Influence of organizational factors on the offer and success rate of a trial of labor after cesarean section in Belgium: an ecological study

Griet Vandenberghe; An Vercoutere; Nadège Cuvellier; Elke Van Oost; Charlotte Leroy; Régine Goemaes; Monika Laubach; Michel Boulvain; Caroline Daelemans; B.OSS collaborating group

doi:10.1186/s12884-023-05984-w

Influence of organizational factors on the offer and success rate of a trial of labor after cesarean section in Belgium: an ecological study

BMC Pregnancy Childbirth. 2023 Sep 22;23(1):684. doi: 10.1186/s12884-023-05984-w.

Authors

Griet Vandenberghe^#¹, An Vercoutere^#², Nadège Cuvellier^{2

3}, Elke Van Oost^{4

5}, Charlotte Leroy⁶, Régine Goemaes⁷, Monika Laubach^{7

8}, Michel Boulvain^{2

8}, Caroline Daelemans^{2

9}; B.OSS collaborating group

Collaborators

B.OSS collaborating group:
J Ackermans, D Anton, M Bafort, A Batter, J Belhomme, A Beliard, B Bollen, V Boon, J Bosteels, V Bracke, G Ceysens, F Chaban, F Chantraine, E Christiaensen, L Clabout, P Cryns, M-C Dallequin, B De Keersmaecker, J De Keyser, A De Knijf, P Scheir, J De Loose, A De Vits, T De Vos, B Debecker, C Delforge, J Deloor, V Depauw, A Depierreux, K Devolder, L Claes, S Dirx, C Eerdekens, P Emonts, E Goenen, P Grandjean, S Hollemaert, S Houben, E Jankelevitch, G Janssen, J Quitnelier, Y Kacem, C Klay, A Laurent, J-F Legrève, A Lestrade, C Lietaer, A Loccufier, H Logghe, F Loumaye, V Mariman, N Minten, D Mortier, K Mulders, G Palgen, T Pezin, K Polisiou, C Riera, M Romain, B Rombaut, M Ruymbeke, K Scharpé, C Schockaert, A Segers, E Serkei, P Steenhaut, A Steylemans, B Thaler, W Van Dalen, E Van De Poel, E Van Deynse, R Van Dijck, C Van Holsbeke, L Van Hoorick, G Van Olmen, P Vanballaer, K Vancalsteren, S Vandeginste, S Vandepitte, K Verbeken, A Vereecke, M Verheecke, L Watkins-Masters, V Wijckmans, K Wuyts

Affiliations

¹ Department of Obstetrics, Ghent University Hospital, Vrouwenkliniek, Corneel Heymanslaan 10, 9000, Ghent, Belgium. griet.vandenberghe@uzgent.be.
² Department of Gynaecology and Obstetrics, Université Libre de Bruxelles (ULB) Hôpital Universitaire de Bruxelles (H.U.B.), Hôpital Erasme, Route de Lennik 808, Brussels, 1070, Belgium.
³ Present Address: Department of Gynaecology and Obstetrics, Centre Hospitalier EpiCURA Site Ath, Ath, Belgium.
⁴ Department of Obstetrics, Ghent University Hospital, Vrouwenkliniek, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
⁵ Present Address: Department of Obstetrics, AZ Maria Halle, Halle, Belgium.
⁶ Centre d'Epidémiologie Périnatale (CEpiP) Clos Chapelle-Aux-Champs, 30 Bte, B1.30.04 1200, Brussels, Belgium.
⁷ Study Centre for Perinatal Epidemiology (SPE), Koning Albert II-Laan 35 Bus 29, 1030, Brussels, Belgium.
⁸ Service of Obstetrics and Prenatal Medecine, Universitair Ziekenhuis Brussel, Laarbeklaan 101, 1090, Brussels, Belgium.
⁹ Present Address: Obstetrics Division, Department of Woman, Child and Adolescent Medecine, Geneva University Hospitals, Boulevard de la Cluse, 30, 1205, Geneva, Switzerland.

^# Contributed equally.

Abstract

Background: Trial of Labor After Cesarean is an important strategy for reducing the overall rate of cesarean delivery. Offering the option of vaginal delivery to a woman with a history of cesarean section requires the ability to manage a potential uterine rupture quickly and effectively. This requires infrastructure and organization of the maternity unit so that the decision-to-delivery interval is as short as possible when uterine rupture is suspected. We hypothesize that the organizational characteristics of maternity units in Belgium have an impact on their proposal and success rates of trial of labour after cesarean section.

Methods: We collected data on the organizational characteristics of Belgian maternity units using an online questionnaire. Data on the frequency of cesarean section, trial of labor and vaginal birth after cesarean section were obtained from regional perinatal registries. We analyzed the determinants of the proposal and success of trial of labor after cesarean section and report the associations as mean proportions.

Results: Of the 101 maternity units contacted, 97 responded to the questionnaire and data from 95 was included in the analysis. Continuous on-site presence of a gynecologist and an anesthetist was associated with a higher proportion of trial of labor after cesarean section, compared to units where staff was on-call from home (51% versus 46%, p = 0.04). There is a non-significant trend towards more trial of labor after cesarean section in units with an operating room in or near the delivery unit and a shorter transfer time, in larger units (> 1500 deliveries/year) and in units with a neonatal intensive care unit. The proposal of trial of labor after cesarean section and its success was negatively correlated to the number of cesarean section in the maternity unit (Spearman' rho = 0.50 and 0.42, p value < 0.001).

Conclusions: Organizational differences in maternity units appear to affect the proposal of trial of labor after cesarean section. Addressing these organizational factors may not be sufficient to change practice, given that general tendency to perform a cesarean section in the maternity unit is the main contributor to the percentage of trial of labor after cesarean.

Keywords: Decision-to-delivery interval; Emergency cesarean section; On-call schedule; Trial of labor after cesarean; Vaginal birth after cesarean.

MeSH terms

Belgium
Cesarean Section*
Delivery, Obstetric
Female
Humans
Infant, Newborn
Pregnancy
Trial of Labor
Uterine Rupture*