DETERMINANTS OF SUCCESSFUL VAGINAL BIRTH AFTER CESAREAN SECTION IN LOW-RESOURCE HEALTHCARE SETTINGS

Abstract

Vaginal birth after cesarean delivery remains underutilized in low-resource settings despite rising cesarean section rates and growing evidence supporting trial of labor after cesarean delivery. Identifying reliable, context-specific predictors of VBAC success is essential for improving maternal and neonatal outcomes.A mixed-methods experimental approach was employed, integrating quantitative meta-analysis with qualitative thematic synthesis. Multivariable predictive models were developed using maternal, obstetric, intrapartum, neonatal, and health-system variables. Model performance was assessed through effect estimates, heterogeneity measures, discrimination, and calibration, complemented by advanced graphical analyses. VBAC success was strongly associated with prior vaginal birth, spontaneous labor onset, and favorable cervical dilation at admission, while increasing maternal body mass index, advanced maternal age, and higher neonatal birth weight were linked to reduced success probabilities. Health-system readiness significantly moderated outcomes, particularly in facilities with limited emergency obstetric capacity. Integrated multivariable models demonstrated superior predictive performance compared with single-domain models and remained stable across resource-constrained strata. Visual analyses revealed nonlinear temporal trends and synergistic interactions among key predictors, reinforcing the importance of multidimensional assessment.VBAC can be safely optimized in low-resource settings through context-adapted predictive models and strengthened intrapartum care. Tailored risk stratification frameworks are essential to support evidence-based decision-making, reduce unnecessary repeat cesarean deliveries, and improve maternal and neonatal health outcomes.