title: Planned Home VBAC in the United States, 2004-2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making.
abstract: BACKGROUND
  In the United States, the number of planned home vaginal births after cesarean (VBACs) has increased. This study describes the maternal and neonatal outcomes for women who planned a VBAC at home with midwives who were contributing data to the Midwives Alliance of North America Statistics Project 2.0 cohort during the years 2004-2009.
  
  
  METHODS
  Two subsamples were created from the parent cohort: 12,092 multiparous women without a prior cesarean and 1,052 women with a prior cesarean. Descriptive statistics were calculated for maternal and neonatal outcomes for both groups. Sensitivity analyses comparing women with a prior vaginal birth and those who were at the lowest risk with various subgroups in the parent cohort were also conducted.
  
  
  RESULTS
  Women with a prior cesarean had a VBAC rate of 87 percent, although transfer rates were higher compared with women without a prior cesarean (18% vs 7%, p < 0.001). The most common indication for transfer was failure to progress. Women with a prior cesarean had higher proportions of blood loss, maternal postpartum infections, uterine rupture, and neonatal intensive care unit admissions than those without a prior cesarean. Five neonatal deaths (4.75/1,000) occurred in the prior cesarean group compared with 1.24/1,000 in multiparas without a history of cesarean (p = 0.015).
  
  
  CONCLUSIONS
  Although there is a high likelihood of a vaginal birth at home, women planning a home VBAC should be counseled regarding maternal transfer rates and potential for increased risk to the newborn, particularly if uterine rupture occurs in the home setting.
authors: College of Nursing, University of New Mexico, Albuquerque, New Mexico, USA.
authors: Kim J
authors: KJ
authors: Cox
authors: College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA.
authors: Marit L
authors: ML
authors: Bovbjerg
authors: Department of Anthropology, Oregon State University, Corvallis, Oregon, USA.
authors: Melissa
authors: M
authors: Cheyney
authors: School of Medicine, Departments of Family & Community Medicine and Obstetrics & Gynecology, University of New Mexico, Albuquerque, New Mexico, USA.
authors: Lawrence M
authors: LM
authors: Leeman
mesh_terms: D000328:Adult; D003657:Decision Making; D003710:Demography; D005260:Female; D006700:Home Childbirth / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data
keywords: decision making; home birth; trial of labor; vaginal birth after cesarean