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Birth. 2015 Dec;42(4):299-308. doi: 10.1111/birt.12188. Epub 2015 Aug 26.

Planned Home VBAC in the United States, 2004-2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making.

Author information

1
College of Nursing, University of New Mexico, Albuquerque, New Mexico, USA.
2
College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA.
3
Department of Anthropology, Oregon State University, Corvallis, Oregon, USA.
4
School of Medicine, Departments of Family & Community Medicine and Obstetrics & Gynecology, University of New Mexico, Albuquerque, New Mexico, USA.

Abstract

BACKGROUND:

In the United States, the number of planned home vaginal births after cesarean (VBACs) has increased. This study describes the maternal and neonatal outcomes for women who planned a VBAC at home with midwives who were contributing data to the Midwives Alliance of North America Statistics Project 2.0 cohort during the years 2004-2009.

METHOD:

Two subsamples were created from the parent cohort: 12,092 multiparous women without a prior cesarean and 1,052 women with a prior cesarean. Descriptive statistics were calculated for maternal and neonatal outcomes for both groups. Sensitivity analyses comparing women with a prior vaginal birth and those who were at the lowest risk with various subgroups in the parent cohort were also conducted.

RESULTS:

Women with a prior cesarean had a VBAC rate of 87 percent, although transfer rates were higher compared with women without a prior cesarean (18% vs 7%, p < 0.001). The most common indication for transfer was failure to progress. Women with a prior cesarean had higher proportions of blood loss, maternal postpartum infections, uterine rupture, and neonatal intensive care unit admissions than those without a prior cesarean. Five neonatal deaths (4.75/1,000) occurred in the prior cesarean group compared with 1.24/1,000 in multiparas without a history of cesarean (p = 0.015).

CONCLUSION:

Although there is a high likelihood of a vaginal birth at home, women planning a home VBAC should be counseled regarding maternal transfer rates and potential for increased risk to the newborn, particularly if uterine rupture occurs in the home setting.

KEYWORDS:

decision making; home birth; trial of labor; vaginal birth after cesarean

Comment in

PMID:
26307086
DOI:
10.1111/birt.12188
[Indexed for MEDLINE]

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