Outcome of planned vaginal birth after caesarean (VBAC) at home

Summary

Clinical guidelines recommend that women with a previous caesarean section (CS) should be advised to plan birth in an obstetric unit. Nevertheless a small proportion of women with a previous CS opt for a planned birth in a midwifery-led setting, most commonly at home since many midwifery units will not admit women with a previous CS.

The aim of this study was to compare vaginal birth rates and other outcomes in women planning vaginal birth after caesarean section (VBAC) at home vs. women planning VBAC in an obstetric unit.

The study found that:

• Women who planned VBAC at home had a significantly increased chance of a vaginal birth compared with those planning VBAC in an OU.
• In both settings, the number of adverse outcomes was small but not negligible. Serious adverse maternal outcomes occurred in around 2–4% of births and similar proportions of babies were admitted to a neonatal unit. Stillbirth or Apgar score <7 at 5 minutes occurred in 1–3% of births.
• The chances of transfer were high in women planning VBAC at home (37%), particularly amongst women having a second baby (57%).

The findings do not suggest that clinical guidelines regarding planned place of birth should be changed for women attempting VBAC. The findings from this study can be used to help women who request VBAC at home make an informed choice. Further research is required to identify why some women with a previous CS opt for a home birth, and to establish how those women whose preference is for a vaginal birth can best be supported to achieve this.

Publications

Journal Articles

• Rowe R, Li Y, Knight M, Brocklehurst P, Hollowell J. Maternal and perinatal outcomes in women planning vaginal birth after caesarean (VBAC) at home in England: secondary analysis of the Birthplace national prospective cohort study. BJOG. 2015;123(7):1123-32.