Trial of labour and vaginal birth after previous caesarean section: A population based study of Eastern African immigrants in Victoria, Australia

- African immigrant women are often at higher risk of caesarean in developed countries.
- Yet, little is known about their rates of vaginal birth after caesarean (VBAC).
- We report attempted and successful VBAC for Eastern African immigrant women.
- Unsuccessful VBAC attempt were more common among Eastern African immigrant women.
- The findings suggest these women need improved support when undergoing trial of labour.

ObjectivesVariations in caesarean section (CS) between some immigrant groups and receiving country populations have been widely reported. Often, African immigrant women are at higher risk of CS than the receiving population in developed countries. However, evidence about subsequent mode of birth following CS for African women post-migration is lacking. The objective of this study was to examine differences in attempted and successful vaginal birth after previous caesarean (VBAC) for Eastern African immigrants (Eritrea, Ethiopia, Somalia and Sudan) compared with Australian-born women.DesignA population-based observational study was conducted using the Victorian Perinatal Data Collection. Pearson's chi-square test and logistic regression analysis were performed to generate adjusted odds ratios for attempted and successful VBAC.SettingVictoria, Australia.Participants554 Eastern African immigrants and 24,587 Australian-born eligible women with previous CS having singleton births in public care.Findings41.5% of Eastern African immigrant women and 26.1% Australian-born women attempted a VBAC with 50.9% of Eastern African immigrants and 60.5% of Australian-born women being successful. After adjusting for maternal demographic characteristics and available clinical confounding factors, Eastern African immigrants were more likely to attempt (ORadj 1.94, 95% CI 1.57-2.47) but less likely to succeed (ORadj 0.54 95% CI 0.41-0.71) in having a VBAC.Conclusion/Implications for practiceThere are disparities in attempted and successful VBAC between Eastern African origin and Australian-born women. Unsuccessful VBAC attempt is more common among Eastern African immigrants, suggesting the need for improved strategies to select and support potential candidates for vaginal birth among these immigrants to enhance success and reduce potential complications associated with failed VBAC attempt.