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The current management of vaginal birth after previous caesarean delivery

^1. St Bartholomew's Hospital West Smithfield, London EC1A 7BE, UK Email: ball.elizabeth{at}bartsandthelondon.nhs.uk (corresponding author)
^2. Sunderland Royal Hospital, Kayll Road, Sunderland, Tyne and Wear, SR4 7TP, UK

Key content:

• Judicious promotion of vaginal birth after caesarean section (VBAC) is a reasonable strategy to counter the rising caesarean section rate.
  
• VBAC can achieve cost savings along with greater patient satisfaction.
  
• Appropriate augmentation of labour with oxytocin is not associated with an increase in scar rupture rate.
  
• Induction of labour with prostaglandin should be approached with caution as it is associated with an increased risk of scar rupture.
  
• With careful selection and monitoring, VBAC can be considered in twin pregnancy.
  

Learning objectives:

• To be aware of the specific level of risk of common complications associated with VBAC (including scar rupture) to facilitate appropriate counselling of women.
  
• To become familiar with evidence-based tools that can help predict the outcome of planned VBAC.
  
• To know the signs and symptoms indicating impending or acute scar rupture in order to be able to manage women undergoing VBAC safely in the intrapartum period.
  

Ethical issues:

• Should society be concerned about the trend towards normalising caesarean birth?
  
• To what degree should women be able to choose repeat caesarean section in the absence of a medical indication?
  
• Research confirms that the majority of women can safely achieve a vaginal delivery after one caesarean section. Should units with low rates of successful VBAC be expected to review and justify their outcomes?
  

Please cite this article as: Ball E, Hinshaw K. The current management of vaginal birth after previous caesarean delivery. The Obstetrician & Gynaecologist 2007;9:77–82.

Keywords caesarean section / risk management / trial of scar / uterine rupture / vaginal birth after caesarean section