title: Non-clinical interventions that increase the uptake and success of vaginal birth after caesarean section: a systematic review.
abstract: OBJECTIVE
  The aim of this study was to review non-clinical interventions that increase the uptake and/or the success rates of vaginal birth after caesarean section.
  
  
  BACKGROUND
  Increases in rates of caesarean section are largely due to repeat caesarean section in a subsequent pregnancy. Concerns about vaginal birth after caesarean section have centred on the risk of uterine rupture. Nonetheless, efforts to increase the vaginal birth rate in these women have been made. This study reviews these in relation to non-clinical interventions.
  
  
  METHODS
  Literature was searched up until December 2008 from five databases and a number of relevant professional websites.
  
  
  METHODS
  A systematic review of quantitative studies that evaluated a non-clinical intervention for increasing the uptake and/or the success of vaginal birth after caesarean section was undertaken. Only study designs that involved a comparison group were included. Further exclusions were imposed for quality using the Critical Skills Appraisal Programme.
  
  
  RESULTS
  National guidelines influence vaginal birth after caesarean section rates, but a greater effect is seen when institutions develop local guidelines, adopt a conservative approach to caesarean section, use opinion leaders, give individualized information to women, and give feedback to obstetricians about mode of birth rates. Individual clinician characteristics may impact on the number of women choosing and succeeding in vaginal birth after caesarean section. There is inconsistent evidence that having private health insurance may be a barrier to the uptake and success of vaginal birth after caesarean section.
  
  
  CONCLUSIONS
  Non-clinical factors can have a significant impact on vaginal birth after caesarean section uptake and success.
authors.affiliation: Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology Sydney, New South Wales, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Catling-Paull
authors.forename: Rebecca
authors.initials: R
authors.lastname: Johnston
authors.forename: Clare
authors.initials: C
authors.lastname: Ryan
authors.forename: Maralyn J
authors.initials: MJ
authors.lastname: Foureur
authors.forename: Caroline S E
authors.initials: CS
authors.lastname: Homer
mesh_terms: D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D007348:Insurance, Health; D009774:Obstetrics / Q000379:methods / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D016064:Vaginal Birth after Cesarean / Q000193:education / Q000379:methods* / Q000706:statistics & numerical data