1. Health Roundtable 2009 – HRT 0910 Maternity Services VBAC Clinic A clinic for women with one Caesarean Section Presenter: Robyn Aldridge Hospital: Achilles Contact: Robyn Aldridge dr.robyn.aldridge@gmail.com 042 0538 575 28 May 2009- Melbourne

2. Health Roundtable 2009 – HRT 0910 Maternity Services 2 KEY PROBLEM Increasing number of women with C/S Variable support & education regarding VBAC vs repeat C/S Lower than expected/desired successful VBAC rate

3. Health Roundtable 2009 – HRT 0910 Maternity Services 3 AIM OF THIS PROJECT Improvement Sought – increased successful VBAC rate What areas – Otherwise low risk women By When – within the first year of deliveries With what resources – Dedicated clinic with : –2 Midwives –1 Obstetrician –1 GP Obstetrician

4. Health Roundtable 2009 – HRT 0910 Maternity Services 4 KEY CHANGES IMPLEMENTED 16 women per month in complete clinic care Mixed M/W, Obs & GP Obs visits – permanent staff assigned to the clinic 30 mins for a new visit and 15 for repeat visit Development of VBAC information sheet

5. Health Roundtable 2009 – HRT 0910 Maternity Services 5 OUTCOMES SO FAR Clinic started Jan 2008 – first deliveries in July 2008 Preliminary data from July 2008 to end of April 2009 Bookings 115 women through the clinic Antenatal wishes for delivery Antenatal Plan for Delivery Repeat Elective C/S18 Vaginal Birth93 Uncertain4

6. Health Roundtable 2009 – HRT 0910 Maternity Services OUTCOMES SO FAR Outcomes (n=115) Two pregnancy losses (FDIU at 20/40 & 37/40), n=113 6 OutcomeNumberPercentage NVD3127% Ventouse1110% Forceps54% Repeat Elective C/S4337% Emergency C/S2522%

7. Health Roundtable 2009 – HRT 0910 Maternity Services Planned VBAC Outcomes (numbers) 7

8. Health Roundtable 2009 – HRT 0910 Maternity Services Planned Repeat C/S (numbers) 8

9. Health Roundtable 2009 – HRT 0910 Maternity Services 9 PROJECT EVALUATION Appear a valuable addition to the clinic structure May improve outcomes if the womans preference is known prior to clinic booking or returning those women back to an ordinary clinic if repeat elective C/S chosen or required