title: Vaginal birth after cesarean in German out-of-hospital settings: maternal and neonatal outcomes of women with their second child.
abstract: BACKGROUND
  To offer vaginal birth after cesarean (VBAC) in a hospital setting is recommended in international guidelines, but offering VBAC in out-of-hospital settings is considered controversial. This study describes neonatal and maternal outcomes in mothers who started labor in German out-of-hospital settings.
  
  
  METHODS
  In a retrospective analysis of German out-of-hospital data from 2005 to 2011, included were 24,545 parae II with a singleton pregnancy in a cephalic presentation at term (1,927 with a prior cesarean and 22,618 with a prior vaginal birth).
  
  
  RESULTS
  The overall VBAC rate was 77.8 percent. The intrapartum transfer rate to hospital was 38.3 percent (prior cesarean) versus 4.6 percent (prior vaginal) (p < 0.05), and the 10-minute Apgar < 7 rate was 0.6 versus 0.2 percent (p < 0.05), and the nonemergency intrapartum transfer rate was 91.5 versus 85.0 percent (p < 0.05). Prolonged first stage of labor was the most common reason for intrapartum transfer in both groups. The leading reason for postpartum transfer was retained placenta.
  
  
  CONCLUSIONS
  There was a high rate of successful VBAC in this study. The high nonemergency transfer rate for women with VBAC might mean that midwives are more cautious when attending women with a prior cesarean in out-of-hospital settings. Further studies are necessary to evaluate which women are suitable for VBAC in out-of-hospital settings.
authors.affiliation: Witten/Herdecke University, Germany; University of Applied Sciences Osnabrück, Germany.
authors.forename: Lea
authors.initials: L
authors.lastname: Beckmann
authors.forename: Mary
authors.initials: M
authors.lastname: Barger
authors.forename: Lena
authors.initials: L
authors.lastname: Dorin
authors.forename: Sabine
authors.initials: S
authors.lastname: Metzing
authors.forename: Claudia
authors.initials: C
authors.lastname: Hellmers
mesh_terms: D000328:Adult; D001034:Apgar Score; D016550:Birthing Centers; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004420:Dystocia / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010360:Patient Transfer / Q000706:statistics & numerical data*; D018457:Placenta, Retained / Q000453:epidemiology*; D011247:Pregnancy; D012189:Retrospective Studies; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*
keywords: VBAC; maternal and neonatal outcomes; out-of-hospital setting