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. 2023 Sep 22;23(1):684.
doi: 10.1186/s12884-023-05984-w.

Influence of organizational factors on the offer and success rate of a trial of labor after cesarean section in Belgium: an ecological study

Griet Vandenberghe #  1 , An Vercoutere #  2 , Nadège Cuvellier  2   3 , Elke Van Oost  4   5 , Charlotte Leroy  6 , Régine Goemaes  7 , Monika Laubach  7   8 , Michel Boulvain  2   8 , Caroline Daelemans  2   9 ; B.OSS collaborating group
Collaborators, Affiliations

Influence of organizational factors on the offer and success rate of a trial of labor after cesarean section in Belgium: an ecological study

Griet Vandenberghe et al. BMC Pregnancy Childbirth. .

Abstract

Background: Trial of Labor After Cesarean is an important strategy for reducing the overall rate of cesarean delivery. Offering the option of vaginal delivery to a woman with a history of cesarean section requires the ability to manage a potential uterine rupture quickly and effectively. This requires infrastructure and organization of the maternity unit so that the decision-to-delivery interval is as short as possible when uterine rupture is suspected. We hypothesize that the organizational characteristics of maternity units in Belgium have an impact on their proposal and success rates of trial of labour after cesarean section.

Methods: We collected data on the organizational characteristics of Belgian maternity units using an online questionnaire. Data on the frequency of cesarean section, trial of labor and vaginal birth after cesarean section were obtained from regional perinatal registries. We analyzed the determinants of the proposal and success of trial of labor after cesarean section and report the associations as mean proportions.

Results: Of the 101 maternity units contacted, 97 responded to the questionnaire and data from 95 was included in the analysis. Continuous on-site presence of a gynecologist and an anesthetist was associated with a higher proportion of trial of labor after cesarean section, compared to units where staff was on-call from home (51% versus 46%, p = 0.04). There is a non-significant trend towards more trial of labor after cesarean section in units with an operating room in or near the delivery unit and a shorter transfer time, in larger units (> 1500 deliveries/year) and in units with a neonatal intensive care unit. The proposal of trial of labor after cesarean section and its success was negatively correlated to the number of cesarean section in the maternity unit (Spearman' rho = 0.50 and 0.42, p value < 0.001).

Conclusions: Organizational differences in maternity units appear to affect the proposal of trial of labor after cesarean section. Addressing these organizational factors may not be sufficient to change practice, given that general tendency to perform a cesarean section in the maternity unit is the main contributor to the percentage of trial of labor after cesarean.

Keywords: Decision-to-delivery interval; Emergency cesarean section; On-call schedule; Trial of labor after cesarean; Vaginal birth after cesarean.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Correlation between the proportion of TOLAC and the proportion of VBAC in case of TOLAC. The size of the dots is weighted by the number of women with history of CS in the maternity unit
Fig. 2
Fig. 2
Correlation between the overall proportion of cesarean section and the proportion of TOLAC. The size of the dots is weighted by the number of deliveries per year in the maternity unit
Fig. 3
Fig. 3
Correlation between the overall proportion of cesarean section and the proportion of VBAC in case of TOLAC. The size of the dots is weighted by the number of deliveries per year in the maternity unit
See this image and copyright information in PMC

References

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