What happens next time? Labour choices and outcomes after previous caesarean delivery in district general hospitals

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 95; no. Suppl 1; p. Fa84
• Main Authors: Gopinath, D, Smith, RE, Martindale, EA, Clarke, FR
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.06.2010; BMJ Publishing Group LTD
• ISSN: 1359-2998; 1468-2052
• DOI: 10.1136/adc.2010.189605.71

Introduction Rates of Caesarean section are rising throughout the United Kingdom. Therefore increasing numbers of women are entering subsequent pregnancies with a uterine scar. Some of these women will choose to attempt another vaginal birth after Caesarean (VBAC). Our trust delivers 6500 women annually in two separate consultant led maternity units. The authors undertook a review to identify areas of weak practice and facilitate accurate antenatal counselling of our success rates. Methods This was a retrospective case note review of 100 women with a previous Caesarean delivery. 50 cases were obtained from each unit and reviewed using a standard proforma. Results Debriefing following initial Caesarean delivery was poor (5%). Counselling regarding mode of delivery was varied and tended to occur earlier in one unit than the other. The unit with earlier counselling had a slightly higher uptake of VBAC. 70% of women chose to attempt VBAC. 66% of women had a partogram completed. Action lines were rarely used. There was a wide range of practice in frequency of cervical assessment in both units. 62% of women had a vaginal delivery (6% instrumental delivery). More women had a vaginal delivery in the unit with later counselling/decision making. Seven babies were admitted to NICU. 11 mothers had complications. Conclusion The authors need to standardise practice and undertake a more extensive review to further assess complication rates.