This excerpt is from ICAN, posted February 28, 2014. See the full article here.
by Karen Troy, PhD
The Midwives Alliance of North America (MANA) recently published data from a large and well-tracked series of planned home births, the result of a home birth registry program that was initiated in 2004 (1). The data set included nearly 17,000 planned home births attended by a mix of midwives including CPMs (79%), CNMs (15%), and other unlicensed midwives. Within this cohort were 1054 women with a history of cesarean section who were planning a vaginal birth after cesarean – VBAC – at home. (This is also referred to within the birth community as "HBAC" – home birth after cesarean). Within this subgroup, 87% had successful vaginal births, with 94% of those births occurring at home and the remaining 6% occurring after a transfer to a local hospital. This success rate is substantially higher than the 60-80% success rate reported across other large hospital-based cohorts (2) and likely reflects the high level of commitment to and support of natural birth, both from the mothers and their care providers.
A landmark study published June 18 in the British Medical Journal (BMJ) shows planned home births with Certified Professional Midwives (CPMs) result in significantly lower cesarean rates than planned hospital births.
The 2000 study by a Canadian epidemiologist and a CPM tracked more than 5,000 pregnant women in the United States and Canada planning home birth. The result was a 3.7 percent cesarean rate among all mothers and a 1.7 percent cesarean rate among women who previously gave birth vaginally.
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The CDC has reported:
- The Cesarean Rate for 2004 is 29.1%
- The Rate is up from 27.6% in 2003
- US Cesareans have risen 40% since 1996
- VBAC Rate fell to 9.2%
- Since 1996, the VBAC rate in the US has plummeted 67%
As the number of cesarean sections in the U.S. continues to mount, so does the research showing that mothers and babies may be paying a high price for this surgery. Research published just in the last year has highlighted the short-term and long-term risks of undergoing a cesarean, for both mother and baby. Other research has called into question the assumed safety advantage of cesarean section over vaginal birth in various situations including vaginal birth after multiple cesareans and breech deliveries. Everything we know and continue to learn about cesareans supports more judicious use of the surgery, says Tonya Jamois but it is clear that the procedure is being overused. Major pieces of research released in 2006 showed that women who undergo cesareans versus women experiencing a vaginal birth have a higher risk of dying in childbirth, have a higher chance of suffering from potentially fatal placental problems in subsequent pregnancies, and their babies have a higher chance of being injured during surgery. The list of 15 studies that ICAN collected also shows that vaginal birth after cesarean, including multiple cesareans, continues to be a reasonably safe birthing choice for mothers.