A Study of Patients'Acceptance Towards Vaginal Birth After Caesarean Section

EDITORIAL COMMENT: We accepted this paper for publication because of the information it provides concerning patients' decisions regarding their willingness to attempt vaginal birth after a previous Caesarean section (VBAC). In this study about 50% would accept a VBAC if told that the chance of success was 70%. However the women were not followed‐up to determine the number who actually underwent trial of scar and vaginal birth in a subsequent pregnancy. When counselling women after Caesarean section they should be informed of the rate of trial of scar in the institution concerned as well as the success rate of the procedure. Table A shows that at the Mercy Hospital for Women the rate of trial of scar has remained constant at about 30% of women with a previous Caesarean, and the success rate is about 80%. During this 24‐year‐period the rate of Caesarean section in this hospital increased progressively from 9.3 to 18.8%: in 1994 the rate was 21.4%. We suspect that these hospital figures are similar to other institutions since the trends shown are similar to those in the State of Victoria as a whole. To reduce the rate of Caesarean section there must be a reduction in the number of primary Caesarean sections or a higher rate of trial of scar, or both. Many studies have reported that this is possible in an individual hospital (B, C). Targett studied this subject exhaustively and concluded that to ensure the greatest chance of vaginal delivery with optimum safety, the onset of labour should be spontaneous and the issue should be resolved within 12 hours (D). There is a big difference in the number of women who decide to have a trial of scar and the number who actually have one. In early pregnancy both obstetrician and patient agree to attempt vaginal delivery, but as the pregnancy progresses, the resolve of the parties concerned weakens, and an elective repeat Caesarean is eventually performed. This often occurs when the pregnancy proceeds beyond full‐term and the head remains high, especially if there is an indication for induction of labour. We need data from a study of why women who elect to have a trial of scar end up with a repeat elective Caesarean section to document the problems we must contend with. B. Maher CF, Cave DG, Haran MV. Caesarean section rate reduced. Aust NZ J Obstet Gynaecol 1994; 34: 389–392. C. Chua S, Arulkumaran S, Singh P, Ratnam SS. Trial of labour after previous Caesarean section: Obstetric outcome. Aust NZ J Obstet Gynaecol 1989; 29: 12–17. D, Targett C, Caesarean section and trial of scar. Aust NZ J Obstet Gynaecol 1988; 28: 249–262. Epilogue: The challenge has been taken up by women and their obstetricians in Eire: Coombe Women's Hospital, Dublin. Annual Clinical Report, 1994. MJ Turner. There were 458patients with 1 previous Caesarean section; 348 (76%) were allowed a trial of labour and 85.3% delivered vaginally. Summary: Patients' acceptance towards vaginal birth after Caesarean section (VBAC) was studied in 99 women with previous Caesarean section. Their attitude was strongly related to the chance of success of VBAC. Only 53.3% of patients would accept VBAC if they were told that the chance of success was 70%. A history of vaginal delivery and a negative feeling towards previous operation were positively associated with acceptance of VBAC (p<0.01), while convenience of elective Caesarean section and fear of vaginal delivery (even although most of them had had no vaginal delivery before) were the commonest reasons for refusal. The major causes of a negative feeling towards the previous Caesarean section were postoperative pain and a long recovery period. There was no significant negative effect on acceptance of VBAC if the previous Caesarean section was performed as an emergency operation for slow progress of labour or cephalopelvic disproportion.