Tag Archives: home birth

In Honor of Cesarean Awareness Month: Introducing The VBAC Education Project

10 Apr

VBAC was deemed a reasonable and safe option to a routine repeat cesarean by the National Institutes of Health decades ago (1981). But, in recent years, misinformation about its safety and lack of clear national practice guidelines have succeeded in virtually eliminating VBACs in many hospitals. Intro.keyThousands of women are being denied medical care for VBAC and given no choice but to “consent” to a repeat operation they do not need or want. Mothers have the legal right to make their own health care decisions, but that right, more often than not, is not upheld. The  upcoming, evidence-based VBAC Education Project, endorsed by the International Childbirth Education Association and the International Cesarean Awareness Network was developed to answer the many questions parents have about VBAC and provide educators and maternity care professionals with the resources they need to support women who want to labor after a prior cesarean. This volunteer collaborative project will be available for download at no cost.

The VBAC Education Project consists of four sections:

  • žDeciding if A VBAC Is Right for You: A Parent’s Guide (slides)
  • žVBAC for Educators: A Teaching Guide
  • ž Resources for VBAC and Physiologic Birth
  • žEducational Handouts for Parents

For Parents

žIf you are a parent whose baby was born by cesarean section, VBAC_HandoutsForParentsthis evidence-based slide presentation (14 modules) provides comprehensive information on vaginal birth after a cesarean (VBAC), a safe option to a routine repeat cesarean. It will also help you to understand why you may have had a cesarean and how you can do things differently this time. The Resources will help expand your knowledge about VBAC and physiologic (normal) birth. The Educational Handouts for Parents will give you the tools you need to make informed decisions and help you to have a safe and satisfying birth.

žFor Educators and Group Leaders

VBAC For Educators: A Teaching Guide is a companion to Deciding if A VBAC Is Right for You. If you teach childbirth classes or lead a support group for women with a prior cesarean the supporting e-book, VBAC for Educators: A Teaching Guide will help you to present the material to your students. It includes background information for each of the 14 modules, sample class outlines, teaching tips, examples of hospital guidelines and informed consent forms for VBAC you can duplicate for your own educational use. VBAC_ForEducatorsFor mothers considering a birth-center or home VBAC the Teaching Guide also explores the relative safety of VBAC outcomes for low-risk women who begin labor on their own compared to outcomes for planned hospital VBACs.

For Maternity Care Professionals

žIf you are a labor and delivery nurse, office nurse, doula, community-based maternal-child health worker or birth activist, this visual guide provides the medical facts you need to understand the VBAC option, the psychological issues related to laboring for a VBAC after an unexpected prior cesarean, and the many ways you can support and empower mothers to make their own best decisions about how they want to give birth this time. The Resources and Educational Handouts for Parents will be useful for you and the mothers and families you work with.

žFor Physicians and Midwives

žIf you are a physician or a midwife, this visual guide can help provide expectant parents with evidence-based information about vaginal birth after a cesarean. It can also help them to clarify some of the issues they are most concerned about.VBAC_Resources Clinicians rarely have the time to provide parents with all the information they may need to make informed decisions for birth after a cesarean. This guide can help begin the prenatal conversations you will have with mothers to help them make an informed choice about how they want to give birth this time.

The VBAC Education Project will soon be available for free download from www.vbac.com and the International Childbirth Education Association. We hope it will help parents to find out more about the VBAC option and encourage maternity care professionals to safely support them.

Updated June 24, 2015.

Home Birth Is Safe Despite Medical Opinions

27 Jan

Last week the American College of Obstetricians and Gynecologists (ACOG) issued a press release announcing the publication of  Committee Opinion Number 476, Planned Home Birth questioning the safety of home birth based on a discredited and highly criticized study by lead author  J.R. Wax. The Opinion states that babies are two-to-three times more likely to die when women give birth at home. This is not the first time that ACOG has attempted to discredit the safety of home birth without supporting evidence.

“Although the Committee on Obstetric Practice believes that hospitals and birthing centers are the safest setting for birth,” states ACOG, “it respects the right of a woman to make a medically informed decision about delivery. Women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence. Specifically, they should be informed that although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth.”

ACOG’s opinion is based on a faulty study not “recent evidence.”  Even more egregious, ACOG  is recommending to its members to spread this misinformation to their own patients.

