The Midwife Led VBAC clinic was established in Blackpool Victoria Hospital in 2008 as part of the Caesarean Section toolkit developed by NHS Institute in response to a rising caesarean section rate. Following its implementation the caesarean rate reduced from 28% to 22%. Since its introduction, its effectiveness has not been reviewed. As part of a 360 degree review of caesarean sections within the trust the outcomes of the clinic have been reviewed.Method
A retrospective review of 100 women who attended the midwife led VBAC clinic. Data collected included the desired mode of delivery and the actual mode delivery.Results
At the initial visit, 22% were undecided about mode of delivery, 59% desired a VBAC and 19% asked for planned elective repeat Caesarean section. The actual delivery mode was 33% successful VBAC, 26% emergency caesarean section and 41% planned repeat section. Of those who planned a VBAC, 50% achieved a vaginal birth, 25% had an emergency section and 25% a planned section. Of those women who were undecided 9% had a successful VBAC and 54% had a planned section.Conclusion
There is a definite discrepancy between those planning a VBAC compared to those who undertake it. Whilst our results do not implicate the midwife led VBAC clinic as being ineffective, they highlight the need for a holistic approach to management of caesarean section and subsequent deliveries. This includes ‘getting it right first time’, an immediate debrief and 6 week follow-up and consultant led management plan in subsequent pregnancies.