Birth after caesarean interventions

The rate of birth by caesarean section is continuing to climb throughout NSW in line with other states in Australia and elsewhere. Most of the increase in rates of caesarean section is due to repeat caesarean in a subsequent pregnancy. Few women apparently seek a vaginal birth after a primary caesarean. The reasons are not well researched but may include: fear of uterine rupture in a subsequent labour and birth; fear on the part of health care providers who do not offer any choice other than a repeat caesarean; convenience; unknown reasons.

BACI (Birth After Caesarean Interventions) was a multidisciplinary and multi-centre study of a complex intervention that focuses on women having their first baby and on women who have had a primary caesarean section.

The aim was to undertake a program of research that addressed the issue of keeping birth normal and repeat caesarean section following a primary caesarean birth through a collaborative consortium of researchers from a number of disciplines.

The BACI consortium, led by midwives with collaborations with obstetricians and other groups with research interests in this area, included a multidisciplinary group located in NSW, the ACT, South Australia, Queensland and Western Australia.

Technical report

Interventions for increasing the rates of uptake or success of vaginal birth after caesarean section: A Technical Report examines interventions that increase either the uptake and/or the success rate of vaginal birth after caesarean (VBAC). Identified clinical and non-clinical factors are discussed in relation to their impact on VBAC, and implications for practice are given.

From this report, two papers on the clinical and non-clinical interventions that increase the rate/uptake of VBAC have been published.