Vaginal birth after caesarean section before and during COVID-19 pandemic. Factors associated with successful vaginal birth.
P Hidalgo-Lopezosa, A M Cubero-Luna, J Huertas-Marín and 4 others
PMID 34972660WHAT IT FOUND
Vaginal birth after one caesarean was less likely during the pandemic period: 58.9% versus 83.3% before.
Previous vaginal birth, epidural analgesia, and night birth were linked to higher success in 276 women.
Key findings
01The overall VBAC success rate was 67.4%.
02Vaginal birth was less likely during the pandemic period than before it: 58.9% versus 83.3%, and caesarean section was more common: 41.1% versus 16.7%.
03The adjusted analysis reported birth before the pandemic, birth at night, epidural analgesia, and previous vaginal birth as factors associated with successful VBAC.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single tertiary hospital in southern Spain, so the care model and pandemic response may not match other settings. Retrospective medical records, with possible distortion or loss of variables because different professionals recorded the data. Observational design cannot show that the pandemic caused lower VBAC success; women were grouped only by birth date, and infection status, staffing, resources, policy and clinician decisions were not measured. Only women with one previous low transverse caesarean, singleton cephalic labour and no high-risk pregnancy were included, so findings do not extend to more complex pregnancies. Rare outcomes were few: only 2 uterine ruptures and 2 intrapartum deaths, so safety comparisons are unstable. The pandemic group was larger than the pre-pandemic group (180 versus 96), and some reported associations, such as night birth and oxytocin use, were not clear enough to support causal conclusions.
Declared interests
No funding or conflicts of interest were declared.
The easy way to misread this
Do not conclude that COVID-19 infection or the pandemic itself caused lower VBAC success. The study grouped women by birth date before or during the pandemic, used records from one hospital, and did not measure infection status or separate the effects of oxytocin, amniotomy, epidural use, night birth, staffing, or clinician decisions.