Maternal and neonatal outcomes for women giving birth after previous cesarean
More details
Hide details
Department of Midwifery, University of West Attica, Athens, Greece
Anastasia Charitou   

University of West Attica, Agiou Spyridonos 28, 12243, Egaleo, Greece
Publish date: 2019-04-17
Submission date: 2017-11-26
Final revision date: 2019-04-11
Acceptance date: 2019-04-11
Eur J Midwifery 2019;3(April):8
Rising rates of caesarean section (CS) is an issue of particular concern. Recently, there has been research supporting Vaginal Births After Caesarean (VBAC), which is controversial. In Greece, over half of births in the country are by CS, placing Greece among countries with the highest CS rates. The aim of this study was to investigate the prevalence and the factors associated with VBACs and to compare the maternal/neonatal outcomes with a ‘non-caesarean’ control group.

The data were evaluated and retrospectively gathered on archived singleton births, from medical records of a midwifery-led team, between May 2006 and May 2013. The target group of the study included mothers with a previous CS, who had a second birth. The sample consisted of 71 VBAC women and 583 who had normal spontaneous vaginal delivery (NSVD) as the ‘non-caesarean’ control group.

The duration of labour was longer for the VBACs compared with first-time mothers who gave birth naturally (for duration 481–720 min, 27% vs 10.3%, respectively), episiotomy was more common for VBAC (20.7% vs 7.9%), and epidural analgesia was more often for VBAC (68.4% vs 10%). The percentage of 1-min Apgar score in the range 0–7 in the VBAC group was 5%, and there was no significant difference in women who had NSVD (3.6%). The Apgar score in the 5th minute was always above 8 for both groups.

Severe maternal and neonatal complications are infrequent, and therefore the necessity arises for further continuous studies to ascertain the safety of VBAC.

