Results of the National Study of Vaginal Birth After Cesarean in Birth Centers

Lieberman, Ellice; Ernst, Eunice K.M.; Rooks, Judith P.; Stapleton, Susan R.; Flamm, Bruce L.

doi:10.1097/01.aog.0000143257.29471.82

Cited by 64 publications

(82 citation statements)

References 19 publications

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“…Indeed, there were no reported cases of failed or even attempted instrumental deliveries in cases of acute fetal distress with the cervix fully dilated or in cases of prolonged second stage with the head engaged. By international standards, Vaginal Birth After Caesarean (VBAC) is successful in rates close to 90% with a very low complication rate [14,15]. In Egypt, VBAC has also been found to be safe [16] with 90% success rate without complications compared with only 22.23% in this study.…”

Section: Discussionmentioning

confidence: 55%

Rising Rates of Caesarean Delivery at Mansoura University Hospital: A Reason for Concern

Helal¹

2013

Gynecol Obstet

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Objectives: To study the rates and indications of Caesarean delivery at Mansoura University Hospital in Egypt. Patients and methods:This retrospective study collected data on caesarean delivery rates and indications from the medical records of 34598 women admitted to both emergency and high risk obstetric units over a 5-year period (January 2006-December 2010). Results:The overall rate of caesarean delivery was 47.25%. Rates at the high risk and the emergency units were 79.33% and 29.15% respectively. The annual rate of caesarean delivery increased significantly (p<0.01) from 42.65% in 2006 to 55.33 % in 2010, mainly due to an increase in the rate of caesarean at the emergency unit. The most common causes were repeat caesarean (35.78%), medical disorders complicating pregnancy (14.25%), failure to progress in labor (10.37%) and malpresentations (9.9%). Vaginal birth after caesarean (VBAC) was attempted in 2078 women and was successful in 22.23%. Conclusion:The overall rate of caesarean delivery at Mansoura University hospital was 47.25%. This high rate was mainly attributed to previous caesarean delivery, low rate of successful VBAC and the very low rate of attempted instrumental delivery.

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Section: Discussionmentioning

confidence: 55%

Rising Rates of Caesarean Delivery at Mansoura University Hospital: A Reason for Concern

Helal¹

2013

Gynecol Obstet

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“…30 The NBCS of 1,913 women attempting VBAC in birthing centers found 6 uterine ruptures (0.4%), 1 hysterectomy (0.1%), 15 infants with a 5-minute Apgar of less than 7 (1.0%), and 7 fetal deaths (0.5%). 30 The study concluded that "birth centers should refer women who have undergone previous cesarean deliveries to hospitals for delivery." 30 In the LaFarge community, most women with a previous cesarean refuse hospital delivery.…”

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confidence: 99%

“…30 The study concluded that "birth centers should refer women who have undergone previous cesarean deliveries to hospitals for delivery." 30 In the LaFarge community, most women with a previous cesarean refuse hospital delivery. TOLAC is offered at the birthing center as a safer alternative to TOLAC at home.…”

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confidence: 99%

Low Primary Cesarean Rate and High VBAC Rate With Good Outcomes in an Amish Birthing Center

Deline¹,

Varnes-Epstein²,

Dresang

et al. 2012

The Annals of Family Medicine

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PURPOSE Recent national guidelines encourage a trial of labor after cesarean (TOLAC) as a means of increasing vaginal births after cesarean (VBACs) and decreasing the high US cesarean birth rate and its consequences (2010 National Institute of Health Consensus Statement and American College of Obstetricians and Gynecologists revised guideline). A birthing center serving Amish women in Southwestern Wisconsin offered an opportunity to look at the effects of local culture and practices that support vaginal birth and TOLAC. This study describes childbirth and perinatal outcomes during a 17-year period in LaFarge, Wisconsin. METHODSWe undertook a retrospective analysis of the records of all women admitted to the birth center in labor. Main outcome measures include rates of cesarean deliveries, TOLAC and VBAC deliveries, and perinatal outcomes for 927 deliveries between 1993 and 2010. RESULTSThe cesarean rate was 4% (35 of 927), the TOLAC rate was 100%, and the VBAC rate was 95% (88 of 92). There were no cases of uterine rupture and no maternal deaths. The neonatal death rate of 5.4 of 1,000 was comparable to that of Wisconsin (4.6 of 1,000) and the United States (4.5 of 1,000).CONCLUSIONS Both the culture of the population served and a number of factors relating to the management of labor at the birthing center have affected the rates of cesarean delivery and TOLAC. The results of the LaFarge Amish study support a low-technology approach to delivery where good outcomes are achieved with low cesarean and high VBAC rates. Ann Fam Med 2012;10:530-537. doi:10.1370/afm.1403. INTRODUCTIONT he cesarean rate in the United States has risen from 5.5% in 1970 to 16.5% in 1980 1 to 21% in 1996 to 32.9% in 2009. 2,3 A 2011 study calculates that if trends continue, the 2020 cesarean rate will be 56.2%. 4 The 2007 primary cesarean rate was 23.4%. 5 The vaginal birth after cesarean (VBAC) rate-the percentage of pregnant women who give birth vaginally after a previous cesarean-has fallen from a high of 28.3% in 1996 1 to 8.5% in 2006. 6 The World Health Organization (WHO) and Healthy People 2020 have suggested the ideal cesarean rate should be around 15%. 7,8 The 2010 National Institutes of Health consensus conference on VBAC highlighted high-grade evidence that maternal mortality risk is decreased by VBAC compared with a repeat cesarean (3.8 vs 13.4 of 100,000).2 Data suggest decreasing the primary cesarean delivery rate and increasing the VBAC rate as key strategies to decrease the US cesarean rate. 9Amish communities ascribe religious and cultural value to childbearing. 10,11 Contraception, including sterilization, may be prohibited. 10Advanced maternal age and grand multiparity are common. Amish women of Southwest Wisconsin generally give birth at home attended by an unlicensed birth attendant, mother, mother-in-law, or neighbor. Formal education for men and women is through 8th grade, and women do not work outside the home. Amish culture prohibits electricity, telephone service, and car ownership, leading to delays ...

