Birth after caesarean section: changes over a nine-year period in one Australian state.
OBJECTIVE
to describe the outcomes related to birth after a caesarean section (CS) in one Australian state, New South Wales (NSW), over a nine-year period. The objectives were to determine whether changes had occurred in the rates of attempted and successful vaginal birth after caesarean section (VBAC), induction of labour, place of birth, admission to special care or neonatal intensive care nursery and perinatal mortality.


METHODS
cross-sectional analytic study of hospital births in New South Wales using population-based data from 1998-2006.


METHODS
women experiencing the next birth after a CS where: the total number of previous CS was 1; the presentation at birth was vertex; it was a singleton pregnancy; and, the estimated gestational age was greater than or equal to 37 weeks. A total of 53,455 women met these criteria.


METHODS
data were obtained from NSW Health Department's Midwives Data Collection (MDC). The MDC includes all live births and stillbirths of at least 20 weeks gestation or 400g birth weight in the state.


RESULTS
over the nine-year period, the rate of vaginal birth after caesarean section declined significantly (31-19%). The proportion of women who 'attempted a vaginal birth' also declined (49-35%). Of those women who laboured, the vaginal birth rate declined from 64% to 53%. Babies whose mothers 'attempted' a VBAC were significantly less likely to require admission to a special care nursery (SCN) or neonatal intensive care (NICU). The perinatal mortality rate in babies whose mothers 'attempted' a VBAC was higher than those babies born after an elective caesarean section although the absolute numbers are very small.


CONCLUSIONS
rates of VBAC have declined over this nine-year period. Rates of neonatal mortality and proxy measures of morbidity (admission to a nursery) are generally in the low range for similar settings.


CONCLUSIONS
decisions around the next birth after CS are complex. Efforts to keep the first birth normal and support women who have had a CS to have a normal birth need to be made. More research to predict which women are likely to achieve a successful VBAC and the most effective ways to facilitate a VBAC is essential. Midwives have a critical role to play in these endeavours.
Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology Sydney, NSW 2007, Australia. caroline.homer@uts.edu.au
Caroline S E
CS
Homer
Rebecca
R
Johnston
Maralyn J
MJ
Foureur
D002755:Choice Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D009017:Morbidity; D009517:New South Wales / Q000453:epidemiology; D054238:Perinatal Mortality; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data