2015•Zeitschrift für Geburtshilfe und NeonatologieRequires access
Vaginal mode of birth after previous caesarean section versus elective repeat caesarean section: factors associated with women's preferences in Western Switzerland
Magali Bonzon, André Karch, Kathrin H. Stoll, Susanne Grylka-Bäschlin, Mechthild M. Groß
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Abstract
Objective: High rates of successful vaginal births after previous caesarean section are observed (60% – 80%). Guidelines recommend VBAC for low-risk pregnancies. An elective repeat caesarean section (ERCS) has become more common as well. This study assessed what factors are associated with women's preferences for modes of birth in a subsequent pregnancy after one previous caesarean. Methods: Predictors which were associated with women's preferences for mode of birth after a previous caesarean, were assessed in a cross-sectional web-survey. A multivariable logistic regression model was used to analyse the associations between potential predictors and preferred mode of birth. Results: 349 participants were included in this study. 227 had planned a VBAC, and 122 an ERCS. VBAC success rate was 62.6%. Multivariable logistic regression revealed predictors which were associated with increased odds of women choosing VBAC compared to those who opted for an ERCS: preference for VBAC during the third trimester of their subsequent pregnancy (OR 5.0, CI 95% 1.1 – 15.3), being advised by their healthcare provider to attempt a VBAC (OR 3.0, CI 95% 1.3 – 7.1), having had midwifery care during their subsequent pregnancy (OR 2.3, CI 95% 1.0 – 5.1), wish to let the child choose the moment of birth (OR 1.4, CI 95% 1.2 – 1.8) and reporting that their partner was associated with their choice of mode of birth (OR 1.3, CI 95% 1.1 – 1.6). Contrarily, perceptions of safety for mothers were observed to statistically decrease the chance of women choosing a VBAC (OR 0.7, CI95% 0.6 – 0.9). Conclusion: These results highlight the motivation of women's decisions-making regarding the choice of mode of birth following a previous caesarean. These factors should be addressed in future studies which promote free decision-making for women in order to improve normal birth and maternal and infant health care.