Quality standard
Quality statement 1: Vaginal birth after a caesarean birth
Quality statement 1: Vaginal birth after a caesarean birth
Quality statement
Pregnant women or pregnant people who have had 1 or more previous caesarean births have a documented discussion of the option to plan a vaginal birth.
Rationale
Clinically there is little or no difference in the risk associated with a planned caesarean birth and a planned vaginal birth in pregnant women or pregnant people who have had up to 4 previous caesarean births. If a pregnant woman or pregnant person chooses to plan a vaginal birth after they have previously had a caesarean birth, they should be fully supported in their choice.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that pregnant women or pregnant people who have had 1 or more previous caesarean births have a documented discussion of the option to plan a vaginal birth.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
Process
The proportion of pregnant women or pregnant people who have had 1 or more previous caesarean births who have a documented discussion of the option to plan a vaginal birth.
Numerator – the number in the denominator who have a documented discussion of the option to plan a vaginal birth.
Denominator – the number of pregnant women or pregnant people who have had 1 or more previous caesarean births.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
Outcome
a) Women and people's satisfaction that they were supported in their choice for planned birthing option.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient surveys.
b) Rates of delivery modes for pregnant women or pregnant people who have had previous caesarean births.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. The NHS Digital Maternity services secondary uses dataset collects data on the percentage of women who have had a vaginal birth following a caesarean birth.
What the quality statement means for different audiences
Service providers ensure that systems are in place for pregnant women or pregnant people who have had 1 or more previous caesarean births to have a documented discussion of the option to plan a vaginal birth.
Healthcare professionals ensure that they have a documented discussion with pregnant women or pregnant people who have had 1 or more previous caesarean births that they have the option to plan a vaginal birth and support them in their choice.
Commissioners ensure that they commission services that have systems in place for pregnant women or pregnant people who have had 1 or more previous caesarean births to have a documented discussion of the option to plan a vaginal birth.
Pregnant women or pregnant people who have had a caesarean birth in the past have a discussion with a member of their maternity team (which is recorded in their notes) about the option to plan a vaginal birth.
Source guidance
Caesarean birth. NICE guideline NG192 (2021, updated 2024), recommendations 1.8.1, 1.8.2 and 1.8.5
Definitions of terms used in this quality statement
Documented discussion
Pregnant women or pregnant people should be informed by members of the maternity team that in women or people who have had 4 or fewer previous caesarean births the risk of fever, bladder injuries and surgical injuries does not vary with planned mode of birth but that the risk of uterine rupture is higher for planned vaginal birth. This discussion should be documented in the pregnant woman or pregnant person's notes. [NICE's guideline on caesarean birth, recommendation 1.8.2]
Equality and diversity considerations
Good communication between healthcare professionals and pregnant women or pregnant people is essential. Treatment and care, and the information given about it, should be culturally appropriate. It should also be accessible to pregnant women or pregnant people with additional needs such as physical, sensory or learning disabilities, and to pregnant women or pregnant people who do not speak or read English. Pregnant women or pregnant people should have access to an interpreter or advocate if needed. For pregnant women or pregnant people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.