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Evidence to Improve Care

Vaginal Birth After Caesarean (VBAC)

Care for People Who Have Had a Caesarean Birth and Are Planning Their Next Birth

Click below to see a list of brief quality statements and scroll down for more information.​​


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence. ​

See below for the quality statements and click for more detail.​


Quality Statement 1: Access to Vaginal Birth After Caesarean
People who have had a Caesarean birth before can plan a vaginal birth for their next birth, as long as there is no medical reason not to have one.


Quality Statement 2: Discussion After Caesarean Birth
After a Caesarean birth, people have a discussion with their physician or midwife and receive written information about the reasons for their Caesarean birth and their options for future births.


Quality Statement 3: Shared Decision-Making
Pregnant people who have had a previous Caesarean birth participate in shared decision-making with their physician or midwife. The discussion and planned mode of birth is documented in the perinatal record.


Quality Statement 4: Previous Vaginal Birth
Pregnant people who have had both a previous Caesarean birth and a previous vaginal birth are informed that they have a high likelihood of successful vaginal birth if no contraindication is present.


Quality Statement 5: Operative Reports and Incision Type
Physicians and midwives obtain an operative report from any previous Caesarean births whenever possible. Pregnant people who have had a previous Caesarean birth with an unknown type of uterine incision have an individualized assessment by their physician or midwife to determine the likelihood of a low transverse incision.


Quality Statement 6: Timely Access to Caesarean Birth
Pregnant people planning a vaginal birth after Caesarean are aware of the resources available and not available at their planned place of birth, including physician, midwifery, nursing, anesthesiology, and neonatal care, and the ability to provide timely access to Caesarean birth.


Quality Statement 7: Unplanned Labour
Pregnant people planning an elective repeat Caesarean section should have a documented discussion with their physician or midwife about the feasibility of vaginal birth after Caesarean if they go into unplanned labour. This discussion should take place during antenatal care and again if the person arrives at the hospital in labour.


Quality Statement 8: Induction and Augmentation of Labour
Pregnant people who have had a previous Caesarean birth are offered induction and/or oxytocin augmentation of labour when medically indicated, and are informed by their physician or midwife about the potential benefits and harms associated with the method proposed. Discussion about this should begin in the antenatal period.


Quality Statement 9: Signs and Symptoms of Uterine Rupture
During active labour, pregnant people who have had a previous Caesarean birth are closely monitored for signs or symptoms of uterine rupture.


7

Unplanned Labour

Pregnant people planning an elective repeat Caesarean section should have a documented discussion with their physician or midwife about the feasibility of vaginal birth after Caesarean if they go into unplanned labour. This discussion should take place during antenatal care and again if the person arrives at the hospital in labour.


During antenatal care, physicians and midwives should discuss the possibility of unplanned labour occurring before the scheduled delivery date with people who are planning an elective repeat Caesarean section. Any preferences for attempting a vaginal birth after Caesarean (VBAC) in this situation should be documented in the person’s perinatal record.

People planning an elective repeat Caesarean section who experience unplanned labour should engage in shared decision-making with their physician or midwife about the feasibility of VBAC when they arrive at the hospital in labour. People’s preferences, clinical factors that may increase the risk of uterine rupture, and the clinical judgment of the physician or midwife should be considered when determining the mode of birth. Obstetrical care providers and pregnant people should continue to engage in shared decision-making during labour after Caesarean if there are any changes in maternal or fetal health status that may affect the risks associated with labour and the likelihood of vaginal birth.

For Pregnant People

If you plan to have another Caesarean birth but you go into labour before your scheduled Caesarean, it may still be possible to have a vaginal birth. Talk to your physician or midwife about your options if you go into labour early.


For Clinicians

Engage people who plan an elective repeat Caesarean section in shared decision-making about the feasibility of VBAC if they go into unplanned labour.


For Health Services

Ensure systems, processes, and resources are available for physicians, midwives, and facilities to engage people in shared decision-making about the feasibility of VBAC if they go into unplanned labour.

Process Indicators

Percentage of pregnant people planning an elective repeat Caesarean section who have a documented discussion that includes shared decision-making with their physician or midwife during antenatal care about the feasibility of VBAC in the event of unplanned labour

  • Denominator: number of pregnant people planning an elective repeat Caesarean section

  • Numerator: number of people in the denominator who have a documented discussion that includes shared decision-making with their physician or midwife during antenatal care about the feasibility of VBAC in the event of unplanned labour

  • Data source: local data collection


Percentage of pregnant people planning an elective repeat Caesarean section who experience unplanned labour and have a documented discussion that includes shared decision-making with their physician or midwife about the feasibility of VBAC

  • Denominator: Number of pregnant people planning an elective repeat Caesarean section who experience unplanned labour

  • Numerator: Number of people in the denominator who have a documented discussion that includes shared decision-making with their physician or midwife about the feasibility of VBAC

  • Data source: Local data collection

Unplanned labour

When labour begins spontaneously, before the scheduled elective repeat Caesarean section.

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