TRIAL OF LABOUR AFTER CAESAREAN SECTION PREFERENCE AND ITS DETERMINANTS AMONG WOMEN ATTENDING ANTENATAL CARE AT DISTRICT HOSPITALS, KIGALI, RWANDA

Abstract

Background: Worldwide, the escalating rates of caesarean sections (C-sections) have raised significant public health concerns, with WHO recommending rates below 15% of total deliveries. However, Kigali, Rwanda, exhibits a notably high prevalence of C-sections at 25%. Trial of labour after caesarean section (TOLAC) is advocated by WHO to mitigate maternal and neonatal complications associated with repeat C-sections.

Objective: The study aimed to explore TOLAC preference and its determinants among pregnant women with a previous C-section at three district hospitals in Kigali City.

Methods: This cross-sectional analytical study employed a quantitative approach at Kacyiru, Muhima, and Kibagabaga hospitals. A structured questionnaire was administered to 285 pregnant women, selected using two-step sampling: random selection of three district hospitals as study sites, and purposive sampling of participants. Data were collected via a self-administered questionnaire of single answer and multiple choice questions, entered into Excel and analyzed using IBM® SPSS 21. Univariate, bivariate, and multiple logistic regression analyses were conducted to explore socio-demographic, obstetric characteristics, and TOLAC preference determinants.

Results: Sixty-five percent of participants preferred TOLAC, increasing to 71% with integrated labour pain management. Significant determinants included age (AOR=2.3, 95% CI: 1.38-3.46, P=0.001), information source (AOR=2.5, 95% CI: 1.3-4.73, P=0.006), and history of vaginal delivery (AOR=3, 95% CI: 1.7-5.4, P<0.001).

Discussion: Promoting accessible TOLAC services and labour pain management could enhance uptake, particularly among women with prior vaginal deliveries. Antenatal counselling is pivotal in encouraging TOLAC attempts. Further research is recommended to assess TOLAC feasibility in Rwandan healthcare settings and understand healthcare providers' perspectives.

Conclusions: Efforts should focus on policy implementation to promote TOLAC and mitigate morbidities associated with repeat C-sections in Rwanda's healthcare system.