 2015.
    1. Brown HK, Hill J, Natale R. Caesarean section rates in southwestern Ontario: changes over time after adjusting for important medical and social characteristics. J Obstet Gynaecol Can. 2014;36(7):578–589. doi: 10.1016/S1701-2163(15)30537-5. - DOI - PubMed

Publication types

MeSH terms