VAGINAL BIRTH AFTER CESAREAN BIRTH: A NATIONAL SURVEY OF U.S. MIDWIFERY PRACTICE

Authors

  • Catherine A. Carr CNM, DrPH,

    Corresponding author
      Box 357262, University of Washington, Seattle, WA 98195-7262.
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    • Catherine Carr completed the family nurse practitioner and nurse-midwifery program at Frontier School of Nurse-Midwifery and Family Nursing in 1979 and the DrPH at the University of Michigan in 1993. She is Assistant Professor, Family and Child Nursing at the University of Washington, Seattle where she teaches in the midwifery program. She is a member of the Division of Research, a member of the Board of Review of the Division of Accreditation, and continues to participate in clinical practice.

  • Patricia Burkhardt CNM, DrPH,

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    • Patricia Burkhart completed the nurse-midwifery program at Catholic Maternity Institute in 1964, the MPH at Johns Hopkins University in 1969, and the DrPH at Johns Hopkins University in 1981. She is currently Associate Clinical Professor and Director of the Midwifery Program at New York University. She has held many clinical midwifery positions and international consultancies and is a member of the Governing Board of the Division of Research.

  • Melissa Avery CNM, PhD

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    • Melissa Avery completed the nurse-midwifery program at the University of Kentucky in 1981 and the PhD at the University of Minnesota in 1993. She is currently Associate Professor and Director of the Nurse-Midwifery Program at the University of Minnesota, School of Nursing and continues to participate in full-scope nurse-midwifery practice. She is Chair of the Board of Review of the Division of Accreditation and a member of the Division of Research.


Box 357262, University of Washington, Seattle, WA 98195-7262.

ABSTRACT

Midwives have been providing care for women choosing vaginal birth after cesarean birth (VBAC) for over 20 years. The 1999 American College of Obstetrician Gynecologist (ACOG) guidelines and recent studies questioning the relative safety of VBAC have raised concerns about continuing to offer this option. As part of an effort to understand VBAC care provided by midwives, this study used a national survey sample to examine practices, scope, and recent changes in the provision of VBAC care. The survey, which included demographic and practice items was mailed in late 2000 to a purposeful sample of 325 midwifery practices. The return rate was 62%. Nearly all (94%) of the responding practices were providing VBAC care, and almost half of them (43%) stated that their ability to do so had changed within the past 2 years secondary to recent studies in the obstetric literature, the 1999 ACOG statement, and concerns from third-party payers. Criteria for offering VBAC are stricter, and consent forms are more extensive. Other changes included the need for additional or more intensive support services, in-house anesthesia, and surgery backup. Midwives continue to provide VBAC care, although with some increased restrictions. This study provides background for future research that will determine how midwifery care affects the rate of successful VBACs.

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