We are grateful to all women who contributed with their valuable perspectives. We would also like to acknowledge the contributions of the midwifery-led team.
V.G. Vivilaki reports that she is the Editor-in-Chief of EJM journal and that there are no conflicts of interest with this current work. The rest of the authors also have completed and submitted an ICMJE form for disclosure of potential conflicts of interest and none was reported.
This work has taken place from self-funded midwives.
Not commissioned; externally peer reviewed.
Project, EURO-PERISTAT. European perinatal health report. Health and care of pregnant women and babies in Europe in 2010, 2013. Accessed October 17, 2018.
Morrisson JJ, Rennie JM,Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol. 1995;50(8):597-581. doi:10.1097/00006254-199508000-00007
Guise JM, Eden K, Emeis C, et al. Vaginal Birth After Cesarean: New Insights. Evidence Report/Technology Assessment No.191. Rockville, MD: Agency for Healthcare Research and Quality; 2010.
Marshall NE, Fu R, Guise JM. Impact of multiple cesaren deliveries on maternal morbidity: A systematic Review. Am J Obstet Gynecol. 2011;205(3):262.e1-262.e8. doi:10.1016/j.ajog.2011.06.035
Nilsson C, Lundgren I, Smith V, et al. Women-centred interventions to increase vaginal birth after caesarean section (VBAC): A systematic review. Midwifery. 2015;31(7):657-663. doi:10.1016/j.midw.2015.04.003
World Health Organization. WHO statement on caesarean section rates. Geneva, Switzerland: World Health Organization; 2014.
World Health Organization. Appropriate Technology for Birth. Lancet. 1985;326(8452):436-437. doi:10.1016/s0140-6736(85)92750-3
Foureur M, Turkmani S, Clack DC, et al. Caring for women wanting a vaginal birth after previous caesarean section: A qualitative study of the experiences of midwives and obstetricians. Women and Birth. 2017;30(1):3-8. doi:10.1016/j.wombi.2016.05.011
Clarke M, Savage G, Smith V, et al. Improving the organisation of maternal health service delivery and optimising childbirth by increasing vaginal birth after caesarean section through enhanced women-centred care (OptiBIRTH trial): study protocol for a randomised controlled trial. Trials. 2015;16(1)542. doi:10.1186/s13063-015-1061-y
World Health Organization. WHO statement on caesarean section rates. Geneva: World Health Organization; 2015.
Lundgren I, Healy P, Carroll M, et al. Clinicians’ views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a study from countries with low VBAC rates. BMC Pregnancy and Childbirth. 2016;16(1):350. doi:10.1186/s12884-016-1144-0
World Health Organization. Greece commits to addressing excessive reliance on caesarean sections. Accessed October 17, 2018.
David M, Gross Mechthild M, Wiemer A, Pachaly J, Vetter K. Prior cesarean section—An acceptable risk for vaginal delivery at free-standing midwife-led birth centers? Results of the analysis of vaginal birth after cesarean section (VBAC) in German birth centers. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2009;142(2):106-110. doi:10.1016/j.ejogrb.2008.09.015
Guidelines for vaginal birth after previus ceasarean. (ACOG), American college of obstericians and gynecologists. Washington, DC: ACOG Commitee opinion 64; 1988.
Vaginal Birth after Previous Cesarean Delivery. (ACOG), American College of Obstetricians and Gynecologists. Washington DC: (ACOG Practice Bulletin:115); 2010.
Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. BMJ. 2008;336(7635):85–87. doi;10.1136/
Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GML. Caesarean section for non-medical reasons at term. Cochrane Database Sys Rev. 2012. doi:10.1002/14651858.CD004660.pub3
Tracy S, Tracy M, Sullivan E. Admission of term infants to neonatal intensive care: a population-based study. Birth. 2007;34(4):301–307. doi:10.1111/j.1523-536x.2007.00188.x
Flenady V, Middleton P, Smith G, et al. Stillbirths: the way forward in high-income countries. Lancet. 2011;377(9778):1703–1717. doi:10.1016/s0140-6736(11)60064-0
Dodd JM, Crowther CA, Huertas E, Guise JM, Horey D. Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth (Review). Cochrane Database Syst Rev. 2013;(12):CD004224. doi: 10.1002/14651858.CD004224.pub3
Crowther CA, Dodd JM, Hiller JE, Haslam RR, Robinson. Birth After Caesarean Study Group. Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial. PLoS Medicine. 2012;9(3):e1001192
Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. New England Journal of Medicine. 2004;351(25):2581-2589. doi:10.1056/nejmoa040405
Reif P, Brezinka C, Fischer T, et al. Labour and Childbirth After Previous Caesarean Section - Recommendations of the Austrian Society of Obstetrics and Gynaecology (OEGGG). Geburtsh Frauenheilk. 2016; 76(12):1279–1286. doi:10.1055/s-0042-118335
Mercer BM, Gilbert S, Landon MB, et al. Labor outcomes with increasing number of prior Vaginal Birth After Cesarean Delivery. Obstet Gynecol. 2008;111(2):285-291. doi:10.1097/aog.0b013e31816102b9
Das M, Varma R. Vaginal birth after caesarean section: a practical evidence based approach. Obsterics, Gynecology and Reproductive Medicine. 2012;22(7):177-185. doi:10.1016/j.ogrm.2012.03.004
NICE. Caesarean Section . Clinical Guideline 131. Published November 2011. Accessed October 17, 2018.
Beucher G, Dolley P, Levy-Thissier S, Florian A, Dreyfus M. [Maternal benefits and risks of trial of labor versus elective repeat caesarian delivery in women with a previous caesarian delivery}. J Gynecol Obstet Biol Reprod. 2012;41(8):708-726. doi:10.1016/j.jgyn.2012.09.028
Bujold E, Blackwell SC, Gauthier RJ. Cervical ripening with transcervical foley catheter and the risk of uterine rupture. Obstet Gynecol. 2004;103(1);18–23. doi:10.1097/01.aog.0000109148.23082.c1
Tilden EL, Cheyney M, Guise JM, et al. Vaginal birth after cesarean: neonatal outcomes and United States birth setting. American Journal of Obstetrics & Gynecol. 2017;216(4)403.e1-403.e8. doi:10.1016/j.ajog.2016.12.001
Grylka- Baeschlin S, Petersen A, Karch A, Gross M. Labour duration and timing of the interventions in women planning vaginal birth after caesarean section. Midwifery. 2016;34:221-229. doi:10.1016/j.midw.2015.11.004
Raja JF, Bangash KT, Mahmud G. VBAC ScoringQ Successful vaginal delivery in previous one caesarean section in induced labour. J Pak Med Assoc. 2013;63(9):1147-1151.
Shehadeh A. Elderly primigravida and pregnancy outcome. JRMS. 2002;9(2):8-11.
Tripathi JB, Doshi HU, Kotdawala PJ. Vaginal birth after one caesarean section: analysis of indicators of success. J Indian Med Assoc. 2006;104(3):113-115.
Spong CY, Landon MB, Gilbert S, et al. Risk of Uterine Rupture and Adverse Perinatal Outcome at Term After Cesarean Delivery. Obstet Gynecol. 2007;110(4):801-807. doi:10.1097/01.aog.0000284622.71222.b2
Brill Y, Windrim R. Vaginal birth after Caesarian section: review of antenatal predictors of success. JOGC. 2003;25(4):275-286. doi:10.1016/s1701-2163(16)31030-1