VAGINAL BIRTH AFTER CESAREAN IN A HOSPITAL-BASED BIRTH CENTER STAFFED BY CERTIFIED NURSE-MIDWIVES

Authors

  • Lisa C. Harrington CNM, MPH, MSN,

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    • Lisa C. Harrington was a staff nurse-midwife at Women's and Children's Hospital, Los Angeles County and University of Southern California Medical Center from 1992 to 1993. During this same period, she was also a clinical assistant professor of obstetrics and gynecology in the School of Medicine at the University of Southern California. Since 1994, she has been on the medical staff as a nurse-midwife at Columbia Hospital for Women, Washington, D.C., USA.

  • David A. Miller MD,

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    • David A. Miller is assistant professor of obstetrics and gynecology in the School of Medicine at the University of Southern California, Los Angeles, USA.

  • Cindy J. McClain CNM, MS,

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    • Cindy McClain is a staff nurse-midwife at Women's and Children's Hospital. Los Angeles County and University of Southern California Medical Center, Los Angeles, USA. She is a clinical assistant professor of obstetrics and gynecology in the School of Medicine at the University of Southern California, Los Angeles.

  • Richard H. Paul MD

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    • Richard Paul is director of the Obstetric Service, Division of Maternal-Fetal Medicine at Los Angeles County and University of Southern California Medical Center, Los Angeles, USA. Women's and Children's Hospital. He is professor of obstetrics and gynecology in the School of Medicine at the University of Southern California, Los Angeles.


Cindy J. McClain, CNM, Nurse-Midwifery Service, WCH Rm. 8K5, 1240 N. Mission Road, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA 90033.

ABSTRACT

The efficacy and safety of a trial of labor after previous cesarean were evaluated in selected, low-risk women in a hospital-based birthing center staffed by certified nurse-midwives. A total of 303 low-risk women with one previous cesarean delivery underwent a trial of labor in the birthing center. A matched control, without a previous uterine incision, was selected for each study patient. Hospital charts of 298 matched pairs were available for analysis. Outcome measures included the requirement for intrapartum transfer to medical management, use of oxytocin, method of delivery, uterine scar separation, Apgar scores, birth weights, maternal febrile morbidity, and length of hospital stay. Intrapartum transfer to medical management was necessary in 26 (8.7%) study patients and 31 (10.4%) control subjects. The overall rate (98.3%) of vaginal birth after cesarean among study patients was not statistically different from the vaginal birth rate (99.3%) among control subjects. There were no differences in maternal or neonatal morbidity. The high percentage (84%) of study patients having had a previous uncomplicated vaginal birth after cesarean must be considered a potential limitation of the outcome data; however, the overall vaginal birth rate between study patients with and study patients without previous vaginal birth after cesarean was not statistically different. The latter group was more likely to require transfer to medical management and/or oxytocin augmentation. On the basis of these results, we concluded that for selected, low-risk patients, a trial of labor after one previous cesarean may be managed safely and effectively by certified nurse-midwives in a hospital setting.

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