Audit to review the outcomes of women who had been through VBAC Clinic 

Background:

Caesarean section (CS) rates have increased worldwide, ranges between 15% - 25%. National guidelines likelihood of successful vaginal birth after a previous caesarean section (VBAC) is 72% -75% and recommends trial of labour after a previous CS.

VBAC clinic aims to provide women with a high standard of evidence–based care to enable them to make an informed choice regarding their mode of delivery.

 

Objective:

The objective of this audit was to review the outcomes of women who had been through the midwifery led VBAC clinic at University Hospital of North Midlands NHS Trust (UHNM)

 

Design:

It was a retrospective criterion based audit where we reviewed 3 months’ data from May 2022 – July 2022.

 

Method:

Records of 105 women who attended the VBAC clinic between May – June 2022 was collected retrospectively. We used VBAC guideline and Midwifery led VBAC clinic guidelines of our Trust (UHNM) as standard.

We included all women with 1 previous CS with no other risk factors and any woman with 1 previous CS requesting elective caesarean section (ELCS) in the index pregnancy as per the Trust Midwifery led VBAC clinic guideline.

Outcomes of interest included proper documentation during the VBAC clinic, scar dehiscence, induction of labour (IOL), spontaneous labour and mode of delivery.

 

Data was collected from the K2 Maternity Computer System and recorded onto a Microsoft Excel Spreadsheet.

 

Data was analysed using Microsoft Excel and validated to ensure accuracy.

 

Results:

100% of women received antenatal counselling for VBAC and all had their outcome documented on their records. While 55% and 45% opted for VBAC and ELCS respectively, we only recorded 50% successful VBAC in contrary to national guidelines. There was no scar dehiscence, 37% went into spontaneous labour and 15% had IOL.

 

CONCLUSION:

Uptake rate of VBAC seems low compared to national guidelines. There was good counselling and documentation. Follow up appointments after initial consultation to re discuss options is required. It is worth considering factors associated with failed VBAC in future audits.