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Objective: Balloon catheter is the preferred method for induction of labor in women with prior cesarean section. We sought to evaluate the rate of vaginal delivery, induction-delivery time and outcome predictors after induction with double-balloon catheter. Study design: We conducted a retrospective cohort study including women with prior cesarean section undergoing induction of labor with a double-balloon catheter during the period January 2007–June 2014 at a large, tertiary Danish university hospital. For comparison, we included women with no prior cesarean section undergoing induction with double-balloon catheter after failed medical induction. Inclusion criteria were singleton pregnancy, an unfavorable cervix, intact membranes, cephalic presentation and either previous cesarean section or failed medical induction of labor. Exclusion criteria included contraindications for vaginal delivery, severe fetal malformation and stillbirth. Study subjects were identified in a local computerized system and data extracted from the medical records. Results: Women with prior cesarean section (n = 304) induced with double-balloon catheter had a vaginal delivery rate of 50.3% (95% CI 44.7–55.9) compared to 51.7% (95% CI 39.2–64.1) in women with no prior cesarean section but preceding failed medical induction of labor (n = 58) (p = 0.85). BMI≥30 was associated with increased frequency of cesarean section. Median time from induction to vaginal delivery was 27.1(20.4–31.1) hours and 28.4(25.5–36.1) hours, respectively (p = 0.05). The rate of complete uterine rupture was 1.0%. Conclusions: Similar success rates of approximately 50% for vaginal delivery were observed after induction of labor with a double-balloon catheter in women with and without prior caesarean section. A BMI ≥ 30 was associated with an increased frequency of caesarean section.

Objective: Balloon catheter is the preferred method for induction of labor in women with prior cesarean section. We sought to evaluate the rate of vaginal delivery, induction-delivery time and outcome predictors after induction with double-balloon catheter. Study design: We conducted a retrospective cohort study including women with prior cesarean section undergoing induction of labor with a double-balloon catheter during the period January 2007–June 2014 at a large, tertiary Danish university hospital. For comparison, we included women with no prior cesarean section undergoing induction with double-balloon catheter after failed medical induction. Inclusion criteria were singleton pregnancy, an unfavorable cervix, intact membranes, cephalic presentation and either previous cesarean section or failed medical induction of labor. Exclusion criteria included contraindications for vaginal delivery, severe fetal malformation and stillbirth. Study subjects were identified in a local computerized system and data extracted from the medical records. Results: Women with prior cesarean section (n = 304) induced with double-balloon catheter had a vaginal delivery rate of 50.3% (95% CI 44.7–55.9) compared to 51.7% (95% CI 39.2–64.1) in women with no prior cesarean section but preceding failed medical induction of labor (n = 58) (p = 0.85). BMI≥30 was associated with increased frequency of cesarean section. Median time from induction to vaginal delivery was 27.1(20.4–31.1) hours and 28.4(25.5–36.1) hours, respectively (p = 0.05). The rate of complete uterine rupture was 1.0%. Conclusions: Similar success rates of approximately 50% for vaginal delivery were observed after induction of labor with a double-balloon catheter in women with and without prior caesarean section. A BMI ≥ 30 was associated with an increased frequency of caesarean section.

Objective. To compare the risk of uterine rupture between a cohort of women with previous low-transverse cesarean section (CS) and a cohort with intact uterus. Methods. All women with a singleton pregnancy and previous low-transverse CS requiring induction of labor from January 1, 1992 to December 30, 2001 (n = 310) were compared with a cohort of women with intact uterus undergoing induction of labor during the same study period (n = 5420). Protocols of induction using prostaglandin E-2 gel and oxytocin infusion were consistent within groups, but differed between the previous CS and the intact uterus group. Results. Uterine rupture occurred in 0.3% in the previous CS group vs. 0.03% in the intact uterus group (p = 0.37). Logistic regression analysis showed no significant difference in rate of uterine rupture between the previous CS vs. intact uterus group (p = 0.16) after controlling for maternal age, parity, gestational age at delivery, Bishop score on admission, use of prostaglandin and oxytocin, and birth weight. Our study had adequate power to detect a 0.38% difference in rate of uterine rupture between the two groups (alpha = 0.05, beta = 0.80). Conclusion. Induction of labor is not associated with significantly higher rates of uterine rupture among women with previous low-transverse CS compared with women with intact uterus provided a consistent protocol with strict intervention criteria is adopted.

Aim:This paper is a report of a study to describe the childbirth expectations, influences and knowledge of a group of Western Australian women who experienced a cesarean section (CS) and would prefer a CS in a subsequent pregnancy.Background:Evidence suggests that a previous CS is not an indication for an elective CS in a subsequent pregnancy, but western world data indicate high probability of repeat CS.Methods:Community advertisements invited women who had experienced a CS to participate in a telephone interview. The thematic analysis presented in this paper is derived from data collected during 2003/2004 from 49 participants who had initially expected to birth vaginal but had a CS and who had planned a CS in a subsequent pregnancy or stated that they would choose this option in a future pregnancy.Findings:Before the first CS most women expected and wanted to give birth normally. After having a CS, however, many reframed vaginal birth as uncertain, unsafe and unachievable. For this group of women, the medical discourse that promoted CS as the safest option was a major influence on their decisions. As a result, they reconstructed CS as an acceptable alternative that was safer for them and their babies, allowed them to be better prepared, and was convenient.Conclusion:In the present climate, enabling women to keep birth 'fear' in perspective may be an important strategy if we are to improve the uptake of vaginal birth after CS and the quality of care offered to women during the normal, but major, life event of childbirth.