Summary
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.
Version history
The first edition of this guideline was published in 2007; reviewed 2012 – update required.
This is the second edition of this guideline, published in 2015; reviewed 2018 – no update required; reviewed 2020 – no update required; reviewed 2021 – no update required; reviewed 2022 – no update required; reviewed 2023 – an update is in development.
Developer declaration of interests
Available on request.