Work

Clinical, psychosocial and cognitive outcomes following VBAC: a protocol for a sub-national cohort study in Saudi Arabia (2019–2024)

Year: 2026

Type: article

Abstract: Introduction Over recent decades, global caesarean section (CS) rates have risen sharply. In Saudi Arabia, this trend has become particularly noticeable, with the national CS rate reaching 28.1% in 2024. Vaginal birth after CS (VBAC) offers a safe alternative to elective repeat CS (ERCS) for many women with previous CS. VBAC is linked to lower maternal complications, faster recovery and lower healthcare costs. However, despite its known advantages, there is a significant lack of strong evidence connecting VBAC practices to potential clinical, psychosocial and cognitive health outcomes for mothers and children in the Saudi context. This study protocol presents a detailed assessment of both short-term and long-term health outcomes for mothers who undergo VBAC and their children, compared with those who have ERCS, within a specific regional population in Saudi Arabia. Methods and analysis This retrospective cohort study uses data routinely collected from the BESTCare electronic medical record system managed by the Ministry of National Guard Health Affairs. The eligible participants are women of reproductive age (15–49 years) with a history of one previous CS (either ERCS or emergency CS) followed by a vaginal birth. The study will involve graphical, descriptive and analytical statistics, including multiple logistic regression to assess VBAC outcomes. During the exploratory phase, principal component analysis will identify key domains related to VBAC. Additionally, workshops involving study researchers and both internal and external panels of experts will review interim analyses, allowing for a stepwise assessment of the project’s progress. Ethics and dissemination The study received approval from the Institutional Review Board at the King Abdullah International Medical Research Center, with approval number NRR24/089/9, in accordance with the Saudi Law of Ethics of Research on Living Creatures. The findings of this study will be disseminated through publication in a peer-reviewed scientific journal and through dissemination workshop.

Source: BMJ Open

DOI: 10.1136/bmjopen-2025-114754