Incidence of vaginal birth after cesarean section in Al-Zahraa Maternity and Pediatrics Teaching Hospital

Background. As we approach the centennial of the maxim «Once a cesarean, always a cesarean,» the debate over the safety and viability of vaginal birth after cesarean (VBAC) continues. With cesarean section (CS) rates climbing globally, there is a revitalized interest in VBAC as a means to reduce maternal and neonatal morbidities associated with repeated cesarean operations. Objective of the study: to evaluate the incidence of VBAC at Al-Zahraa Maternity and Pediatrics Teaching Hospital (Iraq) and identify risk factors those influence the success or failure in trials of labor after cesarean section (TOLAC).Materials and methods. This observational study conducted at Al-Zahraa Maternity and Pediatrics Teaching Hospital from October 2023 to April 2024 involved women who had undergone one previous CS. During this time, comprehensive demographic and medical data were collected from participants to assess the outcomes of TOLAC in this population. Obtained data were analyzed using various statistical tools to identify trends and outcomes associated with TOLAC attempts.Results. Among 418 study participants, 268 (64.1%) attempted TOLAC, with a VBAC success rate of 39.20% (from the total study sample representing 61.2% of TOLAC cases). Statistical analysis revealed that older women, those with a longer interval since their last CS, and those with a history of previous vaginal delivery or previous VBAC demonstrated higher success rates. Common impediments to successful VBAC included labor progression issues and fetal distress.Conclusions. VBAC is viable and reduces risks linked to repeated CS, with a 39.20% success rate among those attempting TOLAC. Success factors include longer intervals since the last CS and no major comorbidities. Common barriers to successful VBAC include labor progression issues and fetal distress.