Perspectives on the practice of vaginal birth after caesarean section in East Africa.

BACKGROUND: The increasing Caesarean section rates being observed in most facilities will ultimately result in a larger proportion of women with previous scar. Choices need to be made by both the patient and the health worker between attempted Vaginal Birth after Caesarean section (VBAC) and Elective Repeat Caesarean section (ERCS). Both practices are associated with perinatal risks and benefits that call for certain objectivity and prudence in decision making especially where resources are scarce. OBJECTIVE: To determine perceptions on the practice of vaginal birth after Caesarean section among maternity service providers in East Africa. DESIGN: A semi-qualitative cross sectional survey using self administered questionnaires. SETTING: The study was undertaken among delegates attending a regional Obstetrics and Gynaecology conference in Mombasa, Kenya. SUBJECT: Sixty three consenting delegates were interviewed RESULTS: A majority (69.8%) of the respondents were consultants and midwives working in government facilities. Fifty eight out of the 63 respondents offered VBAC in their institutions despite acknowledging sub-optimal antenatal preparation. The main concerns identified were; deficiencies in healthcare delivery systems, inadequate human resources, lack of unit guidelines, inappropriate maternal education and inappropriate foetal monitoring tools. CONCLUSION: The practice of vaginal birth after Caesarean section was perceived to be sub-optimal with many existing deficiencies that need urgent action to ensure the safety of mothers and newborns. We therefore recommend that unless these concerns raised by maternity providers are addressed then the practice of VBAC in the region should not be encouraged.