Timing of cesarean and its impact on labor duration and genital tract trauma at the first subsequent vaginal birth: a retrospective cohort study

BackgroundThe objectives of this study were to explore the course of labor and the risk of obstetric anal sphincter injury at the first vaginal birth after cesarean section (fVBAC) in comparison to primiparous vaginal birth (PVB) in women without epidural analgesia and to assess if laboring before the previous cesarean affected these outcomes.MethodsAll fVBACs without epidural analgesia and the subsequent PVBs (controls) between 2012 and 2016 were included in this retrospective cohort study. Data were collected from health records and included maternal demographics, gestational age, and labor details (duration of 1st and 2nd stages, labor induction or augmentation, birthweight, operative vaginal birth, estimated blood loss, extent of childbirth trauma) in both groups as well as cervical dilation at the time of previous cesarean in the fVBAC group. Wilcoxon and Chi-square tests were used for data analyses.ResultsThe study comprised 510 women; 255 fVBACs and 255 controls. The majority of fVBACs were after a pre-labor cesarean section - 177 (69.4%). There was a statistically significant difference in the recorded duration of first stage between the fVBACs and controls (289 vs. 347min respectively, p<.001). Women were less likely to have an intact perineum in the fVBAC group (29.8 vs. 43.1%, p<0.01), however, there was no statistically significant difference in anal sphincter injury rates between both groups (2.3 vs. 1.9%, p=0.76). The groups differed in rates of cervical tears requiring suturing (21.2 vs. 12.9%, p=0.01). On further subgroup analysis, the duration of first stage of labor was shorter in women who previously had a caesarean section late in labor ( 8cm cervical dilatation) compared to a pre-labor cesarean section, however, there were no differences in other outcomes.ConclusionCompared to primiparous women having a vaginal birth, women having their first vaginal birth after a cesarean section have a shorter 1st stage of labor (particularly if the cesarean was performed in advanced labor), a higher risk of sustaining cervical lacerations and perineal trauma. However, there was no difference in the risk of sustaining obstetric anal sphincter injuries between the study groups.