A critical review of vaginal birth rates after a primary Caesarean in Queensland hospitals

Introduction For women with a lower uterine incision without indication for repeat Caesarean section (CS), vaginal birth for their next pregnancy is a safe option. Although these women should be encouraged to consider vaginal birth after a Caesarean section (VBAC) it is not consistently supported in practice. There is relatively little information on the extent to which maternal preference, birthing decisions and outcomes match best available evidence. Aim To describe current VBAC rates for women in Queensland, Australia and compare this to safe, achievable VBAC rates reported in national and international studies. Method Perinatal data from 2004 to 2011 were reviewed to determine current VBAC rates following a primary CS for women birthing in Queensland. These were compared with VBAC rates reported in the literature. Results Queensland has a high overall CS rate and high repeat CS rate compared with the national average. In 2010, Queensland VBAC rates for next birth following primary CS were 14% (range 13-21% public sector, 7-11% private hospitals). This is substantially lower than achievable Australian rates of 24% and international rates. Conclusion Low VBAC rates reflect low numbers of women commencing labour in a pregnancy subsequent to a primary CS. There is unexplained variation in VBAC rates between maternity facilities. Clinical reviews to support evidence-based practice are warranted. What is known about the topic Repeat CS is a major contributor to high CS rates in industrialised countries. What does this paper add Following a primary CS, women in Queensland are less likely to commence labour and achieve a vaginal birth compared with rates reported in national and international VBAC studies. What are the implications for practitioners Maternity clinicians need to be aware of best practice and contextualise the evidence for individual women to improve VBAC rates. © AHHA 2013.