Sociostructural Interventions Concerning Vaginal Birth After Cesarean: A Scoping Review of Recent Studies.

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.