Vaginal Birth After Cesarean Section: A Pilot Study of Outcomes in Women Receiving Midwifery Care

Abstract

A recent trend discouraging or not offering women a choice to labor after a cesarean birth has resulted in higher cesarean birth rates and lower rates of vaginal birth after cesarean birth (VBAC). The few studies describing midwifery practice have demonstrated favorable outcomes; however, the studies are too small to thoroughly evaluate critical outcomes. In this retrospective descriptive study, clinical outcome data were obtained from eight midwifery practices. The aims were to collect, aggregate, and analyze data from multiple midwifery practices and then describe outcomes. Usable data representing 649 trials of labor were submitted. Overall, 72% (range 64%-100%) of women gave birth vaginally. Mean infant birth weight was 3,501 (SD = 534) g, and the mean Apgar scores were 7.99 (SD = 1.4; median 8) at 1 minute and 8.84 (SD = 0.8; median 9) at 5 minutes. Only 5.3% (n = 14) of infants were admitted to the neonatal intensive care unit. This small retrospective study demonstrates similar outcomes to those reported in the current literature. A larger prospective study to carefully describe midwifery care outcomes using a common data collection method is needed to provide evidence for determining the continuation of VBAC as part of midwifery care.

Relationship Between Malpractice Litigation Pressure and Rates of Cesarean Section and Vaginal Birth After Cesarean Section

“…Managed care penetration, 35 hospital ownership 36 and location, 37 and type of delivering clinician 38 are all provider-side factors that may influence obstetricians’ choice of delivery method. Our model includes variables to control for each of these factors across states and time.…”

Care for Women Desiring Vaginal Birth After Cesarean

“…Unlike the previous studies, only 7% of the women had a previous vaginal birth, and 16% had a previous VBAC. There were no uterine ruptures, and only 5.3% of newborns were admitted to the NICU 46 . There were some limitations to this pilot study, as data were only available for one‐half to two‐thirds of the variables of interest.…”

“…In a more recent retrospective study, Avery et al 46 analyzed data from 649 trials of labor managed in multiple midwifery practices. Overall, 72% of women gave birth vaginally.…”

Can a Vaginal Birth After Cesarean Delivery be a Normal Labor and Birth? Lessons from Midwifery Applied to Trial of Labor After a Previous Cesarean Delivery

“…61 For this reason, most hospitals require intravenous access (eg, heparin lock) and continuous fetal monitoring for women who are undergoing TOLAC. 62,63 Some also require an intrauterine pressure catheter in the hope of detecting sudden loss of pressure if a uterine rupture occurs. Two studies have evaluated intrauterine catheter readings before and after a uterine incision for cesarean birth 64 and before and after uterine rupture.…”

“…In addition to the studies by Lieberman and colleagues 9 and David and colleagues 56 described earlier in this article, 1 retrospective review of women undergoing TOLAC who are cared for by midwives in the United States found a VBAC success rate of 72% (n 5 649) and no uterine ruptures. 62 The data for this study were contributed by 8 different midwifery practices that were predominately hospital based, and specific care practices were not documented. Harrington and colleagues 92 reported the results of 303 women who underwent TOLAC in a hospital-based birthing center.…”