A Description of the Management and Outcomes of Vaginal Birth After Cesarean Birth in the Homebirth Setting

Authors

  • Gwen Latendresse CNM, MS,

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    • Gwen Latendresse, CNM, MS, is an auxiliary faculty member at the University of Utah College of Nursing, where she is currently enrolled in full-time study toward a PhD degree under a doctoral fellowship program.

  • Patricia Aikins Murphy CNM, DrPH,

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    • Patricia Aikins Murphy, CNM, DrPH, FACNM, is an Associate Professor at the University of Utah College of Nursing, where she holds the Annette Poulson Cumming Endowed Chair in Women's and Reproductive Health.

  • Judith T. Fullerton CNM, PhD

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    • Judith T. Fullerton, CNM, PhD, FACNM, is Sr. Technical Advisor, Monitoring & Evaluation, Project Concern International, San Diego, CA, and also serves as consultant to international agencies involved in reproductive health programming worldwide.


Patricia Aikins Murphy, CNM, DrPH, University of Utah College of Nursing, 10 South 2000 East, Salt Lake City, UT 84112–5880. E-mail: patricia.murphy@nurs.utah.edu

Abstract

Our objective was to describe the outcomes of intended home birth among 57 women with a previous cesarean birth. Data were drawn from a larger prospective study of intended homebirth in nurse-midwifery practice. Available data included demographics, perinatal risk information, and outcomes of prenatal, intrapartum, postpartum, and neonatal care. The hospital course was reviewed for those transferred to the hospital setting. Fifty-three of 57 women (93%) had a spontaneous vaginal birth, 1 had a vacuum-assisted birth, and 3 (5.3%) had a repeat cesarean birth. Thirty-one of 32 (97%) women who had a previous vaginal birth after cesarean birth (VBAC) had a successful VBAC; 22 of 25 (88%) women without a history of VBAC successfully delivered vaginally. Fifty (87.7%) of these women delivered in the home setting, whereas 7 (12.3%) delivered in the hospital setting. None of the women experienced uterine rupture or dehiscence. One infant was stillborn. This event was attributed to a postdates pregnancy with meconium. Certified nurse-midwives with homebirth practices must be knowledgeable about the risks for mother and baby, screen clientele appropriately, and be able to counsel patients with regard to potential adverse outcomes. Given what is presently known, VBAC is not recommended in the homebirth setting. It is imperative in the light of current evidence and practice climate to advocate for the availability of certified nurse-midwife services and woman-centered care in the hospital setting.

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