VAGINAL BIRTH AFTER CESAREAN IN A HOSPITAL-BASED BIRTH CENTER STAFFEDBY CERTIFIED NURSE-MIDWIVES

The efficacy and safety of a trial of labor after previous cesarean we re evaluated in selected, low-risk women in a hospital-based birthing center staffed by certified nurse-midwives. A total of 303 low-risk wo men with one previous cesarean delivery underwent a trial of labor in the birthing center. A matched control, without a previous uterine inc ision, was selected for each study patient. Hospital charts of 298 mat ched pairs were available for analysis. Outcome measures included the requirement for intrapartum transfer to medical management, use of oxy tocin, method of delivery, uterine scar separation, Apgar scores, birt h weights, maternal febrile morbidity, and length of hospital stay. In trapartum transfer to medical management was necessary in 26 (8.7%) st udy patients and 31 (10.4%) control subjects. The overall rate (98.3%) of vaginal birth after cesarean among study patients was not statisti cally different from the vaginal birth rate (99.3%) among control subj ects. There were no differences in maternal or neonatal morbidity. The high percentage (84%) of study patients having had a previous uncompl icated vaginal birth after cesarean must be considered a potential lim itation of the outcome data; however, the overall vaginal birth rate b etween study patients with and study patients without previous vaginal birth after cesarean was not statistically different. The latter grou p was more likely to require transfer to medical management and/or oxy tocin augmentation. On the basis of these results, we concluded that f or selected, low-risk patients, a trial of labor after one previous ce sarean may be managed safely and effectively by certified nurse-midwiv es in a hospital setting. (C) 1997 by the American College of Nurse-Mi dwives.