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

Authors

  • Melissa D. Avery CNM, PhD,

    Corresponding author
    1. Melissa D. 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 participates in full-scope nurse-midwifery practice.
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  • Catherine A. Carr CNM, DrPH,

    1. Catherine A. 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 Associate Professor, Family and Child Nursing at the University of Washington, Seattle where she teaches in the midwifery program and participates in clinical practice.
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  • Patricia Burkhardt CNM, DrPH

    1. 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.
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University of Minnesota, School of Nursing, 308 Harvard Street SE, Minneapolis, MN 55455. E-mail: avery003@umn.edu

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.

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