Planned Home <scp>VBAC</scp> in the United States, 2004–2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making

Cox, Kim J.; Bovbjerg, Marit L.; Cheyney, Melissa; Leeman, Lawrence

doi:10.1111/birt.12188

Cited by 36 publications

(27 citation statements)

References 29 publications

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“…23 Our findings suggest that this is also true among women delivering by VBAC out-of-hospital. Congruent with prior research, 16 results of this study signal that women birthing their second child or without a history of vaginal birth are more vulnerable to poor neonatal outcomes when delivering by VBAC in out-of-hospital settings.…”

Section: Commentsupporting

confidence: 55%

“…15 The third study utilized data on planned home births from a national, voluntary registry, comparing outcomes among multiparous women with prior CD (n = 1052) to those without (n = 12,092), finding significantly elevated rates of poor neonatal outcomes in the TOLAC sub-sample. 16 Despite the increasing frequency of out-of-hospital VBAC, 6, 7 to our knowledge there are no US studies comparing VBAC outcomes between hospital and out-of-hospital settings.…”

Section: Introductionmentioning

confidence: 99%

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Vaginal birth after cesarean: neonatal outcomes and United States birth setting

Tilden

Cheyney

Guise

et al. 2017

American Journal of Obstetrics and Gynecology

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Background Women seeking VBAC may find limited in-hospital options. Increasing numbers of US women are delivering by VBAC out-of-hospital. Little is known about neonatal outcomes among those delivering by VBAC in vs. out-of-hospital. Objective(s) To compare neonatal outcomes between women delivering via VBAC in hospital vs. out-of-hospital (home and freestanding birth center). Study Design Retrospective cohort study using 2007-2010 linked US birth and death records to compare singleton, term, vertex, non-anomalous, live born neonates who delivered by VBAC in or out-of-hospital. Descriptive statistics and multivariate regression analyses were conducted to estimate unadjusted, absolute, and relative birth setting risk differences. Stratification by parity and history of vaginal birth examined association between birth setting and each outcome. Sensitivity analyses involving three transfer status scenarios were conducted. Results A small proportion of the total number of US women with a history of cesarean (n = 1,138,813) delivered by VBAC (n = 109,970, 9.65%) with a large majority of these delivering in-hospital (n = 106,823, 97.14%). The proportion of home VBAC births increased from 1.78% to 2.45%. A pattern of increased neonatal morbidity was noted in unadjusted analysis (neonatal seizures, Apgar score <7 or <4, neonatal seizures), with higher morbidity noted in the out-of-hospital setting (neonatal seizures: 23 (0.02%) vs. 6 (0.19%), p <0.001; Apgar score <7: 2859 (2.68%) vs. 139 (4.42%), p <0.001; Apgar score <4: 431 (0.4%) vs. 23 (0.73), p = 0.01). A similar, but non-significant, pattern of increased risk was observed for neonatal death and ventilator support among those born in the out-of-hospital setting. Multivariate regression estimated that neonates born out-of-hospital had higher odds of poor outcomes (neonatal seizures (adjusted odds ratio [aOR] 8.53, 95% confidence interval [CI] 2.87-25.4); Apgar <7 (aOR, 1.62; 95% CI, 1.35-1.96); Apgar <4 (aOR 1.77, CI 1.12-2.79)). While odds of neonatal death (aOR, 2.1; CI 0.73-6.05, p = 0.18) and ventilator support (aOR 1.36, CI 0.75-2.46) appeared to be increased in out-of-hospital settings, findings did not reach statistical significance. Women birthing their second child by VBAC in out-of-hospital settings had higher odds of neonatal morbidity and mortality compared to women of higher parity. Women without a history of vaginal birth prior to out-of-hospital VBAC delivery had higher odds of neonatal morbidity and mortality compared to those with a history of vaginal birth. Sensitivity analyses generated distributions of plausible alternative estimates by outcome Conclusions Fewer than 1 in 10 US women with a prior CD delivered by VBAC in any setting and increasing proportions of these women delivered out-of-hospital. Adverse outcomes were more frequent for neonates born out-of-hospital, with risk concentrated among women birthing their second child and women without a history of vaginal birth. This information urgently signals the need to increase availa...

