Vaginal birth after caesarean: how NICE guidelines can inform midwifery practice
Vaginal birth after caesarean (VBAC) is an increasingly common choice offered to women in the UK. March 2019 saw the National Institute of Health and Care Excellence (NICE) publish new guidelines surrounding this area of intrapartum care. NICE's recommendations could be used in conjunction with existing guidelines, for example those published by the Royal College of Obstetrics and Gynaecology (RCOG) in 2015, to improve the experiences for women choosing VBAC and support healthcare professionals caring for women choosing trial of labour after caesarean (TOLAC) and VBAC. This article explores the history of VBAC and discusses how the new guidelines may inform future practice.
The National Institute for Health and Care Excellence ([NICE], 2019a) published new intrapartum care guidelines for women with existing medical conditions or obstetric complications and their babies. They contained new guidance for healthcare professionals caring for women in labour who are opting for a vaginal birth after caesarean section (VBAC). The guidelines were welcomed by many in the midwifery profession, primarily due to their individualised and more woman-centred approach.
Globally, increasing numbers of women are undergoing caesarean section (Boerma, 2018), with the potential for many of these women to go on to give birth to subsequent children. Determining whether women are suitable for a trial of labour after caesarean section (TOLAC) is a vitally important area of obstetrics and midwifery (Robson et al, 2015). Balanced counselling to aid women's choice is particularly important as data suggest that common interventions in childbirth, such as caesarean section, are associated with poorer long-term health outcomes (Clark and Silver, 2011).
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