Acceptance of trial of labour after caesarean with checklist used in counselling during antenatal care at a teaching institution in Bihar, India: A prospective observational study.

Abstract

Trial of labour after caesarean (TOLAC) should be preferred over Elective Repeat Caesarean Deliveries (ERCD) if not contraindicated. For this, proper counselling of patient for TOLAC is needed beginning from antenatal period. To evaluate the preference of women for the mode of delivery after the first CD using RCOG checklist during antenatal period. This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India for a period of 18 months. A total of 157 patients fulfilling the inclusion criteria were divided into two groups. Group 1: (117 cases) All booked pregnant women counselled throughout the antenatal period using RCOG checklist. Group 2: All unbooked pregnant women not counselled for TOLAC during antenatal period. Baseline demographic and obstetrical details, preferred mode of delivery, reason for the preferred mode of delivery, any change in preference, reason for change in preference, actual mode of delivery, the success rate of VBAC, and maternal and neonatal outcomes were recorded in both groups and data were statistically analyzed. Increased acceptance for TOLAC was seen among participants of both groups, but difference was not statistically significant (<i>P</i> = 0.158). There was significant difference between number of women preferring TOLAC during counselling (47.9% and 35% in Group 1 and 2, respectively) versus the number of women who actually underwent TOLAC (28.2% and 66.7% in Group 1 and 2, respectively). Success rate of VBAC in Group 1 and Group 2 was 28.2%. and 66.7% respectively, and overall VBAC success rate was 37.2%. Maternal and neonatal outcomes with different modes of delivery were not statistically significant. Antenatal counselling using RCOG checklist increases preference for TOLAC, but the number of women who actually underwent TOLAC was significantly less. Various reasons behind this need to be addressed and analyze, and plan should be made to increase TOLAC and successful VBAC rate.