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

Abstract

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.

Social inequality in sexual and reproductive health in Ecuador: an analysis of gaps by levels of provincial poverty 2009–2015

“…Number of births attended at home per 1000 live births as an indicator of access to reproductive health services. Evidence has suggested that compared to hospital deliveries, there are suboptimal outcomes for both mother and child at home deliveries [29, 30].…”

Determinants of Low Fifth Minute Apgar Score among Newborn Delivered in Jimma University Medical Center, Southwest Ethiopia

“…The Apgar score was proposed in 1952 as a means of rapidly evaluating the clinical status of newborn infants [1] and currently remains an accepted method for newborn infant assessment immediately after delivery [2]. Reduced Apgar score, including less than five Apgar score components, is as valuable as the full Apgar score to predict neonatal mortality [3].…”

How birth outcomes among a cohort of Guatemalan women with a history of prior cesarean vary by mode or birth across different interpregnancy intervals

“…This suggests that if providers want to counsel women on trial of labor with respect to IPI, they would be justified in citing a trend toward an increase in stillbirth at less than 12 months, but a recommendation against trial of labor for this reason would not be supported by the results of our analysis. While a concerning finding that vaginal delivery after cesarean increases the odds of stillbirth compared to repeat cesarean in this population, neonatal outcomes are already known to be better under these circumstances and thus, this is not a novel finding [18][19][20][21].…”