Department of Obstetrics and Gynaecology, Lagos State University College of Medicine, Lagos, Nigeria.
Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, No 1 - 5, Oba Akinjobi Way, Ikeja, Nigeria.
BMC Pregnancy Childbirth. 2023 Jan 30;23(1):82. doi: 10.1186/s12884-023-05348-4.
Prior caesarean delivery (CD) impacts CD rates in many parts of the world. In low and middle-income countries, few women attempt a trial of labour after caesarean delivery (TOLAC) due to inadequate resources for safe vaginal birth after caesarean delivery (VBAC). The CD rates continue to rise as more women undergo repeat CD. In Nigeria, VBAC rate is low and the contribution of women's prior childbirth experiences and delivery wishes to this situation deserves further investigation. This study examined the parturient factor in the low VBAC rate to recommend strategies for change.
To describe prior caesarean-related childbirth experiences and attitudes towards subsequent vaginal birth in pregnant women with one previous CD.
This cross-sectional study of antenatal clinic attendees in a tertiary hospital employed the convenience sampling method to recruit 216 consenting women with one previous CD. Structured questionnaires were used to collect information on participants' prior caesarean-related birth experiences, attitudes to vaginal birth in the index pregnancy, future delivery intentions and eventual delivery route. Univariate and bivariate analyses compared delivery wishes based on CD type. SPSS version 22.0 was used for data analysis.
The modal maternal and gestational age groups were 30-39 years (68.1%) and 29-34 weeks (49.1%) respectively; majorities (60.6%) were secundigravida; 61.6% experienced labour before their CDs while 76.9% had emergency CDs. Complications were documented in 1.4% and 11.1% of mothers and babies respectively. Ninety percent reported a satisfactory overall childbirth experience. A majority (83.3%) preferred TOLAC in the index pregnancy because they desired natural childbirth while 16.7% wanted a repeat CD due to the fear of fetal-maternal complications. The previous CD type and desire for more babies were significantly associated with respondents' preferred mode of delivery (p = 0.001 and 0.023 respectively). Women with previous emergency CD were more likely to prefer vaginal delivery.
Antenatal women prefer TOLAC in subsequent pregnancies despite prior satisfactory caesarean-related birth experiences. Adoption of TOLAC in appropriately selected cases will impact women's psyche positively and reduce CD rate.
既往剖宫产（CD）在世界许多地区都会影响 CD 率。在低收入和中等收入国家，由于缺乏安全的剖宫产术后阴道分娩（VBAC）资源，很少有妇女尝试剖宫产术后试产（TOLAC）。随着更多的妇女接受重复 CD，CD 率继续上升。在尼日利亚，VBAC 率较低，产妇先前的分娩经历和分娩愿望对这种情况的贡献值得进一步调查。本研究检查了 VBAC 率低的产妇因素，以提出改变的策略。
描述既往与剖宫产相关的分娩经历，并了解有过一次剖宫产的孕妇对随后阴道分娩的态度。
本横断面研究采用便利抽样法，对一家三级医院的产前门诊就诊者进行了研究，共招募了 216 名有一次既往剖宫产的同意参加研究的妇女。使用结构化问卷收集参与者既往与剖宫产相关的分娩经历、本次妊娠阴道分娩的态度、未来分娩意向和最终分娩方式的信息。采用单变量和双变量分析比较了根据剖宫产类型的分娩意愿。采用 SPSS 版本 22.0 进行数据分析。
产妇的年龄和孕龄以 30-39 岁（68.1%）和 29-34 周（49.1%）为主；大多数（60.6%）为经产妇；61.6%在剖宫产前有过临产，76.9%为急症剖宫产。母亲和婴儿的并发症发生率分别为 1.4%和 11.1%。90%的人报告整体分娩体验满意。大多数（83.3%）在本次妊娠中首选 TOLAC，因为他们希望自然分娩，而 16.7%因为担心胎儿-母亲并发症而希望再次剖宫产。既往剖宫产类型和希望生育更多孩子与受访者首选的分娩方式显著相关（p=0.001 和 0.023）。有既往急症剖宫产的妇女更倾向于选择阴道分娩。
尽管有既往满意的剖宫产相关分娩经历，产前妇女仍在后续妊娠中首选 TOLAC。在适当选择的情况下采用 TOLAC 将对妇女的心理产生积极影响，并降低 CD 率。
