Beyond the Scar: VBAC vs ERCD – Exploring Best Delivery Option for Women with Prior Caesarean sections

Objective: To evaluate the maternal and neonatal outcomes and risks associated with Vaginal Birth after Caesarean (VBAC) versus Elective Repeat Caesarean Delivery (ERCD), in order to determine the safest and most appropriate mode of delivery among women presenting with prior Caesarean section history. Methodology: This is a randomized controlled trial conducted from ERCD from January to December 2023 at Obs $ Gynae Dept. Bahawal Victoria Hospital, Quaid-e-Azam Medical College Bahawalpur. A total of 150 to either VBAC or ERCD would be included. The results of maternal morbidity included bleeding, infection, and uterine rupture. Neonatal health was assessed using Apgar scores, NICU admission rates, and early neonatal mortality. Maternal satisfaction and postpartum depression were measured against the Edinburgh Postnatal Depression Scale (EPDS). SPSS version 26 was used for data entry and analysis. Results: Mean age of 29.3 ± 3.8 years was in VBAC group and 28.15 ± 2.7 years in the ERCD group. Uterine rupture was significantly higher in the VBAC group (8% vs. 0%, p = 0.027), while hemorrhage >1000 ml was more frequent in VBAC (6.67% vs. 1.33%, p = 0.067) and infection rate was slightly higher in the VBAC group (4% vs. 2.67%). Additionally ERCD group showed better neonatal outcomes, including higher Apgar scores and fewer NICU admissions (8% vs. 30.67%) p = <0.05. However, uterine rupture was significantly more common in the VBAC group (8%, p = 0.027). Maternal satisfaction was similar in both groups, but postpartum depression was more frequent in the ERCD group (21% vs. 13%, p = 0.037). Conclusion: ERCD observed to be the safer option overall, particularly in terms of neonatal outcomes and reduced maternal complications, while it may be associated with higher emotional costs, including an increased risk of postpartum depression. In parallel, VBAC offers the advantage of natural birth and similar maternal satisfaction but carries a higher risk of complications and require a strict monitoring.