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Birth after Previous Caesarean Birth (Green-top Guideline No. 45)

Published: 01/10/2015

This is the second edition of this guideline. The first edition was published in 2007 under the same title.

There has been continued debate about defining an acceptable caesarean delivery rate and what rate achieves optimal maternal and infant outcomes. The overall caesarean delivery rate in England for 2012–2013 was 25.5%; the majority were emergency (14.8%) rather than elective (10.7%) caesarean births. The caesarean delivery rates for Wales, Northern Ireland and Scotland in 2012–2013 were 27.5%, 29.8% and 27.3% respectively. Hence, counselling women for and managing birth after caesarean delivery are important issues.

There is a consensus (National Institute for Health and Care Excellence [NICE], Royal College of Obstetricians and Gynaecologists [RCOG], American College of Obstetricians and Gynecologists [ACOG]/ National Institutes of Health [NIH] that planned VBAC is a clinically safe choice for the majority of women with a single previous lower segment caesarean delivery. Such a strategy is also supported by health economic modelling and would also at least limit any escalation of the caesarean delivery rate and maternal morbidity associated with multiple caesarean deliveries. This guideline provides evidence-based recommendations on best practice for the antenatal and intrapartum management of women undergoing planned VBAC and ERCS.

Declaration of interests (guideline developers)

Professor JK Gupta FRCOG, Birmingham: Professor Gupta’s department and R&D have received grants from the National Institute for Health Research (NIHR), Ethicon, Bayer and Medicem. He has received consulting fees or honoraria for Thermachoice and Essure devices from Ethicon and Bayer respectively and commercial support for attending meetings or conferences from Thermachoice, Essure and Dilapan devices from Ethicon, Bayer and Medicem respectively. Professor Gupta receives payment as Editor-in-Chief of the European Journal of Obstetrics & Gynecology and Reproductive Biology (EJOG). He has received fees for expert testimony in clinical negligence and criminal cases and has received payment for lectures from Thermachoice, Essure and Mirena devices from Ethicon and Bayer. Professor Gupta has received royalties as editor for various undergraduate books e.g. Core Clinical Cases in Obstetrics and Gynaecology published by CRC Press, Taylor & Francis Group. He is a Medical Advisor for Femcare-Nikomed (manufacturer of Filshie clip sterilisation system).

Professor GCS Smith FRCOG, Cambridge: Professor Smith receives/has received grant support (within last 5 years) from the NIHR, the Medical Research Council (MRC), Action Medical Research, the Chief Scientist’s Office (Scotland), the Stillbirth and Neonatal Death Society, the British Heart Foundation and the Evelyn Trust. Professor Smith receives/has received research support from GE (supply of two diagnostic ultrasound systems, from Roche (supply of equipment and reagents for biomarker studies, approx. 900,000USD in value) and from GlaxoSmithKline (GSK) (approx. 300,000USD project to study effects of retosiban in human myometrium). Professor Smith has been paid to attend advisory boards by GSK and Roche. Professor Smith has acted as a paid consultant to GSK. Professor Smith has received support to attend a scientific meeting from Chiesi. Professor Smith is named inventor in a statement submitted by GSK (UK) for novel application of an existing GSK compound for the prevention of preterm birth (PCT/EP2014/062602).

Mr RR Chodankar MRCOG, Camberley: None declared.