Women-centred interventions to increase vaginal birth after caesarean section (VBAC): A systematic review

• Published in: Midwifery 2015-07, Vol.31 (7), p.657-663
• Main Authors: Nilsson, Christina, Lundgren, Ingela, Smith, Valerie, Vehvilainen-Julkunen, Katri, Nicoletti, Jane, Devane, Declan, Bernloehr, Annette, van Limbeek, Evelien, Lalor, Joan, Begley, Cecily
• Format: Article
• Language: English
• Subjects: Caesarean; Caesarean section; Caesarean section (CS); CHILDBIRTH; DELIVERY; Europe; EXPERIENCES; FEAR; Female; Humans; MATERNAL REQUEST; Maternal-Child Health Services; Midwifery; MODE; MORBIDITY; Nursing; Obstetrics, Gynecology and Reproductive Medicine; Omvårdnad; Patient-Centered Care; PREFERENCE; Pregnancy; PREGNANT-WOMEN; Prenatal Care; Randomized Controlled Trials as Topic; RANDOMIZED CONTROLLED-TRIAL; Reproduktionsmedicin och gynekologi; Systematic review; Vaginal birth after caesarean; Vaginal birth after caesarean (VBAC); Vaginal Birth after Cesarean; VBAC; Women-centred intervention
• ISSN: 0266-6138; 1532-3099; 1532-3099
• DOI: 10.1016/j.midw.2015.04.003

to evaluate the effectiveness of women-centred interventions during pregnancy and birth to increase rates of vaginal birth after caesarean. we searched bibliographic databases for randomised trials or cluster randomised trials on women-centred interventions during pregnancy and birth designed to increase VBAC rates in women with at least one previous caesarean section. Comparator groups included standard or usual care or an alternative treatment aimed at increasing VBAC rates. The methodological quality of included studies was assessed independently by two authors using the Effective Public Health Practice Project quality assessment tool. Outcome data were extracted independently from each included study by two review authors. in total, 821 citations were identified and screened by title and abstract; 806 were excluded and full text of 15 assessed. Of these, 12 were excluded leaving three papers included in the review. Two studies evaluated the effectiveness of decision aids for mode of birth and one evaluated the effectiveness of an antenatal education programme. The findings demonstrate that neither the use of decision aids nor information/education of women have a significant effect on VBAC rates. Nevertheless, decision-aids significantly decrease women׳s decisional conflict about mode of birth, and information programmes significantly increase their knowledge about the risks and benefits of possible modes of birth. few studies evaluated women-centred interventions designed to improve VBAC rates, and all interventions were applied in pregnancy only, none during the birth. There is an urgent need to develop and evaluate the effectiveness of all types of women-centred interventions during pregnancy and birth, designed to improve VBAC rates. decision-aids and information programmes during pregnancy should be provided for women as, even though they do not affect the rate of VBAC, they decrease women׳s decisional conflict and increase their knowledge about possible modes of birth. •We searched for randomised studies on women-centred interventions designed to improve VBAC rates.•There were only three studies that evaluated interventions in pregnancy, none during the birth.•There were no studies showing any effect on VBAC rates.•Decision-aids and information programmes can help women make decisions on mode of birth.•There is an urgent need to develop women-centred interventions for improving VBAC rates.