Birth after caesarean section: Changes over a nine-year period in one Australian state

Homer, CSE; Johnston, R; Foureur, MJ

Birth after caesarean section: Changes over a nine-year period in one Australian state

Homer, CSE

Johnston, R Foureur, MJ

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Publication Type:: Journal Article
Citation:: Midwifery, 2011, 27 (2), pp. 165 - 169
Issue Date:: 2011-04-01

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Field	Value	Language
dc.contributor.author	Homer, CSE https://orcid.org/0000-0002-7454-3011	en_US
dc.contributor.author	Johnston, R	en_US
dc.contributor.author	Foureur, MJ https://orcid.org/0000-0002-0454-0165	en_US
dc.date.available	2009-04-26	en_US
dc.date.issued	2011-04-01	en_US
dc.identifier.citation	Midwifery, 2011, 27 (2), pp. 165 - 169	en_US
dc.identifier.issn	0266-6138	en_US
dc.identifier.uri	http://hdl.handle.net/10453/15617
dc.description.abstract	Objectives: to describe the outcomes related to birth after a caesarean section (CS) in one Australian state, New South Wales (NSW), over a nine-year period. The objectives were to determine whether changes had occurred in the rates of attempted and successful vaginal birth after caesarean section (VBAC), induction of labour, place of birth, admission to special care or neonatal intensive care nursery and perinatal mortality. Design and setting: cross-sectional analytic study of hospital births in New South Wales using population-based data from 1998-2006. Participants: women experiencing the next birth after a CS where: the total number of previous CS was 1; the presentation at birth was vertex; it was a singleton pregnancy; and, the estimated gestational age was greater than or equal to 37 weeks. A total of 53,455 women met these criteria. Measurements: data were obtained from NSW Health Department's Midwives Data Collection (MDC). The MDC includes all live births and stillbirths of at least 20 weeks gestation or 400. g birth weight in the state. Findings: over the nine-year period, the rate of vaginal birth after caesarean section declined significantly (31-19%). The proportion of women who 'attempted a vaginal birth' also declined (49-35%). Of those women who laboured, the vaginal birth rate declined from 64% to 53%. Babies whose mothers 'attempted' a VBAC were significantly less likely to require admission to a special care nursery (SCN) or neonatal intensive care (NICU). The perinatal mortality rate in babies whose mothers 'attempted' a VBAC was higher than those babies born after an elective caesarean section although the absolute numbers are very small. Key conclusions: rates of VBAC have declined over this nine-year period. Rates of neonatal mortality and proxy measures of morbidity (admission to a nursery) are generally in the low range for similar settings. Implications for practice: decisions around the next birth after CS are complex. Efforts to keep the first birth normal and support women who have had a CS to have a normal birth need to be made. More research to predict which women are likely to achieve a successful VBAC and the most effective ways to facilitate a VBAC is essential. Midwives have a critical role to play in these endeavours. © 2009 Elsevier Ltd.	en_US
dc.relation.ispartof	Midwifery	en_US
dc.relation.isbasedon	10.1016/j.midw.2009.04.009	en_US
dc.subject.classification	Nursing	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Infant, Newborn, Diseases	en_US
dc.subject.mesh	Pregnancy Outcome	en_US
dc.subject.mesh	Home Childbirth	en_US
dc.subject.mesh	Vaginal Birth after Cesarean	en_US
dc.subject.mesh	Morbidity	en_US
dc.subject.mesh	Cross-Sectional Studies	en_US
dc.subject.mesh	Choice Behavior	en_US
dc.subject.mesh	Pregnancy	en_US
dc.subject.mesh	Trial of Labor	en_US
dc.subject.mesh	Infant, Newborn	en_US
dc.subject.mesh	Intensive Care Units, Neonatal	en_US
dc.subject.mesh	Hospitals, Maternity	en_US
dc.subject.mesh	New South Wales	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Practice Guidelines as Topic	en_US
dc.subject.mesh	Perinatal Mortality	en_US
dc.title	Birth after caesarean section: Changes over a nine-year period in one Australian state	en_US
dc.type	Journal Article
utslib.citation.volume	2	en_US
utslib.citation.volume	27	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1114 Paediatrics and Reproductive Medicine	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Midwifery
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
pubs.organisational-group	/University of Technology Sydney/Strength - WHO CC
utslib.copyright.status	open_access
pubs.issue	2	en_US
pubs.publication-status	Published	en_US
pubs.volume	27	en_US

Abstract:

Objectives: to describe the outcomes related to birth after a caesarean section (CS) in one Australian state, New South Wales (NSW), over a nine-year period. The objectives were to determine whether changes had occurred in the rates of attempted and successful vaginal birth after caesarean section (VBAC), induction of labour, place of birth, admission to special care or neonatal intensive care nursery and perinatal mortality. Design and setting: cross-sectional analytic study of hospital births in New South Wales using population-based data from 1998-2006. Participants: women experiencing the next birth after a CS where: the total number of previous CS was 1; the presentation at birth was vertex; it was a singleton pregnancy; and, the estimated gestational age was greater than or equal to 37 weeks. A total of 53,455 women met these criteria. Measurements: data were obtained from NSW Health Department's Midwives Data Collection (MDC). The MDC includes all live births and stillbirths of at least 20 weeks gestation or 400. g birth weight in the state. Findings: over the nine-year period, the rate of vaginal birth after caesarean section declined significantly (31-19%). The proportion of women who 'attempted a vaginal birth' also declined (49-35%). Of those women who laboured, the vaginal birth rate declined from 64% to 53%. Babies whose mothers 'attempted' a VBAC were significantly less likely to require admission to a special care nursery (SCN) or neonatal intensive care (NICU). The perinatal mortality rate in babies whose mothers 'attempted' a VBAC was higher than those babies born after an elective caesarean section although the absolute numbers are very small. Key conclusions: rates of VBAC have declined over this nine-year period. Rates of neonatal mortality and proxy measures of morbidity (admission to a nursery) are generally in the low range for similar settings. Implications for practice: decisions around the next birth after CS are complex. Efforts to keep the first birth normal and support women who have had a CS to have a normal birth need to be made. More research to predict which women are likely to achieve a successful VBAC and the most effective ways to facilitate a VBAC is essential. Midwives have a critical role to play in these endeavours. © 2009 Elsevier Ltd.

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http://hdl.handle.net/10453/15617