title: 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.
abstract: OBJECTIVE
  To compare vaginal birth rates in women planning vaginal birth after caesarean (VBAC) at home versus in an obstetric unit (OU) and explore transfer rates in women planning home VBAC.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  OUs and planned home births in England.
  
  
  METHODS
  1436 women planning VBAC in the Birthplace cohort, including 209 planning home VBAC.
  
  
  METHODS
  We used Poisson regression to calculate relative risks adjusted for maternal characteristics.
  
  
  METHODS
  
  
  
  RESULTS
  (i) vaginal birth and (ii) transfer from planned home birth to OU during labour or immediately after birth.
  
  
  RESULTS
  (i) composite of maternal blood transfusion or admission to higher level care, (ii) stillbirth or Apgar score <7 at 5 minutes, (iii) neonatal unit admission.
  
  
  RESULTS
  Planned VBAC at home was associated with a statistically significant increase in the chances of having a vaginal birth compared with planned VBAC in an OU (adjusted relative risk 1.15, 95% confidence interval 1.06-1.24). The risk of an adverse maternal outcome was around 2-3% in both settings, with a similar risk of an adverse neonatal outcome. Transfer rates were high (37%) and varied markedly by parity (para 1, 56.7% versus para 2+, 24.6%).
  
  
  CONCLUSIONS
  Women in the cohort who planned VBAC at home had an increased chance of a vaginal birth compared with those planning VBAC in an OU, but transfer rates were high, particularly for women with only one previous birth, and the risk of an adverse maternal or perinatal outcome was around 2-3%. No change in guidance can be recommended.
  
  
  CONCLUSIONS
  Higher vaginal birth rates in planned VBAC at home versus in OU but 2-3% adverse outcomes and high transfer rate.
authors.affiliation: Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: R
authors.initials: R
authors.lastname: Rowe
authors.affiliation: Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.affiliation: Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Knight
authors.affiliation: Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.|Institute for Women's Health, University College London, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Brocklehurst
authors.affiliation: Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hollowell
mesh_terms: D000328:Adult; D001034:Apgar Score; D001803:Blood Transfusion / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Caesarean; home birth; transfer; vaginal birth after caesarean (VBAC)