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Evidence to Improve Care

Vaginal Birth After Caesarean (VBAC)

Care for People Who Have Had a Caesarean Birth and Are Planning Their Next Birth

Click below to see a list of brief quality statements and scroll down for more information.​​


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence. ​

See below for the quality statements and click for more detail.​


Quality Statement 1: Access to Vaginal Birth After Caesarean
People who have had a Caesarean birth before can plan a vaginal birth for their next birth, as long as there is no medical reason not to have one.


Quality Statement 2: Discussion After Caesarean Birth
After a Caesarean birth, people have a discussion with their physician or midwife and receive written information about the reasons for their Caesarean birth and their options for future births.


Quality Statement 3: Shared Decision-Making
Pregnant people who have had a previous Caesarean birth participate in shared decision-making with their physician or midwife. The discussion and planned mode of birth is documented in the perinatal record.


Quality Statement 4: Previous Vaginal Birth
Pregnant people who have had both a previous Caesarean birth and a previous vaginal birth are informed that they have a high likelihood of successful vaginal birth if no contraindication is present.


Quality Statement 5: Operative Reports and Incision Type
Physicians and midwives obtain an operative report from any previous Caesarean births whenever possible. Pregnant people who have had a previous Caesarean birth with an unknown type of uterine incision have an individualized assessment by their physician or midwife to determine the likelihood of a low transverse incision.


Quality Statement 6: Timely Access to Caesarean Birth
Pregnant people planning a vaginal birth after Caesarean are aware of the resources available and not available at their planned place of birth, including physician, midwifery, nursing, anesthesiology, and neonatal care, and the ability to provide timely access to Caesarean birth.


Quality Statement 7: Unplanned Labour
Pregnant people planning an elective repeat Caesarean section should have a documented discussion with their physician or midwife about the feasibility of vaginal birth after Caesarean if they go into unplanned labour. This discussion should take place during antenatal care and again if the person arrives at the hospital in labour.


Quality Statement 8: Induction and Augmentation of Labour
Pregnant people who have had a previous Caesarean birth are offered induction and/or oxytocin augmentation of labour when medically indicated, and are informed by their physician or midwife about the potential benefits and harms associated with the method proposed. Discussion about this should begin in the antenatal period.


Quality Statement 9: Signs and Symptoms of Uterine Rupture
During active labour, pregnant people who have had a previous Caesarean birth are closely monitored for signs or symptoms of uterine rupture.


2

Discussion After Caesarean Birth

After a Caesarean birth, people have a discussion with their physician or midwife and receive written information about the reasons for their Caesarean birth and their options for future births.


Preferences for future births are usually established between pregnancies. Therefore, vaginal birth after Caesarean should be presented as an option for future births at discharge from hospital and again at the 6-week postnatal visit. It is important to discuss the reasons for the initial Caesarean birth so that the person and their family can use that information for family planning and future births. Discussion should also include the association between a delivery interval of less than 18 to 24 months and increased risk of uterine rupture. The physician or midwife should ask about the person’s emotional state and well-being and encourage them to ask questions.

Information should be provided during the discussion and also in written form so that it can be retained and shared. Written information facilitates communication with care providers from one birth to the next, because the clinical context and factors involved in the previous Caesarean birth are then clear, not only to the physician or midwife but also to the pregnant person and their family. This information can support shared decision-making during the next pregnancy, and this discussion should be repeated for each subsequent Caesarean birth.

For Pregnant People

Before you leave the hospital, your physician or midwife should talk with you about why you had a Caesarean birth and what your options are for future births. They should give you this information in a written report (see Definitions section). They should also talk about this at your 6-week follow-up appointment.


For Clinicians

Have a discussion with people who have had a Caesarean birth and provide written information about the reasons for their Caesarean birth and their options for future births.


For Health Services

Ensure that systems, resources, and training are available for physicians and midwives to have discussions and provide written information about the reasons for Caesarean births and options for future births.

Process Indicators

Percentage of people who have had a Caesarean birth and who have a discussion with their physician or midwife about the reasons for their Caesarean birth and their options for future births at discharge

  • Denominator: number of people who have had a Caesarean birth

  • Numerator: number of people in the denominator who have a discussion with their physician or midwife about the reasons for their Caesarean birth and their options for future births at discharge

  • Data source: local data collection


Percentage of people who have had a Caesarean birth and who have a discussion with their physician or midwife about the reasons for their Caesarean birth and their options for future births at the 6-week postnatal visit

  • Denominator: Number of people who have had a Caesarean birth

  • Numerator: Number of people in the denominator who have a discussion with their physician or midwife about the reasons for their Caesarean birth and their options for future births at the 6-week postnatal visit

  • Data source: local data collection


Percentage of people who have had a Caesarean birth and who receive written information after a discussion with their physician or midwife about the reasons for their Caesarean birth and their options for future births at discharge and at the 6-week postnatal visit

  • Denominator: Number of people who have had a Caesarean birth and who have a discussion with their physician or midwife about the reasons for their Caesarean birth and their options for future births at discharge and at the 6-week postnatal visit

  • Numerator: Number of people in the denominator who receive written information about the reasons for their Caesarean birth and their options for future births at discharge and at the 6-week postnatal visit

  • Data source: local data collection

Discussion

A conversation between the person who had a Caesarean birth, their family, and a physician or midwife to provide accurate information about the reason for the Caesarean birth, including the clinical situation, recurring and non-recurring indications for Caesarean birth, and how it might affect options for future births. This conversation should happen before the person is discharged from hospital and should be reviewed at the 6-week postnatal visit. It should take place after each Caesarean birth.


Written information

Written information could be in the form of an operative report, but should be in a format that is easy to read and includes the following:

  • Gestational age

  • Reason for Caesarean section

  • Fetal position and presentation

  • Length of labour and dilation before Caesarean section

  • Whether labour was induced or augmented

  • Type of uterine incision, extension of the incision, and closure

  • Any contraindication to future vaginal birth


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