Abstract
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
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Article info
Publication history
Published online: June 05, 2021
Accepted:
May 27,
2021
Received in revised form:
May 18,
2021
Received:
September 2,
2019
Identification
Copyright
© 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
