Randomised trial of assigned mode of delivery after a previous cesarean section--impact on maternal psychological dynamics.
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.
Law
Lai Wa
LW
Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. lwlaw@cuhk.edu.hk
Pang
Man Wah
MW
Chung
Tony Kwok-Hung
TK
Lao
Terence Tzu-Hsi
TT
Lee
Dominic Tak-Shing
DT
Leung
Tak Yeung
TY
Sahota
Daljit Singh
DS
Lau
Tze Kin
TK
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*