Mode of birth after caesarean section: individual prediction scores using Scottish population data

BackgroundRising caesarean section (CS) rates are a global health concern. Contemporary data indicates that almost 50% of CS are electively performed, with a high proportion of these being a repeat procedure. Vaginal birth after caesarean (VBAC) is recognised as a safe way to give birth in developed countries. UK national maternity policy and worldwide professional guidance supports shared decision-making about mode of birth with women following CS. Evidence suggests that women want individualised information, particularly about their likeilihood of successful VBAC, to enable them to participate in the decision making process. This study aimed to identify characteristics that could inform a predictive model which would allow women to receive personalised and clinically specific information about their likelihood of achieving a successful VBAC in subsequent pregnancies.MethodsAn observational study using anonymised clinical data extracted from a detailed, comprehensive socio-demographic and clinical dataset. All women who attempted a singleton term VBAC between 2000 and 2012 were included. Data were analysed using both logistic regression and Bayesian statistical techniques to identify clinical and demographic variables predictive of successful VBAC.ResultsVariables significantly associated with VBAC were: ethnicity (p?=?0.011), maternal obstetric complications (p