Vaginal Birth after Cesarean (VBAC)

  A client had a cesarean delivery in a hospital setting for breech presentation with her first pregnancy. She is pregnant again and after exploring her delivery options, has decided she wants to attempt a vaginal birth after cesarean (VBAC). She has had an uncomplicated pregnancy this time and the fetus is not breech. The same OB-GYN will be assisting in her delivery. The OB-GYN performs a systematic review of the literature to assess the benefits and harms of VBAC versus repeat cesarean delivery. 1. What kinds and sources of data does the OB-GYN need to review in order to make a rational clinical planning decision? 2. Which types of studies available on this topic would be the most useful in clinical decision making? 3. What types of studies would you want to exclude? 4. Why would there be a lack of randomized clinical trials (RCT’s) available to address this clinical question?