Incidence and outcome of vaginal birth after cesarean among women receiving counseling at El Manial University Hospital

Abstract

Background Repeated cesarean section (CS) is the most significant factor contributing to overall increased CS rates. The primary indicator of repeated CS is a prior CS. Vaginal birth after cesarean (VBAC) is a trial to reduce CS rates. Aim The aim of study was to examine the effect of counseling on the incidence, maternal, and neonatal outcomes of VBAC. Design A quasi-experimental one-group posttest-only design was adopted for this study. Setting The study was conducted at the Outpatient Clinic and Casualty Department at Manial University Hospital affiliated to Cairo University. Sample A purposive sample of pregnant women was recruited through a period of 6 months from July to December 2019 based on certain criteria; the most important one is to have a previous CS. Tool A structured interviewing tool, labor progress record (Partograph), and neonatal Apgar score were used to collect the data. Results A total of 90 participants were enrolled into study. A total of 79 (87.8%) women agreed to have VBAC after counseling compared with only 11 (12.2%), who refused to have VBAC and chose CS. The trial of labor after cesarean (TOLAC) rate was 40.5%. The rate of VBAC was 31.6%. Success rate of TOLAC was 78.1%, whereas failed TOLAC was 21.9% owing to lack of labor progress and fetal distress. Overall, 68.4% had CSs lower segment cesarean section (LSCS). Among them, 37% had elective LSCS and 63% had emergency LSCS. Physician decision without any medical indication for CS was the most common indications of elective repeat CS, with a rate of 85%. Oligohydramnios was the most common cause for emergency CS delivery, with a rate of 44.5%. All women who delivered VBAC had normal progress of labor and their babies had normal Apgar score (8–10). No cases that underwent VBAC had any morbidity or mortality. Conclusion Counseling is needed for the selection of VBAC as a mode of delivery. Successful VBAC is associated with better fetomaternal and neonatal outcomes, so most women with one previous cesarean delivery with a low-transverse incision should be counseled and encouraged to undergo a trial of labor in her recurrent pregnancy. Recommendations A qualitative research study should be conducted to assess the satisfaction of women from VBAC and compare it with CS.