Trial of vaginal delivery after caesarean section, the present and the future after adoption of the new nice guidelines. (18th April 2012)

• Record Type: Journal Article
• Authors: Fawzy, M; Norman, S; Lynch, P; Mires, G
• Is Part Of: Archives of disease in childhood. Volume 97(2012)Supplement 1
• Page Start: A99
• Page End: A99
• Publication Date: 2012-04-18
• Subjects: Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/fetalneonatal-2012-301809.322
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Introduction: trial of vaginal birth after caesarean section (VBAC) offers women with history of previous caesarean section the chance of a vaginal delivery with its associated lower risk of morbidity. Recently published NICE guidance however has advocated a more liberal approach to caesarean section based purely on maternal request rather than clinical indication. Adoption of such a policy may negatively impact patient uptake of VBAC with a consequent nationwide increase in the caesarean section rates. The current study aimed to examine current uptake of VBAC before implementation of the new NICE guidance in order to gain insight into the possible future effect on uptake rates. Methods: This was a retrospective analysis of data from 68 patients screened for suitability for VBAC at the time of booking in a 6-month period at Ninewells Hospital, Dundee. Results: 64 patients were deemed eligible based on local guidelines. At term 14 patients were no longer suitable for VBAC due to various obstetric reasons. Of the remaining 50 patients 44% (n=28) opted for elective caesarean section. In the remaining cohort, VBAC was successful in 77% of cases. Conclusion: Findings suggest that despite VBAC being a highly successful option for selected patients, drop-out rates are currently high despite careful selection and counselling. This rate is likely to increase further with the adoption of the new NICE guidelines. Hospitals should therefore prepare for what may be a dramatic increase in elective caesarean section rates coupled with an increased demand on resources such as theatre time and staff.