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Caesarean rates are rising worldwide, the main contributor being the elective repeat caesarean. During the past decades, rates of vaginal birth after caesarean dropped considerably. This requires insight in women's preferences regarding giving birth following a previous caesarean. To gain a better understanding of women's values and preferences regarding the upcoming birth following a previous caesarean. Using Q methodology, this study systematically explores and categorises their preferences. Q methodology is an innovative research approach to explore and compare a variety of viewpoints on a certain subject. Thirty-one statements on birth after caesarean were developed based on the health belief model. Thirty-six purposively sampled pregnant women with a history of caesarean ranked these statements from least to most important. By-person factor analysis was used to identify patterns which, supplemented with interview data, were interpreted as preferences. Three distinct preferences for giving birth after a caesarean were found; (a) " Minimise the risks for me and my child ", giving priority to professional advice and risk of adverse events, (b) " Seek the benefits of normal birth ", desiring to give birth as normal as possible for both emotional and practical reasons, (c) " Opt for repeat caesarean ", expressing the belief that a planned caesarean brings comfort. Preferences for birth after caesarean vary considerably among pregnant women. The findings help to understand the different types of information valued by women who need to decide on their mode of birth after a first caesarean. [ABSTRACT FROM AUTHOR]

Objectives Variations in caesarean section (CS) between some immigrant groups and receiving country populations have been widely reported. Often, African immigrant women are at higher risk of CS than the receiving population in developed countries. However, evidence about subsequent mode of birth following CS for African women post-migration is lacking. The objective of this study was to examine differences in attempted and successful vaginal birth after previous caesarean (VBAC) for Eastern African immigrants (Eritrea, Ethiopia, Somalia and Sudan) compared with Australian-born women. Design A population-based observational study was conducted using the Victorian Perinatal Data Collection. Pearson's chi-square test and logistic regression analysis were performed to generate adjusted odds ratios for attempted and successful VBAC. Setting Victoria, Australia. Participants 554 Eastern African immigrants and 24,587 Australian-born eligible women with previous CS having singleton births in public care. Findings 41.5% of Eastern African immigrant women and 26.1% Australian-born women attempted a VBAC with 50.9% of Eastern African immigrants and 60.5% of Australian-born women being successful. After adjusting for maternal demographic characteristics and available clinical confounding factors, Eastern African immigrants were more likely to attempt (OR adj 1.94, 95% CI 1.57–2.47) but less likely to succeed (OR adj 0.54 95% CI 0.41–0.71) in having a VBAC. Conclusion/Implications for practice There are disparities in attempted and successful VBAC between Eastern African origin and Australian-born women. Unsuccessful VBAC attempt is more common among Eastern African immigrants, suggesting the need for improved strategies to select and support potential candidates for vaginal birth among these immigrants to enhance success and reduce potential complications associated with failed VBAC attempt. [ABSTRACT FROM AUTHOR]

Summary: Background: Previous studies assessing the safety of vaginal birth after caesarean section (VBAC) have compared VBAC to elective repeat caesarean section (ERCS), despite the fact that the risks posed by each are considerably different. Explaining the complications of VBAC in a way that is meaningful to women can be challenging, and thus a comparison to a similar group of women who have also not undergone previous vaginal delivery may be a more relevant comparison. Research question: When counselling women undergoing planned VBAC, should a comparison of outcomes be made to women undergoing ERCS, or is a comparison to other nulliparous women undergoing vaginal birth a more valid comparison in terms of risk outcomes? Participants and methods: A retrospective cohort study was undertaken comprising a consecutive cohort of 21,389 women who delivered, stratified by Robson''s criteria into Robson groups 1–5. Those in Robson groups 6–10 were not included. Demographic data and maternal/neonatal outcomes were reviewed, with main outcome measures comprising uterine rupture, post-partum haemorrhage (PPH), 3rd/4th degree tears and neonatal morbidity. Results: There was no increase in PPH, vaginal tears or neonatal complications in the VBAC group when compared to Robson groups 1 and 2 (nulliparous women in spontaneous or induced labour, respectively). Uterine rupture rates were low in all groups, with no correlation identified. Discussion: The maternal and neonatal morbidity associated with VBAC is comparable to primiparous women undergoing a vaginal birth. Conclusion: In demonstrating the low relative morbidity in this comparison, these outcomes may aid in counselling women faced with the choice of VBAC versus ERCS. [Copyright &y& Elsevier]

Summary: Caesarean section (CS) rates continue to rise. Vaginal birth after Caesarean section (VBAC) for a woman needs to be determined on an individual basis. With careful selection, the majority of women (60–80%) will achieve vaginal delivery with minimal risks. There are two randomized controlled trials underway that are likely to have an impact on clinical management of women who have undergone prior Caesarean. The first is the CAESAR study, which will evaluate whether the single or two layers closure of the uterine incision has a significant impact on immediate morbidity and that of future pregnancies. The second is the ACTOBAC trial (A collaborative trial of birth after Caesarean) in which women who have undergone prior Caesarean will be randomized to vaginal versus Caesarean birth. Until data from these studies are available, the evidence to date suggests that for most women who have undergone prior low segment Caesarean a trial of labour should be offered after providing adequate information. The fetal condition and progress of labour should be monitored closely. Prompt resort to emergency CS should be undertaken with signs of fetal compromise or of scar dehiscence. [Copyright &y& Elsevier]