Online Program

Vaginal birth after cesarean section in german out-of-hospital midwifery care

Tuesday, November 5, 2013

Lea Beckmann, University of Applied Sciences Osnabrück, University of Applied Sciences Osnabrück/University of Witten Herdecke, 49009 Osnabrück, Germany
Sabine Metzing, School of Nursing Science, University of Witten Herdecke, 58453 Witten, Germany
Claudia Hellmers, University of Applied Sciences Osnabrück, 49009 Osnabrück, Germany
Background: With the rising rate of Cesarean sections in Germany there is also an increase in the number of women who have had a previous cesarean in the out-of-hospital midwifery care. In 2010, 513 (4.8%) cesarean sections were documented as the direct preceding mode of birth in this setting. Given the risk of uterine rupture and placental complications the vaginal birth after cesarean (VBAC) in the non-clinical setting is considered controversial. Methods: Secondary analysis of German perinatal out-of-hospital data from 2005 to 2011. Data analysis includes women with a prior cesarean section who started labor in an out-of-hospital setting (n=2217). All women had a singleton pregnancy with cephalic presentation at term. Results: The overall VBAC rate is 76,6%. One third (36%) of the women were transferred to a hospital. Of these transferred women, 57,6% had a cesarean section. Five minutes Apgar score ≤7 was seen for 1.8%, and ten minutes Apgar score ≤7 was seen for 0,6% of all newborns. Haemorrhage or placental complications were documented in 4% of births. Conclusion: The results, which are consistent with other German data, show few differences to the existing American studies and enrich the discussion of this issue. As in the USA, the parentsx decision to give birth in an out-of-hospital setting led to a high rate of VBAC.

Learning Areas:

Public health or related nursing
Public health or related research

Learning Objectives:
Discuss the outcome and the risk of vaginal birth after cesarean section in an out-of-hospital setting.

Keyword(s): Midwifery, Outcome Measures

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a midwife with 20 a twenty-year experience. I am writing my dissertation about the vaginal birth after caesarean section in out-of-hospital settings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.