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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.


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.


In an emergency, the risk to the person and the newborn is increased if a Caesarean birth is delayed. Therefore, the physician or midwife should advise that the safest place for a vaginal birth after Caesarean (VBAC) is in hospital, where there is access to continuous fetal monitoring and timely access to Caesarean birth. Physicians and midwives must be aware of the availability of physician, midwifery, nursing, anesthesiology, and pediatric staff for people in labour in their hospital. This information should be shared with people planning a VBAC as part of shared decision-making (Quality Statement 3). Hospitals should have written policies and protocols to promote and ensure access to VBAC that include how physicians are notified or consulted to provide timely Caesarean birth if needed. Maternal factors that may increase the potential risk of uterine rupture should be discussed and considered when planning birth location, and referral to a more comprehensive service that includes supports for planned VBAC may be appropriate.

For Pregnant People

If you choose to plan a vaginal birth after Caesarean, your physician or midwife should tell you about the expertise available and not available where you plan to give birth, and what would happen if you needed an unplanned Caesarean birth. If you’re planning to have a vaginal birth after Caesarean, the safest place to have it is in hospital.


For Clinicians

Inform pregnant people planning a VBAC about the physician, midwifery, nursing, anesthesiology, and neonatal resources available and not available at their planned place of birth in case they need an unplanned Caesarean birth. If an out-of-hospital birth is planned, inform people about plans for transport and timely transfer to hospital.


For Health Services

Ensure that physicians and midwives and other relevant staff in the health service have the knowledge to inform pregnant people planning a VBAC about the resources available and not available at their planned place of birth. Practice should be supported by a written policy, protocol, or guideline.

Process Indicator

Percentage of pregnant people planning a VBAC who have a documented discussion about the resources available and not available at their planned place of birth, including obstetric, nursing, anesthesiology, neonatal care, and the ability to provide timely access to Caesarean birth

  • Denominator: number of pregnant people planning a VBAC

  • Numerator: number of people in the denominator who have a documented discussion about the resources available and not available at their planned place of birth, including obstetric, nursing, anesthesiology, neonatal care, and the ability to provide timely access to Caesarean birth

  • Data source: local data collection

Timely access

When there is an indication for Caesarean section, it should occur promptly, as delay in surgery could result in serious maternal and/or neonatal harm.

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