Quality standard

Quality statement 1: Vaginal birth after a caesarean birth

Quality statement

Pregnant women who have had 1 or more previous caesarean births have a documented discussion of the option to plan a vaginal birth.

Rationale

Clinically there is little or no difference in the risk associated with a planned caesarean birth and a planned vaginal birth in women who have had up to 4 previous caesarean births. If a woman chooses to plan a vaginal birth after she has previously given birth by caesarean section, she should be fully supported in her choice.

Quality measures

Structure

Evidence of local arrangements to ensure that pregnant women who have had 1 or more previous caesarean births have a documented discussion of the option to plan a vaginal birth.

Data source: Local data collection.

Process

The proportion of pregnant women who have had 1 or more previous caesarean births who have a documented discussion of the option to plan a vaginal birth.

Numerator – the number of women in the denominator who have a documented discussion of the option to plan a vaginal birth.

Denominator – the number of pregnant women who have had 1 or more previous caesarean births.

Data source: Local data collection.

Outcome

a) Women's satisfaction that they were supported in their choice for planned birthing option.

Data source: Local data collection.

b) Rates of delivery modes for women who have had previous caesarean births.

Data source: The NHS Digital Maternity services secondary uses dataset collects data on delivery method and previous caesarean sections.

What the quality statement means for different audiences

Service providers ensure that systems are in place for pregnant women who have had 1 or more previous caesarean births to have a documented discussion of the option to plan a vaginal birth.

Healthcare professionals ensure that they have a documented discussion with women who have had 1 or more previous caesarean births that they have the option to plan a vaginal birth and support them in their choice.

Commissioners ensure that ensure that they commission services that have systems in place for pregnant women who have had 1 or more previous caesarean births to have a documented discussion of the option to plan a vaginal birth.

Pregnant women who have had a caesarean birth in the past have a discussion with a member of their maternity team (which is recorded in their notes) about the option to plan a vaginal birth.

Source guidance

Caesarean birth. NICE guideline NG192 (2021), recommendations 1.8.1, 1.8.2 and 1.8.5

Definitions of terms used in this quality statement

Documented discussion

Pregnant women should be informed by members of the maternity team that in women who have had 4 or fewer previous caesarean births the risk of fever, bladder injuries and surgical injuries does not vary with planned mode of birth but that the risk of uterine rupture is higher for planned vaginal birth. This discussion should be documented in the woman's notes. [NICE's guideline on caesarean birth, recommendation 1.8.2]

Equality and diversity considerations

Good communication between healthcare professionals and pregnant women is essential. Treatment and care, and the information given about it, should be culturally appropriate. It should also be accessible to women with additional needs such as physical, sensory or learning disabilities, and to women who do not speak or read English. Women should have access to an interpreter or advocate if needed. For women with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.