Caesarean delivery is an operation done to deliver a baby through an incision in the uterus. It is the most frequently performed surgical procedure worldwide . Even though, variation exists in rates of caesarean delivery across countries; currently the rate ranges from 10% to 40% [1, 2]. This high caesarean section rate has put burden on the economy of nations and individuals.
Previous caesarean section has been found to be the commonest cause of increased caesarean section rate in many parts of the world . Because of increased risk of maternal complications with repeat caesarean section and safety of VBAC, trial of labour for selected group of patients with previous scar has become a preferred strategy .
In1988 ACOG recommended that, in the absence of a contraindication, a woman with one previous low-transverse cesarean delivery be counseled to attempt labor in a subsequent pregnancy [1, 4].
Vaginal birth after cesarean section (VBAC) is associated with shorter maternal hospitalizations, less blood loss and fewer transfusions, fewer infections, and fewer thrombo-embolic events than cesarean delivery. Several reports have indicated that the absolute risk of uterine rupture attributable to a trial of labor is about 1 per 1000 [1–4].
A 60 to 80% success rate of vaginal birth after previous caesarean section has been reported by many authors if the primary caesarean was done for nonrecurring indications . Some of the non recurring indications for caesarean section are: poor labour progress, foetal distress, placenta previa, transverse lie, breech presentation, oblique lie, pregnancy induced hypertension and twins .
The VBAC rate of hospitals in sub-Saharan Africa is between 37 to 97%. A Meta analysis done, in sub-Saharan countries showed a VBAC success rate of 63–75% .
There is considerable variation in the proportion of women who are offered and attempt VBAC across centres. British figures indicate that among women with a prior caesarean section, 33% will successfully achieve vaginal birth in the subsequent pregnancy. Again there was considerable variation across institutions, ranging from 6% to 64% .
One study in Lahore reported Successful vaginal delivery in 70% of the patients and repeat emergency caesarean section in 30% of the patients. The leading indications for the repeat caesarean sections were: failure to progress, fetal distress and scar tenderness. There were no maternal and foetal complications occurred. They concluded that VBAC is a safe practice .
Caesarean rate is increasing in Ethiopia because of the flourishing private hospitals in major towns. Even though teaching hospitals offer trial of labour for mothers with one scar, there is no study done which shows the rate of VBAC acceptance and success in Ethiopian Hospitals.
A study conducted in Brazil from1985 1995, the rate of TOL was found to be 11%. The factors significantly associated with vaginal delivery were monthly family income below 5-fold the Brazilian minimum monthly wage, reliance on the Brazilian national health system for healthcare, low maternal age, and first cesarean section indicated because of fetal breech or transverse presentation, or twin pregnancy .
Mother’s choice on mode of delivery is the most important single factor in offering trial of labour. Women’s expectations for birth and mode of birth preferences are influenced not only by knowledge of the potential benefits and risks but also demographic, obstetrical and social factors. This knowledge would help while counseling mothers for VBAC .
The crucial questions are how to reliably predict successful vaginal birth after Caesarean section, and how to determine and quantify the magnitude of the risk of failure that is acceptable to women. Many studies have addressed methods for identifying women at low and high risk of failure of an attempted vaginal birth after a prior caesarean but none of them have resulted in a validated result. Even those factors found to be associated with successful VBAC vary from centre to centre. Currently, therefore, there is no single validated tool which holds true for all to predict successful vaginal birth among women with a prior cesarean delivery.
The purpose of the present study was to identify maternal demographic, past and present obstetric determinants of successful VBAC in teaching hospitals in Ethiopia. This is of great help for physicians in the joint physician-patient decision while offering TOL.