Vaginal birth after Caesarean section: a practical evidence-based approach

Around 10% of the obstetric population have experienced prior Caesarean delivery. This article provides a practical evidence-based approach to the antenatal and intrapartum management of such women. A gestation-specific strategy is suggested. Women with an uncomplicated pregnancy and single previous lower segment Caesarean delivery may be managed in shared community care following counselling by a consultant midwife. It is important to provide complete informed consent detailing the risks and benefits for the woman that are individualised to her circumstances. It is estimated that planned vaginal birth after Caesarean exposes the woman to an additional 0.25% risk (or 1 in 400) for experiencing an adverse perinatal outcome (antepartum stillbirth, delivery-related perinatal death or hypoxic ischaemic encephalopathy) compared with opting for elective repeat Caesarean section (ERCS). It is likely that this risk is significantly reduced for women who opt for ERCS at the start of the 39th week; however, direct evidence to support this is lacking.