Birth after previous caesarean section
Midwifery and obstetric involvement in supported decision making and subsequent clinical practice around birth after caesarean section has been much debated and negotiated for some time. This article discusses some of the clinical evidence and factors to be taken into account when providing support and information for women and birthing people considering their options for birth after caesarean. The article focuses on the currently published guidelines to support practice and guide discussions with women and birthing people. In the article, the terms ‘planned vaginal birth’ and ‘vaginal birth after caesarean’ are used interchangeably.
Research published by the World Health Organization (WHO, 2021) has shown that caesarean section incidence is globally increasing from 7% in 1990 to a current 21% of all births, with an estimated rise to 29% by 2030 (Betran et al, 2021). In some countries, the incidence of lower (uterine) segment caesarean section already outnumbers the incidence of vaginal birth, with wide variation between countries in incidences, some having rates as high as 43% (Betran et al, 2021). UK statistics presented by the National Maternity and Perinatal Audit Project Team (2019) suggest an overall caesarean section rate of 25.8%, (11.3% elective, 14.5% emergency), with incidence rates for multiparous women and birthing people 15.7% (elective) and 9.4% (emergency). The report indicates that the overall rate of vaginal birth after caesarean is 24.5% (this figure limited to secundiparous women).
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