Abstract:
Vaginal delivery after previous cesarean section (VBAC) has been found to be safe and to have a success rate above 60%. However, many care providers and pregnant women are reluctant to initiate or accept trial of labor after cesarean delivery. Care providers in low resource settings find counseling to be difficult in part because predictors of success that are reported in the literature are from developed countries and evidence from developing countries is scanty. This study aims to investigate potential predictors associated with a successful trial of labor after Cesarean Section (TOLAC) in low resource settings.
Methods: A cross-sectional study design involving women with one previous cesarean delivery admitted for delivery from 15th September 2015 to December 16th 2015 in the three large teaching hospitals in Rwanda (Butare University Teaching Hospital (BUTH), /Kigali Teaching Hospital (KUTH) and Muhima District Hospital). Patient demographics were collected and chart review was performed.
Results: The majority of the participants were married women aged between 18-34 years and had a community base insurance. Those who stay in urban area are nearly 70% and 60.9% of the participants completed primary education. Three quarters of patient had counseling prior to admission about TOLAC and 40.6% reported that the counseling was from her doctor. The majority (97%) experienced spontaneous labor and above half of them had a cervical dilatation on admission of ≥ 4 cm. Half of the sample (50, 4%) had a successful VBAC. Results from multiple regression analysis show that previous vaginal delivery, previous VBAC, and admission cervical dilatation were independent predictors to the success of TOLAC.
Conclusion: In patients without any contraindication to vaginal delivery, TOLAC is a safe option. In this study, successful VBAC was associated with past obstetrics history (prior vaginal delivery and/or prior VBAC) and to the current labor (spontaneous labor and advanced admission cervical dilatation).
