Women who had a caesarean section in a previous pregnancy are much more likely to have a successful vaginal birth if their antenatal care is led by a midwife, according to UK researchers.
The study, by researchers from Manchester and Southampton, is the first of its kind to evaluate the influence on vaginal birth after caesarean rates of midwife-led antenatal care versus care led by an obstetrician.
“This demonstrates the importance of the midwife in supporting and promoting vaginal birth after caesarean”
They compared rates for vaginal birth after caesarean before and after the implementation of midwife-led antenatal care for women with one previous caesarean birth and no other risk factors.
Data was collected from the records of relevant women who gave birth at a large maternity hospital in England in either 2008 or 2011.
Both intended and actual vaginal birth after caesarean rates were higher in 2011, compared with 2008 – 90% versus 77%, and 61% versus 47%, respectively.
In addition, mean rates of unscheduled antenatal care sought via the delivery suite and inpatient admissions were lower in 2011 than 2008.
Postnatal maternal and neonatal safety outcomes were similar between the years, except mean postnatal length of stay, which was shorter in 2011, compared with 2008 – 2.67 versus 3.15 days.
“Implementation of midwife-led antenatal care for women with one previous caesarean offers a safe and effective alternative to traditional obstetrician-led antenatal care, and is associated with increased rates of intended and actual vaginal birth after caesarean,” said the study authors in the journal Birth.
“Implementation of midwife-led antenatal care for women with one previous caesarean offers a safe and effective alternative”
The Royal College of Midwives noted that, although caesarean sections are safe, research was increasingly showing that vaginal birth and labour could protect against long term-risks such as impaired immune response, asthma, obesity and type 2 diabetes in the baby.
Jane Munro, quality and audit development advisor at the RCM, said: “This is an interesting study and adds to the body of evidence reporting on the value of midwifery led care.”
“Existing research has indicated that previous childbirth experience plays an important role in decision-making about methods of childbirth chosen by women,” she noted.
“This study demonstrates the importance of the role of the midwife in supporting and promoting vaginal birth after caesarean,” she said. “The majority of women who have had one caesarean section can have a vaginal birth next time.”
Ms Munro added: “There is too much variation among maternity units in caesarean section rates that is not accounted for by differences in the population served. We need to find out why this is happening and take steps to reduce that variation.”