Birth after previous caesarean
Caesarean section rates have increased in many countries, including the UK, where around 30% of all births now occur by caesarean. This has led to increasing numbers of pregnant women with a history of previous caesarean section. Pregnant women who have had previous caesarean section should be offered the opportunity to discuss whether, in light of their own clinical circumstances, to:
- plan another birth by caesarean (known as an Elective Repeat Caesarean Section or ERCS)
or - plan a vaginal birth (known as a planned Vaginal Birth After previous Caesarean or VBAC)
Clinical guidelines advise that women should be counselled about the benefits and harms of planning another caesarean compared to planning a vaginal birth. However, more research is needed to fully understand what the short and longer-term benefits and harms of these two options are for women and their children.
What was the aim of this research?
For women who have had a caesarean section in the past, this research aimed to find out the short and longer-term effects of planning a vaginal birth compared to planning another caesarean section on women and their children.
In doing so, the research aimed to provide information to help women make an informed decision about this aspect of their maternity care.
How was the research done?
The research used existing information on up to 74,043 births to women who have had one or more previous caesarean sections in Scotland. Information about the mother and child was obtained from a number of existing Scottish national data sources including:
- Birth records
- Death records
- Records of hospital care
- Records of medicines that have been prescribed and dispensed
- Records of child health reviews carried out on pre-school children
- School records
The information from these data sources was linked together by an independent organisation with expertise in linking these records, working to strict data security regulations and under contract to the Information Services Division (ISD) Scotland. Personal identifiable information such as names were removed before the researchers were given access to the data.
Findings from this research
Findings from this research have been published:
Fitzpatrick KE, Kurinczuk JJ, Bhattacharya S, Quigley MA (2019) Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland. PLoS Med 16(9): e1002913. https://doi.org/ 10.1371/journal.pmed.1002913
Fitzpatrick KE, Quigley MA, Smith DJ, Kurinczuk JJ. Planned mode of birth after previous caesarean section and women's use of psychotropic medication in the first year postpartum: a population-based record linkage cohort study. Psychological Medicine 2021; 1-12. doi: 10.1017/S003329172995322
Fitzpatrick KE, Kurinczuk JJ, Quigley MA. Planned mode of birth after previous caesarean section and special educational needs in childhood: a population-based record linkage cohort study. BJOG: An International Journal of Obstetrics and Gynaecology 2021; https//doi.org/10.1111/1471-0528.16828
Fitzpatrick KE, Abdel-Fattah M, Hemelaar J, Kurinczuk JJ, Quigley MA (2022) Planned mode of birth after previous cesarean section and risk of undergoing pelvic floor surgery: A Scottish population-based record linkage cohort study. PLoS Med 19(11): e1004119. https://doi.org/ 10.1371/journal.pmed.1004119
One page summary of the key messages from the research:
NPEU Planning how to give birth after previous caesarean section – Key messages v1.0 - 23.11.21
Plain English leaflet of the research findings:
NPEU Lay Summary planned mode of birth after previous CS v2.0 - 23.11.21
Who lead and funded this research?
This research was led by Kate Fitzpatrick at the NPEU, University of Oxford.
She was funded by a National Institute for Health Research (NIHR) Doctoral Research Fellowship (DRF-2016-09-078) for this research project.