Vaginal birth after caesarean section is not a safe option in low resource settings

Abstract

Vaginal Birth After Caesarean Section (VBAC), has for a long time been practised in low resource settings using nonconventional methods. This not only poses danger to the woman and her baby, but could also have serious legal and ethical implications. The adoption of this practice had been informed by observational studies with many deficiencies, despite other studies from settings where the standard of care is much better, showing that Elective Repeat Caesarean Section (ERCS) may actually be safer than VBAC. This raises  questions on whether we should insist on a dangerous practice when there are safer alternatives. We highlight some of the challenges faced in making this decision and discuss why the fear of ERCS may not be justified  after all in low resource settings. Since a reduction in caesarean section rate may not be applicable in these regions with an already low coverage, emphasis should be on adequate birth spacing and safer primary operative delivery.

Keywords: Vaginal birth after caesarean section, Elective repeat caesarean section, Low resource settings