VBACs more likely with midwifery led care

When women who have previously had a cesarean section are cared for primarily by a midwife in their next pregnancy, they are more likely to want and actually end up having a vaginal birth (termed vaginal birth after cesarean or VBAC), new research finds.

Researchers from the University of Manchester compared patient records for 405 women giving birth at one hospital. The group of women from the year 2008 had antenatal care led by obstetricians, and the subsequent group from 2011 experienced midwife led care. This difference was the result of a change to hospital policy. The two groups had very few differences in regards to age, socio-economics, ethnicity, and other variables – meaning that the main variance between the two were the lead in their antenatal care.

The results showed that the number of women intending to give birth by VBAC was much higher in the midwife-led group (increase from 77% to 90%). This pattern continued when assessing those who actually achieved a VBAC delivery, with 61% in the midwife-led group, compared to 47% in the obstetrician-led group.

These results indicate that midwife-led care offers an effective alternative for women who have had one previous cesarean. This is a key finding, as many women opt to have a cesarean birth if they have previously experienced one. Dr Helen White, from the research team, comments “There aren’t many initiatives out there to break this cycle, so this finding is important for providing evidence that midwives are best placed to promote vaginal birth.”

Jane Munro, from the Royal College of Midwives, furthers: “The majority of women who have had one caesarean can have a vaginal birth next time. Women should speak to midwives and doctors about what options they have, so they fully understand the risks and benefits of what care pathway is available to them.”

 
For more information, the study can be found here.