# Mode of birth in subsequent pregnancy when first birth was vacuum extraction or second stage cesarean section at a tertiary referral hospital in Uganda

## TL;DR

Women who had a vacuum extraction in their first birth are more likely to have a vaginal birth in subsequent pregnancies compared to those who had a cesarean section.

## Contribution

The study provides evidence that vacuum extraction in the first birth increases the likelihood of vaginal birth in subsequent pregnancies compared to second stage cesarean section.

## Key findings

- Women with a first birth by vacuum extraction had a 78.4% rate of subsequent vaginal birth.
- Women with a first birth by second stage cesarean section had a 38.6% rate of subsequent vaginal birth.
- Vacuum extraction is associated with higher chances of spontaneous vaginal birth in subsequent pregnancies.

## Abstract

The trends of increasing use of cesarean section (CS) with a decrease in assisted vaginal birth (vacuum extraction or forceps) is a major concern in health care systems all over the world, particularly in low-resource settings. Studies show that a first birth by CS is associated with an increased risk of repeat CS in subsequent births. In addition, CS compared to assisted vaginal birth (AVB), attracts higher health service costs. Resource-constrained countries have low rates of AVB compared to high-income countries. The aim of this study was to compare mode of birth in the subsequent pregnancy among women who previously gave birth by vacuum extraction or second stage CS in their first pregnancy at Mulago National Referral Hospital, Uganda.

This was a retrospective cohort study that involved interviews of 81 mothers who had a vacuum extraction or second stage CS in their first pregnancy at Mulago hospital between November 2014 to July 2015. Mode of birth in the subsequent pregnancy was compared using Chi-2 square test and a Fisher’s exact test with a 0.05 level of statistical significance.

Higher rates of vaginal birth were achieved among women who had a vacuum extraction (78.4%) compared to those who had a second stage CS in their first pregnancy (38.6%), p < 0.001.

Vacuum extraction increases a woman’s chance of having a subsequent spontaneous vaginal birth compared to second stage CS. Health professionals need to continue to offer choice of vacuum extraction in the second stage of labor among laboring women that fulfill its indication. This will help curb the up-surging rates of CS.