MODEL 1: Mode of birth after Caesarean Section, a preparatory phase study for quality improvement

Funding: CSO project No. CZG/3/17

Investigators:Janet Tucker, Tracey Humphrey, Lena Crichton, Alison Powell.

Summary

Previous work showed wide variation between Scottish maternity units’ rates of mode of birth after Caesarean Section (CS), increasing Elective Repeat CS ((ERCS) 46% (2005) vs 30% (1999)) and falling vaginal births (VBAC). And our casenote review showed women’s preferences for planned mode of delivery seldom recorded. Evidence indicates balanced benefits and risks of alternative modes of birth (for women with previous CS but no other complications), and guidelines advocate that this information, merged with patient preferences, should inform decision-making. This preparatory phase study will inform an initiative for improving the quality of woman-centred care in decision-making about mode of delivery after one previous Caesarean section. Case-studies of 4 major Scottish Maternity Units will explore current context, practice and readiness for a quality improvement initiative. Findings will inform a future implementation ensuring a robust, evaluable and professionally-supported quality improvement initiative.