Background
Repeat Cesarean section (C-section) is a major contributor to the high rate of C-sections in Canada. The majority of women with a previous C-section are eligible for a trial of labour leading to vaginal birth, yet the number of women choosing this option has dropped by half within the past decade.
Purpose
This study examines the factors Canadian women who have had a previous c-section consider when deciding on delivery method, as well as the issues Canadian maternity care providers consider in counselling these women on this important decision. The most current clinical practice guidelines from both the Society of Obstetricians and Gynaecologists of Canada (2005) and the American Congress of Obstetricians and Gynecologists (reaffirmed 2015) continue to recommend that women with one previous C-section and no medical contraindications be counseled about vaginal birth after one previous C-section and should be offered a trial of labour. The study findings will help inform maternity care providers, women, policy makers, health services planners in the development of strategies to support vaginal births after C-section when appropriate and judicious use of C-section when medically indicated.
Phase 1
Phase I of our study has been completed. We conducted in-depth telephone interviews with pregnant women who have had a previous C-section, to explore and describe the factors they consider when deciding on their preferred method of delivery for the present pregnancy. Similarly we conducted in-depth telephone interviews with obstetricians, family physicians and midwives, providing prenatal and/or intra-partum care, to examine the factors they considered when counseling pregnant women with a previous C-section on delivery method.
The study findings from Phase I are being used to develop two surveys, one for pregnant women with one previous C-section and one for maternity care providers (obstetricians, family physicians and midwives). The survey being developed for pregnant women will further explore the factors they consider when deciding their preference for an elective repeat C-section or a trial of labour. The survey developed for maternity care providers will further explore the factors they consider when counselling pregnant women, with a previous C-section on method of delivery.
Phase 2
We are currently recruiting participants for Phase II of this study. We have developed the maternity care provider survey from the findings in Phase I of the study. The survey is an anonymous online survey, which should take 15 to 20 minutes to complete. The survey further explores the factors providers consider when counselling women, with a previous C-section on method of delivery.
We have completed the development of the women’s online survey based in the Phase 1 research findings. The survey was developed for women who have had one previous C-section to further explore the factors they consider when deciding their preference for an elective repeat C-section or a trial of labour.
References
SOGC (2005). Guidelines for Vaginal Birth After Previous Caesarean Birth. No155, February 2005, http://sogc.org/wp-content/uploads/2013/01/155E-CPG-February2005.pdf
ACOG (2010) Vaginal Birth after previous Cesarean Delivery, Number 115, August 2010, Reaffirmed 2015. http://www.acog.org/Resources-And-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Obstetrics/Vaginal-Birth-After-Previous-Cesarean-Delivery
