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Background: Trial of Labor After Cesarean is an important strategy for reducing the overall rate of cesarean delivery. Offering the option of vaginal delivery to a woman with a history of cesarean section requires the ability to manage a potential uterine rupture quickly and effectively. This requires infrastructure and organization of the maternity unit so that the decision-to-delivery interval is as short as possible when uterine rupture is suspected. We hypothesize that the organizational characteristics of maternity units in Belgium have an impact on their proposal and success rates of trial of labour after cesarean section. Methods: We collected data on the organizational characteristics of Belgian maternity units using an online questionnaire. Data on the frequency of cesarean section, trial of labor and vaginal birth after cesarean section were obtained from regional perinatal registries. We analyzed the determinants of the proposal and success of trial of labor after cesarean section and report the associations as mean proportions. Results: Of the 101 maternity units contacted, 97 responded to the questionnaire and data from 95 was included in the analysis. Continuous on-site presence of a gynecologist and an anesthetist was associated with a higher proportion of trial of labor after cesarean section, compared to units where staff was on-call from home (51% versus 46%, p = 0.04). There is a non-significant trend towards more trial of labor after cesarean section in units with an operating room in or near the delivery unit and a shorter transfer time, in larger units (> 1500 deliveries/year) and in units with a neonatal intensive care unit. The proposal of trial of labor after cesarean section and its success was negatively correlated to the number of cesarean section in the maternity unit (Spearman' rho = 0.50 and 0.42, p value < 0.001). Conclusions: Organizational differences in maternity units appear to affect the proposal of trial of labor after cesarean section. Addressing these organizational factors may not be sufficient to change practice, given that general tendency to perform a cesarean section in the maternity unit is the main contributor to the percentage of trial of labor after cesarean. [ABSTRACT FROM AUTHOR]

Objectives: Our aim was to compare maternal and neonatal outcomes of women with a low‐risk pregnancy attending the "Cocoon," an alongside midwifery‐led birth center and care pathway, with women with a low‐risk pregnancy attending the traditional care pathway in a tertiary care hospital in Belgium. Methods: We performed a retrospective cohort study of maternal and neonatal outcomes of women with a low‐risk pregnancy who chose to adhere to the Cocoon pathway of care (n = 590) and women with a low‐risk pregnancy who chose the traditional pathway of care (n = 394) from March 1, 2014, to February 29, 2016. We performed all analyses using an intention‐to‐treat approach. Results: In this setting, the cesarean birth rate was 10.3% compared with 16.0% in the traditional care pathway (adjusted odds ratios [aOR] 0.42 [95% CI 0.25‐0.69]), the induction rate was 16.3% compared with 30.5% (0.46 [0.30‐0.69]), the epidural analgesia rate was 24.9% compared with 59.1% (0.15 [0.09‐0.22]), and the episiotomy rate was 6.8% compared with 14.5% (0.31 [0.17‐0.56]). There was no increase in adverse neonatal outcomes. Intrapartum and postpartum transfer rates to the traditional pathway of care were 21.1% and 7.1%, respectively. Conclusions: Women planning their births in the midwifery‐led unit, the Cocoon, experienced fewer interventions with no increase in adverse neonatal outcomes. Our study gives initial support for the introduction of similar midwifery‐led care pathways in other hospitals in Belgium. [ABSTRACT FROM AUTHOR]