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
Observational Study
. 2019 Feb 28;19(1):84.
doi: 10.1186/s12884-019-2226-6.

Mode of birth after caesarean section: individual prediction scores using Scottish population data

Sara Helen Denham  1 , Tracy Humphrey  2 , Claire deLabrusse  3 , Nadine Dougall  2
Affiliations
Observational Study

Mode of birth after caesarean section: individual prediction scores using Scottish population data

Sara Helen Denham et al. BMC Pregnancy Childbirth. .

Abstract

Background: Rising caesarean section (CS) rates are a global health concern. Contemporary data indicates that almost 50% of CS are electively performed, with a high proportion of these being a repeat procedure. Vaginal birth after caesarean (VBAC) is recognised as a safe way to give birth in developed countries. UK national maternity policy and worldwide professional guidance supports shared decision-making about mode of birth with women following CS. Evidence suggests that women want individualised information, particularly about their likeilihood of successful VBAC, to enable them to participate in the decision making process. This study aimed to identify characteristics that could inform a predictive model which would allow women to receive personalised and clinically specific information about their likelihood of achieving a successful VBAC in subsequent pregnancies.

Methods: An observational study using anonymised clinical data extracted from a detailed, comprehensive socio-demographic and clinical dataset. All women who attempted a singleton term VBAC between 2000 and 2012 were included. Data were analysed using both logistic regression and Bayesian statistical techniques to identify clinical and demographic variables predictive of successful VBAC.

Results: Variables significantly associated with VBAC were: ethnicity (p = 0.011), maternal obstetric complications (p < 0.001), previous vaginal birth (p = < 0.001), antepartum haemorrhage (p = 0.005), pre-pregnancy BMI (p < 0.001) and a previous second stage CS (p < 0.001).

Conclusions: By using current literature, expert clinical opinion and having access to clinically detailed variables, this study has identified a new significant characteristic. Women who had a previous CS in the second stage of labour are more likely to have a successful VBAC. This predictor may have international significance for women and clinicians in shared VBAC decision-making. Further research is planned to validate this model on a larger national sample leading to further development of the nomogram tool developed in this study for use in clinical practice to assist women and clinicians in the decision-making process about mode of birth after CS.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval for this study was granted by the Robert Gordon University School of Nursing and Midwifery ethics committee. Permission to access the anonymized (de-identified) data was granted by the Aberdeen Maternal and Neonatal Database steering committee.

Consent for publication

All data was anonymised so individual consent for publication was not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

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

Figures

Fig. 1
Fig. 1
Area under the ROC curve for probability of vaginal birth after caesarean
Fig. 2
Fig. 2
Grampian women’s probability of vaginal birth after caesarean nomogram
See this image and copyright information in PMC

References

    1. Mone F, Harrity C, Toner B, et al. Predicting why women have elective repeat cesarean deliveries and predictors of successful vaginal birth after cesarean. Int J Gynaecol Obstet. 2014. 10.1016/j.ijgo.2013.12.013. - PubMed
    1. Betran AP, Jianfeng Y, Moller AB, et al. The Increasing Trend In Caesarean Section Rates: Global, Regional and National Estimates 1990–2014. PLoS One. 2016;11(2):e0148343. doi: 10.1371/journal.pone.0148343. - DOI - PMC - PubMed
    1. Knight H, Gurol-Urganci I, van der Meulen J, et al. Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success. BJOG. 2014;121:183–193. doi: 10.1111/1471-0528.12508. - DOI - PubMed
    1. Royal College of Obstetricians and Gynaecologists. Birth after previous caesarean birth, Green top guideline no 45 2015. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf. Accessed 20 May 2018.
    1. Information Services Division Scotland, (2017) Births in Scottish hospitals table 4 live births by mode of delivery and induction. http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Births/. Accessed 30 August 2018.

Publication types