Hospitals best for vaginal birth after C-section

For women preparing to give birth, out-of-hospital delivery is not recommended if they have had a previous cesarean section and wish to attempt vaginal delivery, researchers report.

"Since women attempting a vaginal birth after a previous cesarean are better cared for in hospitals than in birth centers, it is most important that hospitals continue to offer this option to women wishing to avoid another surgical delivery," lead researchers Dr. Ellice Lieberman told AMN Health.

Lieberman, at Brigham and Women's Hospital in Boston, and colleagues collected data on 1913 women who intended to have midwife-supported vaginal delivery after a previous cesarean.

As reported in the journal Obstetrics and Gynecology, 1453 of the women went to birth centers when they started labor. Almost one in four of these women were transferred to hospitals before delivery was completed; of these, 87 percent had vaginal births.

There were six cases of uterine rupture, and seven fetal or neonatal deaths.

More than half of the uterine ruptures and deaths involved women who had had more than one cesarean section or had a pregnancy lasting 42 weeks.

The researchers conclude that "a cesarean-scarred uterus was associated with increases in complications that require hospital management. Therefore, birth centers should refer women who have undergone previous cesarean deliveries to hospitals for delivery."

SOURCE: Obstetrics and Gynecology, November 2004.