Clinician-centred interventions to increase vaginal birth after caesarean section (VBAC): a systematic review

Aim of Review: To evaluate the effectiveness of clinician-centred interventions designed to increase the rate of vaginal birth after caesarean (VBAC). Search and Review Methods: The electronic databases of The Cochrane... [ view full abstract ]

Aim of Review: To evaluate the effectiveness of clinician-centred interventions designed to increase the rate of vaginal birth after caesarean (VBAC).

Search and Review Methods: The electronic databases of The Cochrane Library (CENTRAL), PubMed, PsychINFO and CINAHL were searched in July 2014. Randomised trials that evaluated any clinician-led intervention for increasing VBAC rates were eligible for inclusion. Key search terms, such as vaginal birth after caesarean OR VBAC OR caesarean AND randomized controlled trial, etc., were used to guide the search. The methodological quality of the studies was assessed by two reviewers using the Effective Public Health Practice Project assessment tool. Data were extracted independently by three reviewers. The primary outcome measure was VBAC rates.

Results: From 238 identified citations, 11 full-text papers were reviewed and three were included. One study evaluated the effectiveness of antepartum x-ray pelvimetry (XRP) in 306 women with one previous CS. Women allocated to antenatal XRP had lower VBAC rates compared to women allocated to no XRP (RR 0.66; 95% CI 0.44 to 0.98). One study evaluated the effects of external peer review on CS birth in 45 hospitals and found no differences in the proportions of women having a VBAC in peer-reviewed and non-peer reviewed hospitals (MD -1.90; 95% CI -5.39 to 1.59). The third study evaluated opinion leader education and audit and feedback in 16 hospitals. Audit and feedback had no effect on increasing VBAC rates (RR 0.82; 95% CI 0.62 to 1.07). In contrast, an opinion leader education strategy significantly increased VBAC rates (RR 1.74; 95% CI 1.45 to 2.09).

Conclusions: Few studies have evaluated clinician-centred interventions on VBAC rates, and intervention types vary. There is a need for further research that evaluates interventions for increasing VBAC rates that target clinicians, and in different maternity care settings.