Birth after caesarean section - facilitating choice

Introduction The increase in the number of women having a primary Caesarean section (CS) has led to discussion about how to best manage their subsequent deliveries.12 The uptake of vaginal birth after Caesarean section (VBAC) varies widely, and success rates of planned VBAC are reported to be between 40-76%. Following an evidence-based model of promoting normality and reducing unnecessary intervention (3), the ‘Birth Options’ clinic was introduced at the Royal Free hospital (RFH) in Oct 2010. Delivered by a Consultant Obstetrician and a Consultant midwife, this model provides an opportunity for consistent dialogue regarding maternal and fetal risks and benefits of planned VBAC and planned CS to inform women9s choice. Method Data was collected prospectively from consecutive women who attended the weekly birth options clinic. Results Of 143 women seen in the clinic over a 12 month period having had 1 previous CS, 57.2 % opted to aim for VBAC and of those who labored spontaneously, 71.3% achieved vaginal delivery. The CS rate in this maternity unit fell from 30.3% at the commencement of this clinic to 28.1% at the time of submission. Conclusion Whilst other recently introduced initiatives, such as the daily review of all CS, may also contribute, it is likely that this clinic has played a key role in changing the unit culture and therefore a reducing unnecessary intervention.