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“…26 As we push VBAC and vaginal breech delivery out of our hospitals, we may actually make outcomes worse: women who believe their choices will not be respected in such situations may prefer to stay home, and surely VBAC is less safe at home than in the hospital. 27 As patients have no established right to choose vaginal birth in the above scenarios, the future may fi nd all vaginal deliveries threatened. Let us speculate for a moment: would a randomized controlled trial of vaginal delivery vs primary elective cesarean delivery at term show a difference in neonatal outcome?…”

Section: Future Implications For Childbirth Optionsmentioning

confidence: 99%

Patient-Choice Vaginal Delivery?

Leeman

Plante²

2006

The Annals of Family Medicine

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Patient-choice cesarean delivery is increasing in the United States. The American College of Obstetricians and Gynecologists supports this option, citing ethical premises of autonomy and informed consent, despite a lack of evidence for its safety. This increase in patient-choice cesarean delivery occurs during a time when women with a breech-presenting fetus or a previous cesarean section have fewer choices as to vaginal birth. Patient-choice cesarean delivery may become widely disseminated before the potential risks to women and their children have been well analyzed. The growing pressure for cesarean delivery in the absence of a medical indication may ultimately result in a decrease of women's childbirth options. Advocacy of patient-choice requires preserving vaginal birth options as well as cesarean delivery. 2006;4:265-268. DOI: 10.1370/afm.537. Ann Fam Med INTRODUCTIONP atient-choice cesarean delivery, a primary elective cesarean delivery performed without a medical indication, is increasing among pregnant women.1,2 The American College of Obstetricians and Gynecologists (ACOG) has released a formal opinion supporting obstetricians who perform elective primary cesarean delivery, citing the ethical premise of patient autonomy and informed consent.3 As physicians who advocate for women's right to choose among a variety of medical options, we are pleased at the emphasis on preserving women's medical choices. We are, however, perplexed at the narrowness of the choice. In recent years we have seen a decline in women's choices for vaginal birth as vaginal birth after cesarean (VBAC) becomes less available and vaginal breech birth is rarely performed. 4,5 The question of patient-choice cesarean delivery asks only whether a woman should have the right to choose a cesarean delivery in the absence of a medical indication. A woman's right to choose a vaginal delivery is not addressed.Why is cesarean delivery and not vaginal delivery framed in the language of choice? We contrast professional attitudes toward patient choice for vaginal and cesarean birth, explain the importance of considering the effects of a primary elective cesarean delivery on maternal and neonatal outcomes of subsequent pregnancies, and describe the potential longterm implications of the growing acceptance of patient-choice cesarean delivery. IS PATIENT CHOICE AVAILABLE FOR VAGINAL BREECH OR VBAC DELIVERIES?Before 1970 266PAT IENT-CHOICE DELIVERY Term Breech Trial (TBT) in 2000 found increased perinatal mortality or severe morbidity within the fi rst 3 months of birth when breech infants are delivered vaginally rather than by cesarean section. 6 After the publication of this study of short-term outcomes, obstetric practice swung defi nitively away from vaginal delivery of the term breech infant. ACOG published an opinion supporting planned cesarean delivery in patients with breech presentation at term if an external cephalic version is not successful. Yet recent studies have shown that planned vaginal breech in selected populations may be r...

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Results of the National Study of Vaginal Birth After Cesarean in Birth Centers

Abstract: III.

Cited by 64 publications

References 19 publications

Rising Rates of Caesarean Delivery at Mansoura University Hospital: A Reason for Concern

Rising Rates of Caesarean Delivery at Mansoura University Hospital: A Reason for Concern

Low Primary Cesarean Rate and High VBAC Rate With Good Outcomes in an Amish Birthing Center

Patient-Choice Vaginal Delivery?

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