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A study co-authored by CUNY SPH researchers examines clinical research efforts to support vaginal birth after cesarean (VBAC) through interventions focused on the social, institutional, and individual-level factors of birth decisions and outcomes.
In the scoping review, doctoral candidate Nicola Tavella, Distinguished Professor Christian Grov, and Professor Angela Bianco at the Icahn School of Medicine at Mount Sinai, screened over 200 published studies on VBAC-focused interventions. Their review ultimately included 10 studies from nine countries involving tens of thousands of pregnant people with a prior cesarean delivery. These studies evaluated approaches such as shared decision-making counseling, patient decision aids, provider education, and continuity of midwifery care.
While results were mixed regarding whether each intervention improved VBAC likelihood, many interventions improved other outcomes including patient knowledge, shared decision-making, patient-reported experiences, and perinatal morbidity. One trial found that an institution-level decision-support intervention was associated with a 28% lower likelihood of perinatal morbidity.
“Decisions about mode of birth are not solely clinical,” says Tavella. “They are also shaped by access to information, institutional practices, and the broader social environment in which people exist.”
Vaginal birth can be an option for many people with a prior cesarean delivery, and decisions about it require individualized counseling, the researchers say. Stronger, more consistent research on non-biomechanical interventions would strengthen informed decision-making and lessen social disparities in maternal health outcomes, they add.
