In 2013, nearly one-third (32.7%) of childbearing women in the US gave birth by cesarean delivery. In subsequent pregnancies, these women will have to choose between a repeat cesarean delivery and a labor after cesarean (LAC), as well as where and with whom to give birth. Although national guidelines encourage offering LAC to most women with one prior low transverse cesarean, vaginal birth after cesarean (VBAC) rates decreased nationwide, from 28.3 percent in 1996 to 10.6 percent in 2013.
In 2014, the largest study of US home birth to date reported on the outcomes of 16,924 deliveries using data from the Midwives Alliance of North America Statistics Project (MANA Stats) 2.0 cohort (2004–2009). These data included 1,052 women with a history of cesarean delivery. Of these, 87.0 percent had a successful VBAC, although there was an increased risk of intrapartum fetal death (2.85/1,000 vs 0.66/1,000, p = 0.05) in the LAC group compared with multiparous women without a history of cesarean.
For this presentation, our research team further analyzed the LAC cohort within MANA Stats (2.0 and 4.0), with three research aims: 1) to describe the demographics of women choosing community VBAC; 2) to characterize the prenatal and intrapartum care provided; and 3) to report birth outcomes for planned community VBACs. In light of findings from this research and those of other international studies on LAC, I will present evidence-informed guidelines for shared decision-making, risk assessment, and the management of care for families planning LAC in the community setting.
1) Summarize key findings from the most recent studies on labor after cesarean (LAC) in the community setting;
2) Describe the ways research findings can be used to structure shared decision making conversations in the antenatal period; and
3) Critically evaluate guidelines for reducing the risk of intrapartum mortality among LAC clients birthing in the community setting.
4) Compare differences in outcomes following LAC in the community setting from different high-resource nations and maternity care systems
5) Utilize the Four Boxes of Clinical Ethics approach to guide care for pregnant people desiring to LAC in the community setting
Cover photo credit: We thank Jazz Canty for graciously allowing us to use this photo of her Homebirth After Cesarean, along with midwife and photographer Angelina Ruffin, who captured that moment.
Midwife, Researcher, Professor
- Video 1.1: Introduction
- Quiz 1.1
- Video 1.2: General Homebirth Statistics in the United States and Canada
- Quiz 1.2
- Video 2.1: Study #1 ~ Design, Methods, Demographics, and General Outcomes
- Quiz 2.1
- Video 2.2: Study #1 ~ Uterine Rupture and Mortality Rates in LAC
- Quiz 2.2
- Video 3.1: Understanding Risk, Study Methods
- Quiz 3.1
- Video 3.2: Outcomes and Client Patterning
- Quiz 3.2
- Video 4.1: LAC Specific Clinical Implications
- Quiz 4.1
- Video 4.2: Q&A With Live Audience
- Video 4.3: Case Studies for Ethical Consideration
- Quiz 4.2/4.3
- Video 5.1: Future Research
- Quiz 5.1
- Link to post-test and OBNM certificate
- Link to post-test and ACNM Certificate
- MEAC Evaluation Form
- Link to post-test and MEAC certificate
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“This presentation was well organized. Video added visual interest to the presentation. The interspersed "quizzes" helped to solidify information for viewers. I highly recommend this presentation to colleagues who work in hospitals as a means of...”→Read More
“This presentation was well organized. Video added visual interest to the presentation. The interspersed "quizzes" helped to solidify information for viewers. I highly recommend this presentation to colleagues who work in hospitals as a means of deflecting / altering some of their objections to homebirth practices in our area. Hoping that they will actually take the time to view this presentation. Thanks to Hive for bringing us this information in such a useable format.”→Read Less
“Excellent. Material organized and easily understood. Take away good research that I can put into my practice. Diane Holmes, Wabash, IN ”
“Excellent. Material organized and easily understood. Take away good research that I can put into my practice. Diane Holmes, Wabash, IN ”→Read Less