• This case study was provided by Newcastle upon Tyne NHS Foundation Trust.
  • The project was run by the Newcastle obstetrics team, focused on women considering vaginal birth after a previous caesarean section (VBAC).
  • It set out to ensure women understand the risks and benefits of VBAC and make informed decisions.
  • The team made changes to the care pathway, giving women who had had one previous caesarean section more information and midwife-led appointments.

 

 

There are risks and benefits to having a vaginal birth after a caesarean section (VBAC). It is important that women understand these factors and can make an informed decision leading up to their next birth. NICE guidance recommends that women should be made aware of existing evidence but that their preferences should guide the choice.

A pilot study found that women who previously had a caesarean section were more confident about making decisions on their next birth when supported with an informational DVD at 12 weeks’ gestation, and counselling from a midwife at 34 weeks. They felt better informed, were able to access information and ask questions, and felt their decision had been informed and effective. Most women felt midwife-led counselling was better than the DVD.

The Newcastle obstetrics team wanted to apply the learning from the pilot, but a 34-week midwife home visit was unfeasible. Instead they made changes to the care pathway for women who had one previous caesarean section and no other risk factors. These women were given information and attended midwife-led appointments to help them make decisions. They were also sent an adapted Ottawa Decision Guide (ODG) to read and bring to their appointment to facilitate shared decision making discussions.

More than 76 women have completed this pathway. Most women found the information useful and completed the guide. Developing the pathway helped raise awareness of shared decision making in the VBAC team and with clinical colleagues, and has led to further work across the obstetrics team. 

Further reading