Nicola F Tavella, Angela T Bianco, Christian Grov
Of 226 articles identified from two searches, we included a final sample of 10 peer-reviewed interventional studies from 9 different countries including tens of thousands of pregnant people. Most interventions focused on patient-centered decisional support, with mixed success in significantly improving outcomes.
PROBLEM: The intrapartum period is a critical time during which severe maternal morbidity (SMM) can occur, with influential factors such as induction and duration of labor and prolonged membrane rupture contributing to adverse pregnancy outcomes.
BACKGROUND: Despite increased clinical research efforts and systematic reviews, there remain social disparities in SMM rates, including for pregnant people pursuing a trial of labor after cesarean.
AIM: The objective was to synthesize current trials exploring sociostructural interventions to improve rates of vaginal birth after cesarean and related perinatal health outcomes.
METHODS: This scoping review evaluated peer-reviewed prospective interventions to improve vaginal birth after cesarean rates and perinatal health outcomes via a systematic search of studies published in PubMed Central between November 2019 and November 2024.
FINDINGS: Of 226 articles identified from two searches, we included a final sample of 10 peer-reviewed interventional studies from 9 different countries including tens of thousands of pregnant people. Most interventions focused on patient-centered decisional support, with mixed success in significantly improving outcomes.
DISCUSSION: There is a lack of sociostructural interventional studies addressing VBAC, with few studies finding significant effects. While patient-centered interventions show promise in improving birth outcomes for those pursuing TOLAC, most published clinical trials focus on biomechanical interventions, overlooking the associated complex sociostructural elements.