Vaginal Birth after Cesarean Delivery: A safe Alternative to Repeat Cesarean section, a Critical Analysis in Patients

Abstract

Background: Rising global cesarean section (CS) rates have raised concerns regarding increased maternal and neonatal morbidity, prolonged hospital stay, and higher healthcare costs associated with repeat surgical deliveries. Vaginal birth after cesarean (VBAC) has emerged as a safe and effective alternative for carefully selected women with a previous cesarean section; however, its utilization remains limited in many low- and middle-income countries due to safety concerns and resource constraints.

Objective: To evaluate and compare maternal and neonatal outcomes, hospital stay, and overall safety of vaginal birth after cesarean (VBAC) versus elective repeat cesarean section (ERCS).

Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynecology at Dhaka Medical College Hospital in 2024. A total of 100 women with one previous lower segment cesarean section were included, with 50 undergoing VBAC and 50 undergoing ERCS. Baseline demographic and obstetric characteristics were recorded. Outcomes assessed included postpartum hospital stay, maternal and neonatal complications, APGAR scores at 5 minutes, and subgroup outcomes among successful and failed VBAC cases. Statistical analysis was performed using SPSS version 20.0, with appropriate comparative tests applied.

Results: In this study of 100 women, equally divided between VBAC and ERCS groups, the baseline characteristics were comparable. The majority of women were aged £30 years (72% in VBAC vs 68% in ERCS), and BMI distribution was similar, with 48% of VBAC and 44% of ERCS women having a BMI <25 kg/m². Primipara accounted for 40% in VBAC and 36% in ERCS, while multipara were 60% and 64%, respectively. Most neonates weighed ³3 kg (56% in VBAC vs 60% in ERCS). Regarding obstetric outcomes, term pregnancies were observed in 72% of VBAC and 68% of ERCS cases, and cephalic presentation was more frequent in VBAC (84% vs 76%), whereas malpresentation was higher in ERCS (24% vs 16%). Postpartum complications were generally low; postpartum hemorrhage occurred in 4% of VBAC and 8% of ERCS cases, surgical site infection was only in ERCS (8%), and blood transfusion was required in 4% of VBAC and 12% of ERCS cases. Hospital stay was shorter for VBAC, with 72% staying 2–4 days compared to 28% in ERCS, while longer stays of 5–7 days were more common in ERCS (72% vs 28%). APGAR scores of 10 at 5 minutes were high in both groups (88% VBAC, 92% ERCS). Overall complications were slightly higher in ERCS (28%) than VBAC (20%), with maternal complications in 8% of VBAC and 6% of ERCS. Neonatal complications were 12% in VBAC versus 24% in ERCS; among these, respiratory distress occurred in 33.3% of VBAC and 16.7% of ERCS neonates, fever in 16.7% vs 33.3%, jaundice in 50% vs 66.7%, meconium aspiration in 16.7% of VBAC only, and NICU admission in 66.7% vs 41.7%, respectively. Subgroup analysis showed that successful VBAC was associated with better outcomes, including shorter hospital stay (63% vs 37% for VBAC-failed) and lower overall complications (11% vs 17% for VBAC-failed), while neonatal outcomes remained comparable to ERCS.

Conclusion: VBAC is a safe and effective alternative to elective repeat cesarean section in appropriately selected women. It is associated with shorter hospital stay, lower neonatal morbidity, and comparable maternal outcomes. Promoting VBAC through careful patient selection and adequate intrapartum monitoring may help reduce unnecessary repeat cesarean deliveries and improve maternal and neonatal outcomes, particularly in resource-limited settings.

J Dhaka Med Coll. 2025; 34(2) : 64-69