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Neonatal outcomes following one previous caesarean section

02 March 2024
Volume 32 · Issue 3



Vaginal birth following a previous caesarean section is considered a safe option for subsequent births following personal planning and counselling. The aim of this study was to compare neonatal outcomes for both elective caesarean and vaginal birth after a previous caesarean section to aid decision making for women/pregnant people.


This quantitative study used retrospective data from low-risk pregnant people/women at term with one previous caesarean section (n=392). Logistic regression was used to determine the impact of mode of birth on neonatal outcomes. Further descriptive analyses were carried out to explore the results and reasons for admission to neonatal unit.


Apgar scores were higher in the vaginal birth group compared to the elective repeat caesarean group. There were no differences in neonatal unit admissions by mode of birth.


There is minimal difference in neonatal outcomes, regardless of intention for either vaginal birth following a previous caesarean section or elective repeat caesarean. To fully investigate the factors that impacted Apgar scores and neonatal unit admissions for these groups, a much larger sample is needed.

In the UK, one in three births between 2022 and 2023 resulted in a caesarean section (NHS Digital, 2023). For subsequent pregnancies, women/pregnant people who have had a caesarean section must decide whether to plan for an elective repeat caesarean or consider a vaginal birth (National Institute for Health and Care Excellence (NICE), 2023; NHS, 2023). The current success rate for vaginal birth after a previous caesarean section is 72–75% (Royal College of Obstetricians and Gynaecologists, 2015; NHS, 2023) although recent data from the national maternity and perinatal audit (Healthcare Quality Improvement Partnership (HQIP), 2022) clinical report indicate that the rate for England and Wales is 60%.

There is strict guidance on whether a vaginal birth after a previous caesarean section is in the best interests of both mother and child (NICE, 2023). Clinical guidance advocates thorough counselling for this cohort because of the risks associated with each mode of birth. Yet, there is no current standardised, national structure for advice, which can often vary between healthcare professionals (Fitzpatrick et al, 2019). During 2022–23, there were 547 244 births in the NHS, 210 492 of which were via caesarean section (NHS Digital, 2023; NHS, 2023). This equates to 38%, which is higher than the NICE (2023) guidance suggestion of 25–30%. This is a significant number of people potentially requiring informed and holistic tailored guidance on subsequent mode of birth options. The aims of this study were to examine whether there was an increased risk of adverse neonatal outcomes in women/pregnant people who elected to have a vaginal birth after a previous caesarean section, compared with those who choose to have an elective repeat caesarean section, in one NHS trust, providing local and meaningful data.

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