Women-centred interventions to increase vaginal birth after caesarean section (VBAC): A systematic review.
OBJECTIVE
to evaluate the effectiveness of women-centred interventions during pregnancy and birth to increase rates of vaginal birth after caesarean.


METHODS
we searched bibliographic databases for randomised trials or cluster randomised trials on women-centred interventions during pregnancy and birth designed to increase VBAC rates in women with at least one previous caesarean section. Comparator groups included standard or usual care or an alternative treatment aimed at increasing VBAC rates. The methodological quality of included studies was assessed independently by two authors using the Effective Public Health Practice Project quality assessment tool. Outcome data were extracted independently from each included study by two review authors.


RESULTS
in total, 821 citations were identified and screened by title and abstract; 806 were excluded and full text of 15 assessed. Of these, 12 were excluded leaving three papers included in the review. Two studies evaluated the effectiveness of decision aids for mode of birth and one evaluated the effectiveness of an antenatal education programme. The findings demonstrate that neither the use of decision aids nor information/education of women have a significant effect on VBAC rates. Nevertheless, decision-aids significantly decrease women's decisional conflict about mode of birth, and information programmes significantly increase their knowledge about the risks and benefits of possible modes of birth.


CONCLUSIONS
few studies evaluated women-centred interventions designed to improve VBAC rates, and all interventions were applied in pregnancy only, none during the birth. There is an urgent need to develop and evaluate the effectiveness of all types of women-centred interventions during pregnancy and birth, designed to improve VBAC rates.


CONCLUSIONS
decision-aids and information programmes during pregnancy should be provided for women as, even though they do not affect the rate of VBAC, they decrease women's decisional conflict and increase their knowledge about possible modes of birth.
Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, SE-405 30 Gothenburg, Sweden. Electronic address: christina.nilsson@gu.se.
Christina
C
Nilsson
Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, SE-405 30 Gothenburg, Sweden. Electronic address: ingela.lundgren@gu.se.
Ingela
I
Lundgren
School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland. Electronic address: smithv1@tcd.ie.
Valerie
V
Smith
University of Eastern Finland, Faculty of Health Sciences, POB 1627, Kuopio University Hospital, 70211 Kuopio, Finland. Electronic address: katri.vehvilainenjulkunen@uef.fi.
Katri
K
Vehvilainen-Julkunen
Universita Degli Studi di Genova, Via Balbi 5, 16126 Genova, Italy. Electronic address: jnicoletti@libero.it.
Jane
J
Nicoletti
School of Nursing and Midwifery, Saolta University Healthcare Group, University Road, Galway, Ireland. Electronic address: declan.devane@nuigalway.ie.
Declan
D
Devane
Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Electronic address: bernloehr.annette@mh-hannover.de.
Annette
A
Bernloehr
Zuyd University, Department of Midwifery Science, POB 1256, 6201 BG Maastricht, The Netherlands. Electronic address: e.vanlimbeek@av-m.nl.
Evelien
E
van Limbeek
School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland. Electronic address: LALORJ1@tcd.ie.
Joan
J
Lalor
School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland. Electronic address: cbegley@tcd.ie.
Cecily
C
Begley
D005060:Europe; D005260:Female; D006801:Humans; D000068101:Maternal-Child Health Services; D008880:Midwifery; D018802:Patient-Centered Care; D011247:Pregnancy; D011295:Prenatal Care; D016032:Randomized Controlled Trials as Topic; D016064:Vaginal Birth after Cesarean
Caesarean section (CS); Systematic review; Vaginal birth after caesarean (VBAC); Women-centred intervention