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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.


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.


People who labour after a previous Caesarean have a higher risk of uterine rupture than those who choose an elective repeat Caesarean section. Labour progress should be assessed regularly, and people should be monitored closely for signs or symptoms of uterine rupture and receive immediate medical attention if there are any concerns.

Signs or symptoms of uterine rupture may be sudden in onset and include:

  • Atypical and abnormal fetal heart tracings, including a changing baseline heart rate and/or variability (e.g., fetal bradycardia in the first or second stage of labour)

  • Maternal hypotension

  • Maternal tachycardia

  • Hematuria and/or excessive vaginal bleeding

  • Maternal restlessness

  • Loss of fetal presenting part in the pelvis

Continuous electronic fetal monitoring beginning at the onset of active labour and continuing for the duration of labour in people who have had a previous Caesarean birth can identify atypical and abnormal fetal heart rate in a timely manner, including fetal bradycardia—the most consistent and common predictive sign of uterine rupture. Health care professionals should recognize and respond to atypical and abnormal fetal heart tracings.

Any unusual pain or increased requirement for pain relief in people who receive epidural analgesia should command immediate medical attention, because this may be indicative of a pending uterine rupture.

For Pregnant People

While you are in labour, your health care professionals should watch you closely for signs and symptoms of a tear in your uterus.


For Clinicians

Monitor people who have had a previous Caesarean birth closely for signs or symptoms of uterine rupture during active labour.


For Health Services

Ensure that processes and resources are in place to support monitoring of people who have had a previous Caesarean birth closely for signs or symptoms of uterine rupture during active labour.

Process Indicator

Percentage of pregnant people who attempt a vaginal birth after Caesarean who are monitored closely for signs and symptoms of uterine rupture through continuous electronic fetal monitoring

  • Denominator: number of pregnant people who attempt a vaginal birth after Caesarean

  • Numerator: number of people in the denominator who are monitored closely for signs and symptoms of uterine rupture through continuous electronic fetal monitoring

  • Data source: local data collection


Balance Outcome Indicator

Rate of uterine rupture in pregnant people who plan a vaginal birth after Caesarean

  • Denominator: number of pregnant people who plan a vaginal birth after Caesarean

  • Numerator: number of people in the denominator who have a uterine rupture

  • Data source: Better Outcomes Registry and Network

Uterine rupture

A tear in the uterine scar during labour or birth. This is an urgent situation that requires emergency Caesarean section or hysterectomy as soon as possible.

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