Midwifery continuity of care and vaginal birth after caesarean section: A randomised controlled trial

Women Birth. 2022 May;35(3):e294-e301. doi: 10.1016/j.wombi.2021.05.010. Epub 2021 Jun 5.


Problem and background: Caesarean section (CS) rates in Australia and many countries worldwide are high and increasing, with elective repeat caesarean section a significant contributor.

Aim: To determine whether midwifery continuity of care for women with a previous CS increases the proportion of women who plan to attempt a vaginal birth in their current pregnancy.

Methods: A randomised controlled design was undertaken. Women who met the inclusion criteria were randomised to one of two groups; the Community Midwifery Program (CMP) (continuity across the full spectrum - antenatal, intrapartum and postpartum) (n=110) and the Midwifery Antenatal Care (MAC) Program (antenatal continuity of care) (n=111) using a remote randomisation service. Analysis was undertaken on an intention to treat basis. The primary outcome measure was the rate of attempted vaginal birth after caesarean section and secondary outcomes included composite measures of maternal and neonatal wellbeing.

Findings: The model of care did not significantly impact planned vaginal birth at 36 weeks (CMP 66.7% vs MAC 57.3%) or success rate (CMP 27.8% vs MAC 32.7%). The rate of maternal and neonatal complications was similar between the groups.

Conclusion: Model of care did not significantly impact the proportion of women attempting VBAC in this study. The similarity in the number of midwives seen antenatally and during labour and birth suggests that these models of care had more similarities than differences and that the model of continuity could be described as informational continuity. Future research should focus on the impact of relationship based continuity of care.

Keywords: Cesarean section; Midwifery; Midwives; Vaginal Birth after Cesarean; Vaginal birth.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Cesarean Section
  • Continuity of Patient Care
  • Cytidine Monophosphate
  • Female
  • Humans
  • Infant, Newborn
  • Midwifery*
  • Parturition
  • Pregnancy
  • Vaginal Birth after Cesarean*


  • Cytidine Monophosphate