Updated 6th November 2015.
1) Could you provide a copy of your guidelines for the management of vaginal birth after caesarean (VBAC)?
2) Please can you also supply a list of any exclusions and/or restrictions you would apply to a VBAC birth? i.e. would you accommodate home births, water births, access to your midwifery-led unit or birth centre?
Section 2.3 in enclosed guideline. We do allow births in the pool with the use of telemetry cardiotocographs (CTG’s), home births have been supported but each case is reviewed first in a multi disciplinary meeting. On our labour ward we have a low risk birthing room (birthing couch and situated next to the pool) which these women can give birth in. Each woman is managed using a personalised risk assessment so that her care is personalised to her clinical situation and her personal requests.
3) Could you also please advise on how these practice points alter (if at all) should the vbac follow multiple caesareans?
All women would be Consultant reviewed; but normally the plan would be for VBAC unless there any risk factors were identified which would suggest that this was not the best plan for the woman. If the woman chose to continue with a VBAC despite counselling this would be supported and plans to manage the labour safety made in communication with the woman and the professionals. The plan would be made following a multi disciplinary meeting if there were concerns regarding plan to try and support the choice of the woman.
4) The most recent statistics (2013, 2014 and 2015 to date) relating to how many women choose an elective caesarean after they’ve previously had one or more caesareans?
2015 = 37%
2014 = 49%
5) The most recent statistics (2013, 2014 and 2015 to date) relating to how many VBAC women choose to birth at a) midwife-led unit, b) consultant-led unit, c) home?
Data not collected for A) as the midwifery birthing centre in this Trust does not currently care for women who have previously had an LSCS as our criteria for the low risk birthing centre excludes this group of women. This is currently under review. Please see comments at question 8
B) the data for the consultant led service is attached.
C) The data for women who chose a home birth after a previous LSCS is not collected. The numbers of women choosing this birthing option following a previous LSCS are few and those successful in achieving a home birth are very small. Unfortunately our data system is very rudimentary and so we are able to collect very few details on some of our stats.
6) Could you provide your most up to date VBAC success rate statistics?
2015 = 44%
2014 = 61%
7) If available, statistics relating to how many planned VBACs resulted in vaginal birth and how many in caesarean birth? (2013, 2014 and 2015 to date)
2015 = of 148 attempted VBAC, 65 vaginal births and 83 caesarean births
2014 = of 163 attempted VBAC; 100 vaginal births and 63 caesarean births
8) How many VBAC women have transferred from the midwife-led unit to consultant-led unit? Of these how many had a vaginal birth, how many had an assisted birth, how many had a caesarean birth? (2013, 2014 and 2015 to date)
None as they would not fit the criteria for using our low risk birthing unit. We do have a low risk birthing room and adjacent pool on labour ward and women requesting VBAC can use this facility.
9) How many women attempting a VBAC experienced a true uterine rupture? Of these, where was the women (midwife-led unit, consultant-led unit or home) and what was the outcome for mother and baby? (2013, 2014 and 2015 to date)
All cases were delivered within the obstetric unit; 2013 x 4, 2014 x 3, 2015 x 1
Outcome 2015: 1 case the baby went to SCBU, mother had no PPH at LSCS and was discharged home after full recovery. (0.68%)
Outcomes 2014: 3 cases all babies delivered via LSCS all went to SCBU, all 3 mothers had PPH’s but were discharged home after full recovery. (1.84%)
Outcomes 2013: 2 cases babies were alive and well delivered by lower segment caesarean section (LSCS), the 2 other cases babies went to Special care baby unit SCBU, 3 mothers had post partum haemorrhages (PPH) and one mother had no significant blood loss. All mothers discharged home post LSCS following full recovery.
Cambridge VBAC Friends submitted Freedom of Information requests to five local hospitals: The Rosie Hospital in Cambridge; Hinchingbrooke Hospital in Huntingdon; Peterborough City Hospital; The Lister Hospital in Stevenage and The West Suffolk Hospital in Bury St Edmunds. We’ll be publishing the findings in full and they’ll also be available in our private online support group.