title: Randomised trial of assigned mode of delivery after a previous cesarean section--impact on maternal psychological dynamics.
abstract: OBJECTIVE
  This randomised trial was designed to study the psychological status and morbidity during and after delivery among women with a previous cesarean section (CS) who were randomised to planned vaginal birth (VBAC) or planned CS.
  
  
  METHODS
  Two hundred and ninety-eight women with one previous lower segment CS were randomised to either planned VBAC or planned CS. Women were asked to complete psychometric scales during their pregnancy till 6 months after confinement. The primary outcome studied was the differences in psychometric scores between the two study groups.
  
  
  RESULTS
  There were no differences in anxiety, depression, psychological well-being or satisfaction scores between the two groups. Significantly more women in planned VBAC (27/123) requested to change to elective CS, compared to those who were randomised to planned CS (15/135) initially requested to change to planned VBAC (OR: 2.25; 95% CI: 1.13-4.47). Subgroup analyses showed that women who changed from planned CS to VBAC had lower satisfaction at delivery [Client Satisfaction Score: 24.0 (23.0-24.3), 23.0 (22.0-24.0); p=0.009] compared to women who did not change their plan for elective CS.
  
  
  CONCLUSIONS
  The planned mode of delivery, either elective CS or VBAC, in pregnant women who had one previous CS did not influence the psychological dynamic during the course of or after the pregnancy. VBAC was not associated with higher psychological morbidity and therefore should be encouraged.
authors.affiliation: Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. lwlaw@cuhk.edu.hk
authors.forename: Lai Wa
authors.initials: LW
authors.lastname: Law
authors.forename: Man Wah
authors.initials: MW
authors.lastname: Pang
authors.forename: Tony Kwok-Hung
authors.initials: TK
authors.lastname: Chung
authors.forename: Terence Tzu-Hsi
authors.initials: TT
authors.lastname: Lao
authors.forename: Dominic Tak-Shing
authors.initials: DT
authors.lastname: Lee
authors.forename: Tak Yeung
authors.initials: TY
authors.lastname: Leung
authors.forename: Daljit Singh
authors.initials: DS
authors.lastname: Sahota
authors.forename: Tze Kin
authors.initials: TK
authors.lastname: Lau
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications; D017604:Cesarean Section, Repeat / Q000523:psychology*; D003863:Depression / Q000150:complications; D005260:Female; D006801:Humans; D057240:Patient Preference / Q000523:psychology*; D017060:Patient Satisfaction; D011247:Pregnancy; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000523:psychology*