Planned Community VBAC

In the United States, the number of planned home vaginal births after cesarean (VBACs) has increased.In this presentation I describe the maternal and neonatal outcomes for women who planned a VBAC athome with midwives who contribute data to the Midwives Alliance of North America Statistics Project.Two subsamples were created from the parent cohort: 12,092 multiparous women without a priorcesarean and 1,052 women with a prior cesarean. Descriptive statistics were calculated for maternal andneonatal outcomes for both groups. Sensitivity analyses comparing women with a prior vaginal birth andthose who were at the lowest risk with various subgroups in the parent cohort were also conducted.Women with a prior cesarean had a VBAC rate of 87 percent, although transfer rates were highercompared with women without a prior cesarean (18% vs 7%, p < 0.001). The most common indication fortransfer was failure to progress. Women with a prior cesarean had higher proportions of blood loss,maternal postpartum infections, uterine rupture, and neonatal intensive care unit admissions than thosewithout a prior cesarean. Five neonatal deaths (4.75/1,000) occurred in the prior cesarean groupcompared with 1.24/1,000 in multiparas without a history of cesarean (p = 0.015). Although there is ahigh likelihood of a vaginal birth at home, women planning a home VBAC should be counseled regardingmaternal transfer rates and potential for increased risk to the newborn, particularly if uterine ruptureoccurs in the home setting.

Learning Objectives:

1. List the VBAC rate for birthing people with a prior cesarean in the sample, as well as the transfer rate 
2. Describe the most common indication for transfer among the LAC group
3. Explain the risk profiles for those with a prior cesarean, including proportions of blood loss, maternal postpartum infection, uterine rupture, and neonatal intensive care unit admissions relative to those without a prior cesarean 
4. Compare neonatal mortality rates in the prior cesarean group compared with multiparas without a history of cesarean
5. Synthesize what the overall body of research indicates about best practices for managing LAC in the community setting.

This pre-recorded webinar is available only to members of CALM.

Upon completion of all online components, participants will receive a CE Certificate for 1.5 hours of CE approved by the Californians for the Advancement of Midwifery in collaboration and supervision of California Association of Licensed Midwives.