ISRCTN10612254.

Trial name or title	Improving the organisation of maternal health service delivery, and optimising childbirth, by increasing vaginal birth after caesarean section (VBAC) through enhanced women‐centred care
Methods	Countries: Germany, Ireland and Italy Study design: multicentre cluster‐randomised trial
Participants	Participant inclusion criteria Pregnant women aged over 18 years Pregnant women who have had one previous caesarean section Pregnant women who speak a language for which translation is available Pregnant women who give their consent
Interventions	Intervention: evidence‐based education of women and clinicians, introduction of communities of practice (women and clinicians sharing knowledge), opinion leaders, audit and peer review of caesarean sections in each hospital, and joint decision‐making by women and clinicians. The content and details of the intervention will be determined through systematic reviews and qualitative research Control: usual care
Outcomes	Primary outcomes: change from baseline in each hospital in the proportion of women who have had one previous caesarean section who have a vaginal birth during the study Secondary outcomes Gestational age at birth Length of labour Emotional well‐being, feelings of anxiety, control, satisfaction with care and perception of involvement in care, during pregnancy and the postnatal period Intrapartum interventions (induction or augmentation of labour, use of epidural and foetal monitoring, mode of birth) Maternal morbidities during pregnancy and the postnatal period (for example, pain, postpartum haemorrhage, wound infection, abdominal pain, depression) Neonatal morbidities (resuscitation, Apgar scores, admission to intensive care) Breastfeeding Length of hospital stay (mother and infant). Readmission Health economic analyses will be done using data on clinical outcomes, direct costs (such as length of stay and antibiotic use) and indirect costs (such as productivity loss) during pregnancy and postnatal period. The study will also seek to assess adherence to guidelines and practice protocols, adherence to intervention quantity and quality, and midwife‐centred variables; to compare and contrast findings across the different hospitals.
Starting date	December 2013
Contact information	Cecily Begley: cbegley@tcd.ie
Notes	Trial registry number: SRCTN10612254; DOI: 10.1186/ISRCTN10612254