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Open Access Study protocol

Does continuity of care impact decision making in the next birth after a caesarean section (VBAC)? a randomised controlled trial

Caroline SE Homer1*, Karyn Besley1, Jennifer Bell1, Deborah Davis2, Jon Adams1, Alison Porteous3 and Maralyn Foureur1

Author Affiliations

1 Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Level 7, 235-253 Jones St. Broadway, Sydney, NSW, Australia

2 Faculty of Health, University of Canberra, Canberra, Australia

3 Maternity Unit, Gosford Hospital, Gosford, NSW, Australia

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BMC Pregnancy and Childbirth 2013, 13:140  doi:10.1186/1471-2393-13-140

Published: 2 July 2013

Abstract

Background

Caesarean section (CS) has short and long-term health effects for both the woman and her baby. One of the greatest contributors to the CS rate is elective repeat CS. Vaginal birth after caesarean (VBAC) is an option for many women; despite this the proportion of women attempting VBAC remains low. Potentially the relationship that women have with their healthcare professional may have a major influence on the uptake of VBAC. Models of service delivery, which enable an individual approach to care, may make a difference to the uptake of VBAC. Midwifery continuity of care could be an effective model to encourage and support women to choose VBAC.

Methods/Design

A randomised, controlled trial will be undertaken. Eligible pregnant women, whose most recent previous birth was by lower-segment CS, will be randomly allocated 1:1 to an intervention group or control group. The intervention provides midwifery continuity of care to women through pregnancy, labour, birth and early postnatal care. The control group will receive standard hospital care from different midwives through pregnancy, labour, birth and early postnatal care. Both groups will receive an obstetric consultation during pregnancy and at any other time if required. Clinical care will follow the same guidelines in both groups.

Discussion

This study will determine whether midwifery continuity of care influences the decision to attempt a VBAC and impacts on mode of birth, maternal experiences with care and the health of the neonate. Outcomes from this study might influence the way maternity care is provided to this group of women and thus impact on the CS rate. This information will provide high level evidence to policy makers, health service managers and practitioners who are working towards addressing the increased rate of CS.

Trial registration

This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611001214921

Keywords:
Vaginal birth; Obstetrics; Caesarean section; Midwifery care; Vaginal birth after caesarean