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CONFERENCE PROCEEDING
Birth outcomes for women planning vaginal birth after caesarean (VBAC) in midwifery led settings: A systematic review and meta-analysis
1
North Middlesex NHS Trust, Maternity, London, United Kingdom
2
King's College London, Women and Children's Health- Faculty of Life Sciences and Medicine, London, United Kingdom
Eur J Midwifery 2026;10(Supplement 1):A190
ABSTRACT
BACKGROUND:
Limited evidence exists to inform midwives, obstetricians, and women about the safety and success of planned vaginal birth after caesarean (VBAC) in midwifery-led settings compared to obstetric units. This gap restricts informed decision-making about place of birth for women planning VBAC.
OBJECTIVES:
To synthesise existing research comparing maternal and neonatal outcomes of planned VBAC in midwifery-led versus obstetric-led settings in high-income countries.
METHODS:
We systematically searched six databases for quantitative studies on planned VBAC outcomes in midwifery versus obstetric settings (up to August 2022). Included studies were quality assessed using the CASP checklist. Meta-analyses of binary outcomes were performed, reporting risk ratios (RR) with 95% confidence intervals (CI). Narrative synthesis was used for heterogeneous outcomes.
RESULTS:
Two high-quality studies (from 420 screened) were included. Planned VBAC in midwifery-led settings was associated with higher rates of unassisted vaginal birth (RR=1.42; 95% CI 1.37–1.48) and lower rates of emergency caesarean (RR=0.46; 95% CI 0.39–0.56) and instrumental birth (RR=0.33; 95% CI 0.23–0.47) compared to obstetric-led settings. No significant differences were found in uterine rupture (RR=1.03; 95% CI 0.52–2.07), special care nursery admissions (RR=0.71; 95% CI 0.47–1.23), or low Apgar scores (RR=1.16; 95% CI 0.66–2.03).
CONCLUSIONS:
Planned VBAC in midwifery-led settings is linked to increased vaginal birth rates and fewer interventions, with rare adverse perinatal outcomes. Further research is urgently needed to strengthen evidence and support informed choice for women planning VBAC. *This living systematic review will be updated prior to the conference to include all studies published since the initial search, supporting evolving evidence for clinical guidance.
KEY MESSAGE:
Based on high-quality but limited evidence, women planning VBAC in midwifery-led settings experience fewer interventions and comparable safety outcomes to those in obstetric-led settings, supporting informed choice. Labour and birth - VBAC
Limited evidence exists to inform midwives, obstetricians, and women about the safety and success of planned vaginal birth after caesarean (VBAC) in midwifery-led settings compared to obstetric units. This gap restricts informed decision-making about place of birth for women planning VBAC.
OBJECTIVES:
To synthesise existing research comparing maternal and neonatal outcomes of planned VBAC in midwifery-led versus obstetric-led settings in high-income countries.
METHODS:
We systematically searched six databases for quantitative studies on planned VBAC outcomes in midwifery versus obstetric settings (up to August 2022). Included studies were quality assessed using the CASP checklist. Meta-analyses of binary outcomes were performed, reporting risk ratios (RR) with 95% confidence intervals (CI). Narrative synthesis was used for heterogeneous outcomes.
RESULTS:
Two high-quality studies (from 420 screened) were included. Planned VBAC in midwifery-led settings was associated with higher rates of unassisted vaginal birth (RR=1.42; 95% CI 1.37–1.48) and lower rates of emergency caesarean (RR=0.46; 95% CI 0.39–0.56) and instrumental birth (RR=0.33; 95% CI 0.23–0.47) compared to obstetric-led settings. No significant differences were found in uterine rupture (RR=1.03; 95% CI 0.52–2.07), special care nursery admissions (RR=0.71; 95% CI 0.47–1.23), or low Apgar scores (RR=1.16; 95% CI 0.66–2.03).
CONCLUSIONS:
Planned VBAC in midwifery-led settings is linked to increased vaginal birth rates and fewer interventions, with rare adverse perinatal outcomes. Further research is urgently needed to strengthen evidence and support informed choice for women planning VBAC. *This living systematic review will be updated prior to the conference to include all studies published since the initial search, supporting evolving evidence for clinical guidance.
KEY MESSAGE:
Based on high-quality but limited evidence, women planning VBAC in midwifery-led settings experience fewer interventions and comparable safety outcomes to those in obstetric-led settings, supporting informed choice. Labour and birth - VBAC
| eISSN: | 2585-2906 |
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