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

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.