Future birth options should be discussed sooner after first c-section

C-sections expose mothers and newborns to excess risk, so current Canadian clinical guidelines recommend that eligible women be offered a vaginal birth after caesarean, referred to as a VBAC. British Columbia has the highest repeat C-section rates in Canada, with just 33 per cent of women eligible for VBACs between 2012 and 2013 attempting a vaginal birth. Sarah Munro recently published a qualitative study in Women and Birth, examining why women opted for repeat C-sections. In a second study, published in Birth, she interviewed health-care providers and decision-makers about their experiences.

Her findings indicate that women start to form a clear preference about their next birth fairly soon after their first c-section, with little collaboration from health-care professionals. Care providers strongly supported women’s right to choose between a planned VBAC and an elective caesarean but there was a disconnect between when women began to form preferences and when health-care professionals began exploring future plans. Munro is now in the process of developing a patient decision aid for mode of birth, and is working in collaboration with health authorities and the Ministry to test it across the province. The tool will address women’s social and psychological concerns post-caesarean as well as issues about hospital resources and health services. The goal of the tool is to help women, families and care teams make informed, shared decisions and to plan births that reflect women’s values and preferences.
Munro is a postdoctoral fellow in family practice in the faculty of medicine at UBC and Dartmouth College, and a trainee at C2E2. Her two article are now available online: “Seeking Control in the Midst of Uncertainty: Women’s Experiences of Choosing Mode of Birth after Caesarean” (Women & Birth) and “Do Women Have a Choice? Care Providers’ and Decision Makers’ Perspectives on Barriers to Access of Health Services for Birth after a Previous Cesarean” (Birth).

For more on this research, listen to Munro’s interview with Stephen Quinn for CBC Radio’s On the Coast.