Study of the causes of non-acceptance of VBAC in patients with previous one LSCS in a tertiary institution

Deepa B. Karmali, Guruprasad Pednekar, Ajit A. Nagarsenkar


Background: Many women who are eligible candidates for a VBAC (Vaginal Birth after Caesarean) in the current pregnancy opt for a repeat LSCS (Lower Segment Caesarean Section) as a mode of delivery. We decided to evaluate the proportion of patients who opt out of a VBAC and to study the causality of this trend.

Methods: All patients who presented to the Dept. of OBG in our institution and were eligible to have a VBAC were included in the study till the sample size of 100 cases was met. Consultant opinion was sought prior to deciding the mode of delivery.

Results: Incidence of patients of previous one LSCS who were not willing for VBAC was 4%, out of total number of deliveries and 30.7%, out of all cases of patients with previous one LSCS. The reason for not opting for a VBAC in the current pregnancy in the majority of the eligible patients was the desire for a concurrent sterilization procedure. Others cited apprehension of a scar rupture or fear of labor pain or both as their primary reason for opting out of a VBAC.

Conclusions: The high incidence of ERC (Elective Repeat Caesarean) as compared to TOLAC (Trial of Labour after Caesarean) has long-term clinical and financial implications. Counseling given to the pregnant woman with an emphasis on the advantages of VBAC in order that she opts for a VBAC with confidence and enthusiasm is the only way forward.


Caesarean section, Previous LSCS, VBAC refusal

Full Text:



Crowther CA, Dodd JM, Hiller JE, Haslam RR, Robinson JS, Group on behalf of the BACS. Planned Vaginal Birth or Elective Repeat Caesarean: Patient Preference Restricted Cohort with Nested Randomised Trial. Smith GC, editor. PLoS Med. 2012;9(3):1-10.

Dodd JM, Crowther CA, Hiller JE, Haslam RR, Robinson JS. Birth after caesarean study--planned vaginal birth or planned elective repeat caesarean for women at term with a single previous caesarean birth: protocol for a patient preference study and randomised trial. BMC Pregnancy Childbirth. 2007;7(1):17.

Birth V, Previous A. ACOG Practice bulletin no. 115: Vaginal birth after previous cesarean delivery. Obstet Gynecol. 2010;116(2 Pt 1):450-63.

Goel S, Tiwari M, Hariharan C, Shrivastava D. Outcome of post caesarean pregnancy and comparison of maternal and foetal outcome following vaginal birth versus repeat caesarean section in a rural hospital. Int J Reprod Contraception, Obstet Gynecol. 2013;2(1):16-22.

Jawa A, Garg S, Tater A SU. Indications and rates of lower segment caesarean section at tertiary care hospital-an analytical study. Int J Reprod Contracept Obs Gynecol. 2016;5(10):3466-9.

Badge VL, Aggarwal SS, Ambalkar DD, Humne A, Raghuwanshi N. Assessment of indications of lower section caesarean section at tertiary care centre: a cross sectional study. Int J Community Med Public Heal. 2017;4(4):1253-6.

Bala S, Patidar BL, Gupta B. A Retrospective Analysis of Annual Cesarean Section Rate in a Tertiary Care Hospital, KOTA. J Med Sci Clin Res. 2017;05(07):25325-9.

Bragg F, Cromwell DA, Edozien LC, Gurol-Urganci I, Mahmood TA, Templeton A, et al. Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: Cross sectional study. BMJ. 2010;341(c5065):1-8.

Grobman WA, Lai Y, Landon MB, Spong CY, Rouse DJ, Varner MW, et al. The change in the rate of vaginal birth after caesarean section. Paediatr Perinat Epidemiol. 2011;25(1):37-43.

Birth After Previous Caesarean. Green-top Guideline No. 45. 2007;(45):1-17.

Schoorel E, Vankan E, Scheepers H, Augustijn B, Dirksen CD, De Koning M, et al. Involving women in personalised decision-making on mode of delivery after caesarean section: the development and pilot testing of a patient decision aid. BJOG. 2014;121(2):202-9.

Rozen G, Ugoni AM, Sheehan PM. A new perspective on VBAC: A retrospective cohort study. Women and Birth. 2011;24(1):3-9.

Scott J. Intrapartum management of trial of labour after caesarean delivery: evidence and experience. BJOG. 2014;121(2):157-62.

Nikhil A, Desai A, Vijay K, Seema P, Bhumika K, Riddhi P. Analysis of trends in lscs rate and indications of lscs: a study in a medical colleege hospital gmers, Sola, Ahmedabad. Int J Pharm bio Sci. 2015;2(1):1-5.