Prevalence of successful vaginal birth after caesarean section and its associated factors among women delivered in the university of Gondar comprehensive specialized referral hospital, Northwest Ethiopia.

Abstract

Introduction: Caesarean section (CS) is an essential, life-saving surgical intervention used to address obstetric complications. Nonetheless, its excessive use has raised global concerns. In low- and middle-income countries (LMICs) like Ethiopia, the challenges of repeat CS and the limited success of VBAC are particularly problematic. Despite this, there is a significant gap in knowledge regarding vaginal births following a cesarean delivery in Ethiopia, especially in the specific study area.

Objectives: To determine the prevalence and associated factors of successful vaginal birth after one caesarean section in the University of Gondar Comprehensive Specialized Hospital.

Methods: Institutional based cross-sectional study was conducted among 409 women who were randomly selected and had one previous caesarean section delivery and underwent a trial of labor. Data were analyzed and computed using Stata version 14 Software. Multivariable logistic regression analysis was performed to identify the factors associated with successful vaginal birth after caesarean section. A crude and adjusted odds ratio with a 95% confidence interval was used to interpret the results. A P value of < 0.05 indicated statistically significant results.

Results: Of 385 completed charts reviewed, the success rate of vaginal birth after caesarean section was 38.2%,( 95%CI;33.3-43.1%).The factors associated with successful vaginal birth after cesarean section were: prior history of spontaneous vaginal delivery at any point time (AOR = 1.84,95% CI;1.02-3.33), prior history of successful vaginal birth after previous cesarean section (AOR = 2.12, 95%CI;0.97-4.64), no history of stillbirth (AOR = 1.78, 95% CI;1.03-3.07), cervical dilation on admission ≥ 3 cm (AOR = 2.22, 95% CI; 1.14-4.35), station on admission ≥ 0(AOR = 1.94, 95% CI; 1.12-3.37), and Antenatal care follow-up (AOR = 2.48,95%CI;1.26-4.88).

Conclusions: Our study demonstrated a low prevalence of successful VBAC, highlighting that factors such as a prior history of VBAC, spontaneous vaginal delivery at any time, cervical dilatation at admission, history of stillbirth, ANC follow-up, and fetal station at admission are significantly associated with positive outcomes. This evidence clearly indicates that targeted, evidence-based interventions are urgently needed to improve VBAC success rates. Therefore; the Federal Ministry of Health (FMOH), policymakers, and relevant stakeholders should collaborate to develop, implement, and continuously review comprehensive policies and guidelines that support these targeted interventions.