Prior cesarean section--an acceptable risk for vaginal delivery at free-standing midwife-led birth centers? Results of the analysis of vaginal birth after cesarean section (VBAC) in German birth centers.

摘要

OBJECTIVES: Is out-of-hospital vaginal birth at a birth center safe for women with a previous cesarean section? Do their maternal or neonatal outcomes vary significantly from those of a "non-cesarean" control group? STUDY DESIGN: Retrospective evaluation of prospectively collected data on documented singleton births (cephalic presentation, >34/0 weeks of gestation), all of which were second births, occurring between 2000 and 2004 in 1 of 80 German birth centers. Births that occurred in the birth center or when labor had started in the birth center prior to transfer were included for analysis. RESULTS: Three hundred and sixty four women (5.3%) had a previous cesarean. The control group included 6448 parae II with no previous cesarean. Significant differences (p<0.05) between these two groups included: the transfer rate of mothers from a birth center to a hospital clinic during labor, the number of emergency transfers, the method of delivery (repeat cesarean), and the Apgar score at 5 min