Vaginal Birth After Caesarean: Attitudes, Outcomes, and Barriers at South West Nigerian Teaching Hospitals

Vaginal birth after caesarean (VBAC) is a safe option for selected women with prior low-transverse uterine scar and offers significant health system benefits by reducing repeat caesarean rates, yet VBAC practice in Nigerian teaching hospitals has not been comprehensively characterised. This study examines provider attitudes, clinical outcomes, and structural barriers to VBAC at teaching hospitals in Lagos, Ogun, and Oyo States, South West Nigeria. A mixed-methods study combines a retrospective analysis of 180 VBAC trial outcomes over three years with a survey of 40 obstetricians and midwives on VBAC attitudes and practice. Rates, outcomes, and provider attitudes were documented. VBAC trials were conducted in only 24 percent of eligible candidates. Successful VBAC was achieved in 66 percent of trials undertaken. Uterine rupture occurred in 1.7 percent of trials, all in women with prior classical caesarean or more than two prior scars. Emergency caesarean during VBAC trial was required in 28 percent. Provider concern about uterine rupture liability was the most commonly cited barrier (76 percent), followed by absence of a hospital VBAC protocol (54 percent) and continuous electronic foetal monitoring unavailability (48 percent). The study identifies a substantial unmet need for VBAC in South West Nigeria and recommends evidence-based patient selection protocols, continuous foetal monitoring investment, and medical liability clarity to enable broader VBAC access. Keywords: vaginal birth after caesarean, VBAC, uterine rupture, South West Nigeria, caesarean rate