Vaginal birth after two previous c-sections: obstetricians–gynaecologists opinions and practice patterns

Abstract

Objectives. To evaluate obstetricians' practice patterns, opinions and factors influencing decision-making about mode of delivery in women with two previous c-sections.

Methods. A questionnaire was mailed to the 160 obstetricians from the Rhone-Alpes perinatal network. Questionnaires included demographic, organisational information and questions about physicians' opinion, practice patterns and patient counseling concerning vaginal birth after c-section (VBAC) after one and two caesarean sections.

Results. Response rate was 65.6%, 100% and 23.8% would offer VBAC to women with respectively one and two previous c-sections. Uterine rupture rate was largely overestimated in both women with one (2.8%) and two prior c-sections (14.2%). Factors positively influencing obstetricians were cerebral palsy estimated rate less than 20%, a minimal decision to birth delay less than 20 min when emergency c-section would be required. Neonatal severe outcomes consecutive to trial of labour as well as placenta praevia or accreta risk and morbidity associated with multiple c-sections would be insufficiently discussed.

Conclusion. Obstetricians largely prefer a third planned c-section in women with two previous c-sections. This decision is partly based on a large overestimation of immediate maternal and neonatal serious outcomes consecutive to trial of labour as well documented serious long term outcomes of multiple c-sections are insufficiently considered.

Keywords:

• Multiple previous cesareans
• uterine rupture
• VBAC
• planned c-section
• practice pattern

Acknowledgement

The authors acknowledge the Hospices Civils de Lyon for their financial support and the perinatal network AURORE for his technical support.