Informed Decision-Making for Vaginal Birth After C-Section and Repeated Cesarean Section. Does counseling make a difference?

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The global increase in Caesarean Section (CS) rates is a concern for maternal and newborn outcomes and healthcare costs. While vaginal birth after caesarean (VBAC) is often a safe and cost-effective option, elective repeat caesarean sections (ERCS) remain overused. Global clinical guidelines stress indeed the role of counseling and shared decision-making, but the empirical evidence on their effectiveness is limited. In this paper, we aim at assessing whether counseling is associated with a higher likelihood of choosing VBAC rather than ERCS among eligible women, controlling for socio-demographic factors and previous delivery experiences. We administered a structured questionnaire to women, all eligible to VBAC, with one previous CS who gave birth again in 2023 in a major private Hospital in Rome,after having attended counselling sessions related to the VBAC. By running Firth logistic regressions and controlling for socio-demographics and elements linked to their past deliveries’ experience, we estimated correlations between the likelihood of opting for a VBAC and various relevant covariates. We observe that 28% of women experienced a VBAC in our final sample. When considered separately, socio-demographic factors like age and education were associated with VBAC, whereas characteristics of the previous CS were not significant. On the other side, high level of satisfaction with counseling, and attributing great importance to vaginal birth were positively associated with VBAC. The findings suggest that counseling, as long as it reinforces women’s beliefs in the importance of vaginal birth, may be able to increase the choice of VBAC among eligible women and address the concern of the widely used unnecessary CS. JEL codes: I12, I14, I18

Keywords: C-section, vaginal birth after caesarean (VBAC), elective repeat caesarean sections (ERCS), counseling, inequality