Quality statement 1: Vaginal birth after a caesarean section

Quality statement

Pregnant women who have had 1 or more previous caesarean sections 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 section and a planned vaginal birth in women who have had up to 4 previous caesarean sections. 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 measure

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

Process: The proportion of pregnant women who have had 1 or more previous caesarean sections 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 sections.

Outcomes:

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

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

What the quality statement means for each audience

Service providers ensure that systems are in place for pregnant women who have had 1 or more previous caesarean sections 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 sections that they have the option to plan a vaginal birth and support them in their choice.

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

Pregnant women who have had a caesarean section 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

NICE clinical guideline 132 recommendations 1.8.1, 1.8.2 (key priority for implementation) and 1.8.5.

Data source

Structure: Local data collection.

Process: Local data collection.

Outcomes:

a) Local data collection.

b) The Maternity services secondary uses dataset will collect data on 'the method for delivering baby' (global number 17206160) and on 'pregnancy previous caesarean sections' (global number 17200570), once implemented.

Definitions

Documented discussion

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