title: Perceptions and practices of vaginal birth after Caesarean section among privately practicing obstetricians in Kenya.
abstract: OBJECTIVE
  To determine perceptions, preferences and practices of vaginal birth after Caesarean.
  
  
  METHODS
  Cross-sectional descriptive study.
  
  
  METHODS
  Private clinics of obstetricians in five major towns of Kenya.
  
  
  METHODS
  Obstetricians in private practice.
  
  
  METHODS
  Practice and experiences in trial of labour (TOL); need for, and application of, selection criteria in TOL; perceptions on outcomes of TOL and patient preference; perception on trends of vaginal birth after Caesarean (VBAC) and need for policy on TOL.
  
  
  RESULTS
  Nearly all respondents (98.4%) believed in the need for, and application of, selection criteria for allowing TOL. However, only 23% believed in routine screening with radiological pelvimetry, while 63.2% believed in routine foetal weight estimation. All obstetricians (100%) have ever managed TOL in private practice, and 74% had managed at least one case in the last six months. Despite lack of tangible selection criteria, 83.1% think that most women prefer TOL while 95.1% discourage it if perceived as inappropriate. Failure rate of TOL was perceived to be more than 50% by 35.2% of the respondents. A majority of the respondents (about 75%) would prefer TOL on themselves or their spouses. Those who perceived that there was a falling trend of VBAC were 58%, citing increased demand by mothers (45.7%), obstetricians' convenience (40.0%) and fear of litigation (26.8%) as the reasons for this observation. A fluid policy of "TOL whenever it is deemed as appropriate" was preferred by 88.7%.
  
  
  CONCLUSIONS
  The perception of obstetricians is that desire for VBAC predominates over elective repeat Caesarean. However, consensus on appropriate selection criteria is lacking, which leaves the obstetrician in a management dilemma. Hence, there is need to study outcomes of both ERC and TOL in order to come out with objective policy guidelines on management of one previous Caesarean in pregnancy.
authors.affiliation: Department of Obstetrics and Gynaecology, College of Health Science, University of Nairobi, P.O. Box 19676, Nairobi, Kenya.
authors.forename: R
authors.initials: R
authors.lastname: Koigi-Kamau
authors.forename: P K
authors.initials: PK
authors.lastname: Leting
authors.forename: J N
authors.initials: JN
authors.lastname: Kiarie
mesh_terms: D000328:Adult; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D003469:Culture; D005260:Female; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000379:methods / Q000639:trends; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000379:methods / Q000639:trends