Outcome of trial of labour for vaginal birth after one caesarean section

Vaginal birth after cesarean section (VBAC), the term that describes a vaginal delivery in a woman who has given birth via cesarean section in a previous pregnancy. Patients desiring VBAC delivery need to undergo a trial of labor, popularly known as a trial of labor after cesarean section (TOLAC). Delivery by cesarean section has increased significantly worldwide. In the United States, this rate increased from 5% in 1970 to 32.9% in 2009 and 31.9% in 2016 [1]. Several efforts failed to achieve the 15% cesarean delivery rate recommended by WHO [2].

Table 1 shows that the majority of women (75.3%) were between 21–30 years of age, followed by 17.3% in the 31–40 age group, and only 7.41% were over 40. Regarding BMI, half of the participants (50%) had a normal BMI (18.5–25 kg/m²), 45.06% were overweight (BMI 26–30 kg/m²), and 4.9% were obese (BMI >30). A history of previous vaginal delivery was noted in 19.8% of women. Among those who underwent a trial of labor, 33.3% achieved a successful vaginal birth after cesarean (VBAC), while 66.7% required an emergency repeat cesarean section.

Table 1 Demographic and obstetric characteristics of study participants (n=162)

This study explored the outcome of a trial of labour after one previous caesarean section in a tertiary care hospital. It particularly focused on the clinical results and the practical realities that influence decision-making by both clinicians and patients. The findings provide a realistic view of current VBAC practice in Bangladesh, where the success of TOLAC is shaped not only by obstetric factors but also by physicians’ attitudes, patient preferences, and the readiness of the health system.

Patients’ attitudes and expectations also have a major influence on the mode of delivery. In urban areas, women often consider caesarean section a more predictable and comfortable option, while others express a strong desire for normal delivery because of faster recovery and lower cost. The decision is therefore a balance between convenience and risk perception. Proper counselling plays a vital role here. As highlighted in previous studies [14], shared decision-making that clearly explains both the benefits and risks of TOLAC can increase the rate of successful VBAC while maintaining patient safety. In our setting, patient education remains limited, and many women decide based on anecdotal experience rather than medical advice.

This study found that VBAC can be a safe and feasible option for many women, especially those with a history of vaginal delivery and favorable obstetric factors. However, failed TOLAC carries significant risks, including increased maternal morbidity. Predictive factors such as prior vaginal delivery, Bishop score, fetal weight, and maternal age should be considered when counseling women about TOLAC. Further research, particularly RCTs, is essential to refine selection criteria and improve VBAC success rates, ultimately reducing unnecessary repeat cesarean sections. Further prospective, longitudinal studies with larger sample sizes are required to improve VBAC success rates and minimise unnecessary repeat cesarean deliveries.