Prevalence and factors associated with vaginal birth after one caesarean section for a non recurrent indication among women delivering from Kawempe national referral hospital

Abstract

Background: The rate of caesarean sections (CS) has awakened worldwide consciousness among both the general population and the health care givers with some studies showing an exponential rise in CS globally in the last 2 decades ranging from 6.0% to 33%. Globally, 60 to 80 percent of expecting women considered for a trial of labor after caesarean section (TOLAC) will have a successful vaginal birth (VBAC). In Uganda there was a high repeat caesarean section rate of up to 23% among expectant women with one previous scar in 2012. Objectives: To determine the prevalence and factors associated with vaginal birth after one caesarean section for a non-recurrent indication among women delivering from Kawempe national Referral Hospital Methods: This was a cross sectional study that used consecutive sampling. Participants had one previous caesarian section for a non-recurrent indication and attending to the labor suite in Kawempe national referral hospital. The Independent variables were social, demographic and clinical factors including maternal age, marital status, parity, mothers’ education status, inter-pregnancy interval, previous vaginal birth, onset of labor, fetal weight, duration in labor, APGAR score, BMI. Data was collected using structured questionnaires. Data was managed using Epidata software version 4.2. Data analysis was done using STATA version 14. Modified Poisson Regression with robust standard errors was used to determine the factors associated with VBAC. Prevalence ratios with corresponding 95% CIs were reported. Results: The prevalence of VBAC was 57.9%, 95% confidence interval (CI) 51.78% - 63.80%. For every unit (kgs) increase in the weight of the baby, the likelihood to have a VBAC reduces by 33% (aPR = 0.67 95%CI 0.530 - 0.852). Mothers who had an inter-pregnancy interval between 3 and 4 years were less likely to have a VBAC when compared to mothers with an inter-pregnancy interval less than 3 years (aPR = 0.69 95%CI 0.543 - 0.884). Also Mothers who spent 12 or more hours in first stage of labor were less likely to have a successful VBAC when compared to mothers who spent less than 12 hours in labor (aPR = 0.75 95%CI 0.585 – 0.962). Conclusions: The study demonstrates that the prevalence of VBAC for a non-recurrent indication is 57.9% at Kawempe national referral hospital. Birth weight, duration in labor, inter-pregnancy interval and BMI were factors significantly associated with VBAC in the study