Almost two-thirds of women who attempt natural delivery after a c-section are successful

November 20, 2013

Almost two-thirds of women who attempt a natural delivery after having a caesarean section for their first birth are successful, according to a new study published today (20 November) in BJOG: An International Journal of Obstetrics and Gynaecology.

The study, conducted by the Office for Research and Clinical Audit (ORCA) at the Royal College of Obstetricians and Gynaecologists and the London School of Hygiene & Tropical Medicine, aimed to investigate the factors that determine the uptake and success rate of after caesarean.

The data from 143,970 women, who had their first baby by caesarean section between 2004 and 2011, found that just over half (52%) attempted a vaginal birth after caesarean section (VBAC) for their second baby.

Researchers found that younger women, aged 24 or less, were more likely to attempt a VBAC than women aged over 34, 60% vs 45% respectively. Black women (62%) and Asian women (64%) were also found to have higher VBAC attempt rates for their second delivery when compared to (49%).

Of the women who attempted a VBAC almost two-thirds (63%) had a successful natural delivery, though researchers found that black women had a particularly low success rate when compared to white women, 50% vs 66% respectively. The study also showed that women aged over 34 had a lower success rate than women aged 24 or younger, 59% vs 69% respectively.

The reason for the first caesarean section was also found to strongly determine the likelihood of successful natural delivery in the second pregnancy. Furthermore, women with a history of failed induction of labour were almost twice as likely to have a failed VBAC.

The researchers also found variation in the rate of attempted and successful VBAC between NHS trusts. There was almost a threefold variation in attempted VBAC, ranging from 33% to 94%, and almost a twofold variation in successful vaginal delivery for the second baby, between 48% and 84%.

Hannah Knight, Office for Research and Clinical Audit, Royal College of Obstetricians and Gynaecologists, and lead researcher of the paper, said:

"The majority of women with an uncomplicated first caesarean section are candidates for attempting VBAC, but our data found that only half of those women chose this option.

"Women from a non-white ethnic background were more likely than white women to attempt a VBAC, but the success rate in non-white women was lower. This could point to different patient preferences or a lack of access to elective repeat caesarean section for non-white women.

"Interestingly, we also found an unexplained variation in the rate of attempted and successful VBAC between hospitals, which was independent of maternal demographic and clinical risk factors.

"An informed discussion about whether or not to attempt a vaginal delivery after a requires an assessment of the risk of emergency caesarean, and this paper provides valuable information both for women and the and midwives caring for them."

John Thorp, BJOG deputy editor-in-chief, added:

"In England approximately 50,000 women per year are faced with the choice of attempting a trial of labour after having had a c-section for their first delivery.

"This study shows encouraging results with the majority of women who attempted a natural delivery after a primary c-section being successful.

"Current UK guidelines state pregnant with a primary c-section and uncomplicated healthy second pregnancy should be given the option of a vaginal birth for their next baby, or an elective-repeat c-section, and counselled on the risks and benefits of both. Women with any questions about their delivery options should consult with their midwife or obstetrician."

Explore further: Vaginal delivery safest option for women with pelvic girdle pain, study finds

More information: Knight HE, Gurol-Urganci I, van der Meulen JH, Mahmood TA, Richmond DH, Dougall A, Cromwell DA. Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success. BJOG 2013; 10.1111/1471-0528.12508

Related Stories

Vaginal delivery safest option for women with pelvic girdle pain, study finds

January 17, 2013
(Medical Xpress)—Caesarean section increases the risk of persistent pelvic girdle pain after delivery compared with vaginal delivery, according to a new study from the Norwegian Institute of Public Health.

Review of 700,000 women reveals factors affecting vaginal birth after previous cesarean

July 27, 2011
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 ...

Uterine rupture is rare in the UK but increases with the number of previous cesarean deliveries

March 13, 2012
An analysis of the UK Obstetric Surveillance System published in this week's PLoS Medicine shows that uterine rupture—a serious complication of pregnancy in which the wall of the uterus (womb) tears during pregnancy ...

Obesity and induction in Irish, first-time mothers linked with caesarean rates, says study

August 16, 2013
(Medical Xpress)—The rate of emergency caesarean section in Irish mothers is twice that of Eastern European women who give birth in Ireland, according to a study from University College Dublin and the Economic and Social ...

Younger mothers and older mothers are at higher risk of adverse delivery outcomes

June 11, 2013
Younger mothers are at a higher risk of preterm birth while older mothers are more likely to have a caesarean section, suggests a new study published today (12 June) in BJOG: An International Journal of Obstetrics and Gynaecology.

Incontinence 20 years after child birth three times more common after vaginal delivery

March 26, 2012
Women are nearly three times more likely to experience urinary incontinence for more than 10 years following a vaginal delivery rather than a caesarean section, finds new research at the Sahlgrenska Academy at the University ...

Recommended for you

Study shows a significant ongoing decline in sperm counts of Western men

July 25, 2017
In the first systematic review and meta-analysis of trends in sperm count, researchers from the Hebrew University-Hadassah Braun School of Public Health and Community Medicine and the Icahn School of Medicine at Mount Sinai ...

Women exposed to smoke while in womb more likely to miscarry

July 13, 2017
Women exposed to cigarette smoke while in their mothers' wombs are more likely to experience miscarriage as adults, according to new research from the University of Aberdeen.

Lack of a hormone in pregnant mice linked to preeclampsia

June 30, 2017
(Medical Xpress)—A team of researchers from Singapore, the Netherlands and Turkey has isolated a hormone in pregnant mice that appears to be associated with preeclampsia—a pregnancy-related condition characterized by ...

Aspirin reduces risk of pre-eclampsia in pregnant women

June 28, 2017
Taking a low-dose aspirin before bed can reduce the risk of pre-eclampsia, which can cause premature birth and, in extreme cases, maternal and foetal death.

The biology of uterine fluid: How it informs the fetus of mom's world

June 22, 2017
A developing fetus bathes in a mixture of cellular secretions and proteins unique to its mother's uterus. Before fertilization, the pH of uterine fluid helps create a conducive environment for sperm migration, and afterward, ...

New clues in puzzle over pre-eclampsia and cholesterol regulation

June 21, 2017
Scientists studying a mystery link between the dangerous pregnancy complication pre-eclampsia and an increased risk of heart disease in later life for both mother and child have uncovered important new clues.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.