Vaginal birth after two previous c-sections: obstetricians-gynaecologists opinions and practice patterns

J Matern Fetal Neonatal Med. 2010 Dec;23(12):1487-92. doi: 10.3109/14767051003678176. Epub 2010 Mar 17.


Objectives: To evaluate obstetricians' practice patterns, opinions and factors influencing decision-making about mode of delivery in women with two previous c-sections.

Methods: A questionnaire was mailed to the 160 obstetricians from the Rhone-Alpes perinatal network. Questionnaires included demographic, organisational information and questions about physicians' opinion, practice patterns and patient counseling concerning vaginal birth after c-section (VBAC) after one and two caesarean sections.

Results: Response rate was 65.6%, 100% and 23.8% would offer VBAC to women with respectively one and two previous c-sections. Uterine rupture rate was largely overestimated in both women with one (2.8%) and two prior c-sections (14.2%). Factors positively influencing obstetricians were cerebral palsy estimated rate less than 20%, a minimal decision to birth delay less than 20 min when emergency c-section would be required. Neonatal severe outcomes consecutive to trial of labour as well as placenta praevia or accreta risk and morbidity associated with multiple c-sections would be insufficiently discussed.

Conclusion: Obstetricians largely prefer a third planned c-section in women with two previous c-sections. This decision is partly based on a large overestimation of immediate maternal and neonatal serious outcomes consecutive to trial of labour as well documented serious long term outcomes of multiple c-sections are insufficiently considered.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Cerebral Palsy / epidemiology
  • Cesarean Section, Repeat* / adverse effects
  • Counseling
  • Female
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Male
  • Middle Aged
  • Obstetrics / methods*
  • Placenta Accreta
  • Placenta Previa
  • Practice Patterns, Physicians'*
  • Pregnancy
  • Risk Factors
  • Surveys and Questionnaires
  • Trial of Labor
  • Uterine Rupture / epidemiology
  • Vaginal Birth after Cesarean* / adverse effects