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Section: Commentsupporting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Vaginal birth after cesarean: neonatal outcomes and United States birth setting

Tilden

Cheyney

Guise

et al. 2017

American Journal of Obstetrics and Gynecology

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“…37,38 Practices commonly used at home births, such as freedom of movement and continuous labor support, are independently associated with increased success for vaginal birth in general and may also contribute to the increased success of VBAC documented in home birth studies. [39][40][41] In the process of informed consent and shared decision making regarding place of birth, risk stratification in response to a woman's individual risk factors is important. 39,42 The aggregate incidence of uterine rupture after one prior cesarean birth is 4 to 8 per 1000 for women at term who enter labor spontaneously.…”

Section: Newborn Indicationsmentioning

confidence: 99%

Midwifery Provision of Home Birth Services

2015

J Midwife Womens Health

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The number of women in the United States choosing to give birth at home has risen substantially in the past decade, creating an increased need for understanding of the evidence regarding the provision of midwifery care to women and families considering this option. The safety of home birth has been evaluated in observational studies in several industrialized nations, including the United States. Most studies find that women who are essentially healthy at term with a singleton fetus and give birth at home have positive outcomes and a lower rate of interventions during labor. Although some studies have found increased neonatal morbidity and mortality in newborns born at home when compared to newborns born in a hospital, the absolute numbers reported in both birth sites are very low. The purpose of this clinical bulletin is to review the evidence on provision of care to women and families who plan to give birth at home, including roles and responsibilities, shared decision making, informed consent, and ongoing assessment for birth site selection.

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“…The American College of Nurse Midwives (ACNM), citing supposed lack of data on outcomes, has not taken an official position on this issue while the Midwives Alliance of North America (MANA), the American home birth midwifery association, supports planned home TOLAC even though studies show that there is an increased risk to the newborn in home births VBACs. [33,34,35,36,37]…”

Section: Commentsmentioning

confidence: 99%

Serious adverse neonatal outcomes such as 5-minute Apgar score of zero and seizures or severe neurologic dysfunction are increased in planned home births after cesarean delivery

et al. 2017

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The United States is with 37,451 home births in 2014 the country with the largest absolute number of home births among all developed countries. The purpose of this study was to examine the occurrence and risks of a 5-minute Apgar score of zero and neonatal seizures or serious neurologic dysfunction in women with a history of prior cesarean delivery for planned home vaginal birth after cesarean (VBAC), compared to hospital VBAC and hospital birth cesarean deliveries for term normal weight infants in the United States from 2007–2014. We report in this study outcomes of women who had one or more prior cesarean deliveries and included women who had a successful vaginal birth after a trial of labor after cesarean (TOLAC) at home and in the hospital, and a repeat cesarean delivery in the hospital. We excluded preterm births (<37 weeks) and infants weighing under 2500 g. Hospital VBACS were the reference. Women with a planned home birth VBAC had an approximately 10-fold and higher increase in adverse neonatal outcomes when compared to hospital VBACS and hospital repeat cesarean deliveries, a significantly higher incidence and risk of a 5-minute Apgar score of 0 of 1 in 890 (11.24/10,000, relative risk 9.04, 95% confidence interval 4–20.39, p<.0001) and an incidence of neonatal seizures or severe neurologic dysfunction of 1 in 814 (Incidence: 12.27/10,000, relative risk 11.19, 95% confidence interval 5.13–24.29, p<.0001). Because of the significantly increased neonatal risks, obstetric providers should therefore not offer or perform planned home TOLACs and for those desiring a VBAC should strongly recommend a planned TOLAC in the appropriate hospital setting. We emphasize that this stance should be accompanied by effective efforts to make TOLAC available in the appropriate hospital setting.

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

Abstract: 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.

Cited by 36 publications

References 29 publications

Vaginal birth after cesarean: neonatal outcomes and United States birth setting

Vaginal birth after cesarean: neonatal outcomes and United States birth setting

Midwifery Provision of Home Birth Services

Serious adverse neonatal outcomes such as 5-minute Apgar score of zero and seizures or severe neurologic dysfunction are increased in planned home births after cesarean delivery

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