The mode of delivery for women with a previous caesarean delivery remains contentious, with risks and benefits to attempting a vaginal birth after caesarean (VBAC) or having an elective repeat caesarean section.
As part of a new study, researchers compared maternal and infant outcomes after attempted VBAC delivery versus elective repeat caesarean delivery using data on women in Canada (excluding Quebec), who had a prior single previous caesarean delivery, and had a singleton delivery between April 2003 and March 2015.
They found that while absolute rates of severe maternal morbidity and mortality were low, they were significantly higher after attempted VBAC compared with elective repeat caesarean delivery. The association between VBAC and serious neonatal morbidity and mortality showed a temporal worsening.
Presenting the findings in CMAJ (Canadian Medical Association Journal), the authors said health care providers need to help women to contextualise risks better so that they are able to make informed and personalised decisions.
“Temporal worsening of infant outcomes after attempted vaginal birth after caesarean delivery highlights the need for greater care in selecting candidates, and more careful monitoring of labour and delivery,” the authors added.