A wide range of clinical and non-clinical factors can affect whether women go on to have a vaginal delivery after having a caesarean, according to two major reviews published in the August issue of the Journal of Advanced Nursing.
Private health insurance, induction, cervical ripening agents, local guidelines and scoring systems were just some of the issues explored by the reviews of 60 studies, published over 24 years, covering more than 700,000 women and hundreds of hospitals in 13 countries.
Researchers from the Faculty of Nursing, Midwifery and Health at the University of Technology, Sydney, New South Wales, Australia, were keen to see if clinical and non-clinical interventions increased the uptake and/or success of vaginal births after caesarean sections (VBAC).
"Many women who have had caesarean sections opt for the same procedure with their next pregnancy" says lead author Christine Catling-Paull. "Caesarean rates have increased around the world in the past two decades and much of this increase is due to women who have had previous caesareans.
"Research shows that only 33 per cent of women in the UK will have a VBAC and in Australia the rate is even lower at just under 17 per cent. However, another study from the USA shows that 73 per cent of women who had a caesarean went on to have a successful vaginal delivery."
The review of non-clinical factors comprised 34 papers published between 1984 and 2007, covering more than 650,000 women and hundreds of hospitals. Thirteen countries were included, with 18 studies from the USA, three from Canada, three from the UK and one each from Australia, France, China, Ireland, Israel, Jordan, Scotland, Singapore, Switzerland and South Africa.
Key findings included:
The review of clinical factors comprised 27 papers published between 1989 and 2008 and covering more than 50,000 women, including one that also provided information for the non-clinical review. Eighteen studies were from the US, six from Canada, two from the UK and one from Australia.
Key findings included:
"Both of the reviews also confirmed that there is a high caesarean section rate around the world, mainly women choosing to have a repeat caesarean, and there is considerable variation with regard to acceptance, uptake, support and success of women undergoing VBAC" says Christine Catling-Paull.
The authors have come up with a number of key recommendations for clinical practice as a result of the reviews:
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