5 posts from April 2008

Safety and Efficacy of Vaginal Birth After Cesarean Attempts at or Beyond 40 Weeks of Gestation (Obstetrics and Gynecology, 2005;106:700-706)

Summary: Women attempting VBAC before or at 40 weeks gestation had higher success rates (77.8%) than women past 40 weeks gestation (68.7%). Uterine rupture rates between the two groups were similar. So, VBAC after EDD (estimated due date) is just as safe as before or at EDD, though odds of success are lower.

I can't access the full text, just the abstract, so I'm wondering why the success rates differ between "at term" women and "post-dates" women. My guess is that it has nothing to do with the length of gestation but rather with how a woman's labor and delivery is managed differently once she reaches 40 weeks. Just a guess.

A small study, but interesting, nonetheless.

External Cephalic Version for Breech Presentation With or Without Spinal Analgesia in Nulliparous Women at Term

Note to self: if next babe is breech, as first was, maybe try a spinal during ECV.

VBAC Facts recently posted a written dialogue between a mom in Southern California and an OB acting as spokesman for a hospital that recently "banned" VBACs. Mom's letter is here and the OB/hospital response is here. Make sure to read the blogger's comments after the hospital letter.

If this is representative of the kinds of lies and twisted truths perpetuated by obstetricians and hospitals unsupportive of VBACs, it's no wonder the C-section rate is on the rise and VBACs are dwindling.

Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia -- no increased risk to mother or baby from home births compared to hospital births, but home births had significantly fewer interventions.

Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands -- Conclusions: The outcome of planned home births is at least as good as that of planned hospital births in women at low risk receiving midwifery care in the Netherlands. This is great, except that the Netherlands has a completely different philosophy surrounding birth than the United States. Midwifery and home births are standard choices and comprise much higher percentages of birth than in the U.S. So kind of comparing apples to oranges, but still significant, because it shows that midwifery as the standard model of care is just as good, if not better, for most women than the standard OB care common in the U.S.

American College of Nurse-Midwives Position Statement on Home Birth (December 2005)

In short, low-risk home births had outcomes quite similar to low-risk hospital births, in terms of safety. The big difference is the rate of medical interventions: women giving birth in hospitals had much higher rates of episiotomy, forceps/vacuum delivery, and cesarean surgeries than women who planned home births.

So, midwives attending home births achieved the same safety rates as doctors and midwives attending hospital births, but without all the interventions.

Outcomes of planned home births with certified professional midwives: large prospective study in North America

Objective To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system.

Setting All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000.

Participants All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began.

Main outcome measures Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction.

Results 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated.

Conclusions Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.