Delivery outcomes in women with previous caesarean delivery at Zithulele Hospital – A rural district hospital managed by generalist doctors

Background: Women with previous caesarean deliveries (CD) contribute to rising CD rates globally, yet limited evidence exists from rural South African district hospitals. The social value of this study lay in understanding delivery outcomes and safety of vaginal birth after caesarean (VBAC) in a resource-limited, generalist clinician setting. The study addressed a knowledge gap regarding VBAC practices and feasibility outside tertiary centres in rural South Africa. Methods: A descriptive study using a retrospective chart review was conducted at Zithulele Hospital, Eastern Cape. Women with previous CD who delivered at the hospital were included. Data were extracted using a data collection form and analysed using descriptive statistics and comparative tests to identify trends and outcomes in the cohort. Results: A total of 195 records were analysed. The overall hospital CD rate was 23.1%, with women with scarred uteri (Robson group 5) accounting for 25% of all CD. Forty-six per cent achieved VBAC, while 54% delivered by repeat CD; all women with two or more previous CD delivered by CD. Successful VBAC was associated with prior VBAC (p = 0.001) and advanced cervical dilatation at presentation (p 0.001). Maternal complications occurred in 13% of studied population, with 69% following CD. Conclusion: Vaginal birth after caesarean was feasible, safe and moderately successful in this rural setting. Caesarean delivery contributed disproportionately to overall CD rates, largely because of scar-related indications. Contribution: This study provides evidence from a rural clinical context supporting VBAC in district hospitals, highlighting practical factors that strengthen counselling and clinical decision-making within district-level obstetric practice.