In a commentary on the Wax study written for the Birth Journal Marc J.N.C. Keirse, MD,  a member of the editorial team responsible for preparing Effective Care in Pregnancy and Childbirth notes,

“Home birth has attracted a great deal of attention of late, culminating in a meta-analysis to assess its risks for mother and baby. Mothers were estimated to be 2.6 times more likely to die and babies 3 times more likely to die from a planned home birth than from a planned hospital birth. The actual data on which these estimates were based demonstrate that meta-analysis can be developed into an art that suits whatever purpose its authors hope to achieve. Combining studies of home versus hospital, without differentiating what is inside them, where they are, and what is around them, is akin to producing a fruit salad with potatoes, pineapples, and celery.”

ACOG states that hospitals are the safest place to give birth for all women. However, according to the Centers for Disease Control and Prevention (NVSS Vol.58, Number 11, March 3, 2010) low risk women who plan a home birth have fewer  preterm and low birthweight babies. For low-risk women who gave birth between 1990 and 2006 the low birthweight (less than 2,500 grams)  rate was 5.2% for planned home births compared with 8.3% for hospital births. For preterm (less than 37 weeks of gestation) births the rate was 7.2% for home births compared to 12.9% for hospital births.

Home Birth is Safe When Four Important Criteria are Met

Planned home birth is as at least as safe as planned hospital birth for similar groups of women when four important criteria are in place.

1. Pregnant women are low risk.

2. Home was chosen as the intended place for birth.

3. The primary care provider is qualified according to professional licensing standards and trained to assist at home births.

4. A collaborative relationship with consulting physicians and a medical center exists with clear guidelines for continuity of care should a complication arise where the mother or baby would benefit from the transfer.

Based on a review of 16 years of scientific studies on home birth the Coalition for Improving Maternity Services Expert Work Group found that compared to low risk women who plan a hospital birth, low risk women who plan a home birth have similar or better outcomes with fewer medical interventions and fewer cesareans.  The researchers found several health advantages to giving birth at home for both mothers and their infants.

Women who gave birth at home had the same or lower rates of induction and augmentation of labor. They were less likely to need IV fluids, to have an amniotomy (intentional breaking of the bag of waters), or to have continuous electronic fetal monitoring. (Routine continuous electronic monitoring and amniotomy are associated with an increased risk for cesarean section.) At home women had more freedom of movement and more choice of positions for labor and birth. Ultimately the home birth group had fewer cesareans and more VBACs, less or similar incidents of maternal infection requiring antibiotics after birth, and less need for a blood transfusion.

Perinatal outcomes from the planned home births were similar to planned hospital births. Similar rates of newborns were admitted to the intensive care unit and similar or fewer numbers of newborns suffered from birth traumas. The number of babies who died in the first twenty-weight days (perinatal mortality) was similar in the home birth and hospital birth groups. Overall 85 % of women who first gave birth in a hospital and went on to have a home birth preferred their experience of birth at home. Nine out of ten women who planned to have other children said they would have another home birth.

Evidence supporting the safety of home birth is freely available on several websites including  the American College of Nurse Midwives, the Midwives Alliance of North America and  The Big Push for Midwives.

Undoubtedly, this unfounded opinion on the dangers of home birth is likely to cause some alarm. However, given that expectant mothers actively search the internet for information on pregnancy and birth women can be trusted to access the accurate information they need to make an informed choice about home birth.

The Home Birth Scare in the U.K.

19 Oct

It seems that the trend to demonize women who choose a home birth with a midwife is not limited to the United States. In Britain, as reported in the Telegraph, women who want to have a home birth are being told  by  their physicians  that they are too young, too old, or too overweight to risk giving birth at home. The National Health Service in the U.K. has established guidelines for low-risk women who want a home birth, but leaders in the Royal College of Midwives are protesting that physicians are treating women as abnormal  and scaring them into having a hospital birth.

Although the American College of Obstetricians and Gynecologists  (ACOG) states that the safest place to give birth is in the hospital, research shows that for low-risk women, a planned home birth with a licensed midwife is a safe option. With a home birth women are less likely to end up needing  a cesarean and outcomes for mothers and babies are as safe as for hospital births.