Planned Home VBAC in the United States, 2004-2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making

Birth. 2015 Dec;42(4):299-308. doi: 10.1111/birt.12188. Epub 2015 Aug 26.


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.

Method: 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).

Conclusion: 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.

Keywords: decision making; home birth; trial of labor; vaginal birth after cesarean.

MeSH terms

  • Adult
  • Decision Making
  • Demography
  • Female
  • Home Childbirth* / adverse effects
  • Home Childbirth* / methods
  • Home Childbirth* / statistics & numerical data
  • Humans
  • Infant
  • Infant Mortality
  • Infant, Newborn
  • Intensive Care Units, Neonatal / statistics & numerical data
  • Obstetric Labor Complications* / epidemiology
  • Obstetric Labor Complications* / etiology
  • Obstetric Labor Complications* / therapy
  • Pregnancy
  • Pregnancy Outcome / epidemiology
  • Retrospective Studies
  • Socioeconomic Factors
  • United States / epidemiology
  • Vaginal Birth after Cesarean* / adverse effects
  • Vaginal Birth after Cesarean* / methods
  • Vaginal Birth after Cesarean* / statistics & numerical data