RANDOMIZED CONTROLLED TRIAL OF A PRENATAL VAGINAL BIRTH AFTER CESAREAN-SECTION EDUCATION AND SUPPORT PROGRAM

OBJECTIVE: Our objective was to assess whether, for women with previou s cesarean section, a prenatal education and support program promoting vaginal birth after cesarean delivery increases the probability of va ginal delivery. STUDY DESIGN: Women with a single previous cesarean we re recruited before 28 weeks' gestation. Women's self-assessed motivat ion to attempt vaginal birth after a previous cesarean delivery was me asured on a 10 cm visual analog scale: stratum I, low motivation; stra tum II, high motivation. Women were randomized by stratum to one of tw o groups. Those in the ''Verbal'' group participated in an individuali zed education program. Those in the ''Document'' group were provided w ith a pamphlet detailing the benefits of planned vaginal birth after c esarean delivery. RESULTS: Rates of vaginal birth after cesarean secti on were similar in the verbal and document groups: verbal, 339 of 641 (53%); document, 310 of 634 (49%); relative risk 1.1, 95% confidence i nterval 1.0 to 1.2. There was no evidence of heterogeneity across moti vational strata. Regardless of treatment group, women with low motivat ion for vaginal birth after cesarean section were more than three time s as likely to undergo elective repeat cesarean than were women with h igh motivation (47% vs 13%). CONCLUSIONS: There was no evidence that a n individualized prenatal education and support program, when offered to all women with previous cesarean delivery, results in a clinically significant increase in the rate of vaginal birth after cesarean secti on.