title: Vaginal birth after caesarean delivery in Chinese women and Western immigrants in Shanghai.
abstract: Recent studies show a steep rise in caesarean sections in China. Most couples are now eligible to apply for a second child. This retrospective cohort study compares the prevalence of trial of labour and vaginal birth after caesarean section among Chinese and foreign women in Shanghai. In total, 135 of 368 women underwent trial of labour (36.68%), and of those, 77 (57.04%) had a vaginal birth. After inclusion in a multivariate model, factors associated with trial of labour were maternal age <35 years with an adjusted odds ratio of 2.58 (1.49-4.46), absence of a history of ≥3 abortions (2.22 (1.08-4.57)), and European citizenship (1.94 (1.05-3.59)). The prevalence of trial of labour and vaginal birth seems to mirror rates found in countries of origin, but despite a high rate of caesarean section, Chinese women had a higher rate of vaginal birth after caesarean section than North American and Australian women, in particular. Impact statement What is already known on this subject: Caesarean section (CS) rates are rising worldwide. Repeat CS contributes largely to these rates, although vaginal birth after CS (VBAC) rates varies widely between countries. What the results of this study add: North American and Australian women who deliver in Shanghai have low rates of attempted trial of labour after CS (TOLAC) and VBAC, with European women having the highest rate of TOLAC, followed by Chinese women. Implications for clinical practice and/or further research: These findings might reflect different levels of acceptance in line with respective national trends. Studies evaluating the influence of cultural norms on birth preferences after CS are needed. Further research is also needed to assess the overall acceptance of TOLAC in the context of the softening of the one-child policy in China.
authors.affiliation: a Shanghai United Family Hospital , Shanghai , People's Republic of China.
authors.forename: Anne-Frederique
authors.initials: AF
authors.lastname: Minsart
authors.affiliation: a Shanghai United Family Hospital , Shanghai , People's Republic of China.
authors.forename: Hau
authors.initials: H
authors.lastname: Liu
authors.affiliation: a Shanghai United Family Hospital , Shanghai , People's Republic of China.
authors.forename: Shannon
authors.initials: S
authors.lastname: Moffett
authors.affiliation: a Shanghai United Family Hospital , Shanghai , People's Republic of China.
authors.forename: Crystal
authors.initials: C
authors.lastname: Chen
authors.affiliation: a Shanghai United Family Hospital , Shanghai , People's Republic of China.
authors.forename: Ninni
authors.initials: N
authors.lastname: Ji
mesh_terms: D000328:Adult; D000367:Age Factors; D044466:Asian People / Q000706:statistics & numerical data*; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D002681:China; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D016017:Odds Ratio; D011247:Pregnancy; D012189:Retrospective Studies; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*
keywords: Caesarean section; family planning policy; immigration; one-child policy; trial of labour; vaginal birth after caesarean