Skip to content
MHTF logo

Maternal Health Task Force

  • Facebook
  • Twitter
  • Vimeo
  • Flickr
  • Email
  • About
  • Topics
  • Resources
  • Buzz
    • People’s Choice Buzz
  • Blog
MHTF Blog ›

Towards a Global Discourse on Vaginal Birth After Cesarean

Posted on December 13, 2017December 13, 2017

By: Sarah Hodin, MPH, CD(DONA), LCCE, National Senior Manager of Maternal Newborn Health Programs, Steward Health Care

What do we know?

One of the strongest predictors of a woman’s likelihood of having a cesarean delivery is whether she has had one with a previous pregnancy. Vaginal birth after cesarean (VBAC) has been a contentious area in medicine for decades. Studies have demonstrated an association between VBAC and ruptured uterus and neonatal morbidity. However, repeat cesarean delivery also carries increased risks of complications such as placenta accreta in future pregnancies.

When done in an appropriate context with the necessary resources in place, VBAC can have high rates of success. Evidence suggest that the relative risks associated with VBAC and repeat elective cesarean delivery are comparable among low-risk women. In addition to clinical risk factors, there are several elements that can influence a woman’s decision to attempt a VBAC including providers’ beliefs and practices, hospital-level and national policies, limited resources, lack of information, health insurance reimbursement and concerns about malpractice litigation.

Clinical guidelines related to VBAC decision-making and management are inconsistent across hospitals and countries, and most of the research on the safety of and indications for VBAC has been conducted in high-income countries (HICs).

Expanding the conversation

Over the past few decades, cesarean section rates have increased dramatically in virtually every part of the world—including in low- and middle-income countries (LMICs). As global cesarean rates rise, more and more women will be faced with a dilemma: “Do I attempt a VBAC or choose a repeat cesarean?” Weighing the risks and benefits of these choices becomes even more complicated in health facilities that do not meet basic requirements for safe surgery.

More evidence from diverse settings is needed to understand the complexity surrounding VBAC in the global context. Very few studies on this topic have been conducted in LMICs, and findings from HICs may not always apply to different populations and health systems. For example, in some cases, the process of assessing whether a women is a good candidate for VBAC might incorporate facility-level factors such as the availability of safe anesthesia, a sterile operating room and a properly trained surgeon. In HICs, these issues are often not considered relevant in conversations about VBAC.

Obstetricians, midwives and other maternal health care providers around the globe must be trained and equipped to safely conduct cesarean deliveries when needed, carefully monitor attempted VBACs to prevent complications and help women to make informed decisions about which option is best for them and their babies.

—

Explore the Maternal Health Task Force (MHTF)’s mini-series, “The Global Epidemic of Unnecessary Cesarean Sections” [Part 1 | Part 2 | Part 3]

Read the report from a technical meeting that the MHTF hosted with the Fistula Care Plus Project, “Cesarean Section Safety and Quality in Low Resource Settings.”

Subscribe to receive new posts from the MHTF blog in your inbox.

Share this:FacebookTwitterLinkedInReddit
CATEGORIESCATEGORIES: Maternal Health
TOPICSTOPICS: Cesarean Section Commodities Emergency Obstetric and Newborn Care Health Systems Human Resources for Health Intrapartum Care Maternal Morbidity Quality of Care Social Determinants Technology & Innovation

Looking for something specific?

Blog Series

  • Improving Maternal Health Measurement
  • Noncommunicable Diseases and Maternal Health
  • The Global Maternal Health Workforce
  • Quality of Maternal Health Care
  • See more>>

Archives

Blogs we follow

  • Healthy Newborn Network
  • Jacaranda Health
  • Jhpiego Field Notes
  • MamaYe
  • Maternal and Child Survival
  • NPR Goats and Soda
  • White Ribbon Alliance
  • Women Deliver

MHTF Disclaimer

The posts on this blog do not necessarily reflect the views of the Maternal Health Task Force. Our objective is to provide a platform for our Editorial Committee and other experts to post a myriad of data and evidence, as well as opinions/views that exist in the field which will contribute to expanding the maternal health dialogue.
  • About
  • Topics
  • Resources
  • Buzz
    • People’s Choice Buzz
  • Blog

MATERNAL HEALTH TASK FORCE

Harvard Chan School Center of Excellence in Maternal and Child Health
677 Huntington Avenue
Boston, MA 02115
MHTF@hsph.harvard.edu

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant T76MC00001 and entitled Training Grant in Maternal and Child Health. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
  • About
    • Key Facts
    • Renaming the School
    • Office of the Dean
    • Location and Facilities
    • Administrative Offices
    • Contact Information
  • Admissions
    • Office of Admissions
    • Harvard Chan Viewbook
    • Financial Aid
    • Registrar’s Office
    • Summer at the School
  • Academics
    • Departments
    • Degrees
    • Online Degree Program
    • Programs and Requirements
    • Executive/Summer Programs
    • Interdisciplinary Concentrations
    • Office of Education
    • Division of Biological Sciences
    • Division of Policy Translation and Leadership Development
    • Executive and Continuing Professional Education
    • Fellowships and Residencies
    • Academic Calendar
    • Harvard Chan Viewbook
  • Exec Ed
  • Research
    • Office of Research Strategy and Development
    • Harvard Longwood Campus Research Administration
    • Office of Regulatory Affairs and Research Compliance
    • Office of Human Research Administration
    • Centers & Institutes
    • Researchers Directory
    • Postdoctoral Research Fellows
    • Export Controls
    • International Research
  • Faculty
    • Office of Faculty Affairs
    • Office of Diversity and Inclusion
    • Faculty Directory
    • Faculty Searches
  • Students
    • Student Life Main
    • Academic Calendar
    • Career Advancement
    • Countway Library
    • Housing
    • Student News
    • Office for Student Affairs
    • Office of Education
    • Office of Diversity and Inclusion
    • Office of Financial Aid
    • Registrar’s Office
    • Student Billing
    • Orientation
    • Commencement
  • Alumni
  • News
    • News Main
    • Press Releases
    • Harvard Public Health Magazine
    • Explore Research by Topic
    • Mailing Lists
    • Multimedia
    • Office of Communications
  • Make a Gift
    • Campaign for Harvard Chan School
  • Facebook
  • Twitter
  • Vimeo
  • Flickr
  • Email
Maternal Health Task Force Proudly powered by WordPress