VBAC -- Vaginal Birth After Cesarean
HBAC -- Home Birth After Cesarean
TOLAC -- Trial Of Labor After Cesarean (attempting a VBAC)
ERCD -- Elective Repeat Cesarean Delivery
RCS -- Repeat Cesarean Section
April 4, 2017 Update: a new study from the Midwives Alliance of North America (MANA) confirms that attempting a VBAC at home comes with a much higher risk of neonatal death. The study Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States looked at planned, midwife-attended births in a home or freestanding birth center. (Note: in the study, they use the term LAC (Labor after Cesarean) instead of using the term TOLAC or attempted VBAC.)
Here are the neonatal mortality rates for women attempting birth at home or freestanding birth center:
Women with prior vaginal birth, no cesarean history: 1.03/1000
Women attempting VBAC with prior vaginal birth: 1.27/1000
Women attempting VBAC without prior vaginal birth: 10.2/1000
Yes, you read that outrageously awful rate correctly: 10 neonatal deaths per one thousand! Once again, all of these rates are far too high, but especially for women attempting a VBAC who have never had a vaginal birth.
Compare those rates to neonatal mortality rates for USA hospitals:
Hospital CNMs (lower risk pregnancies) = 0.35/1000 to 0.55/1000
Hospital MDs (higher risk pregnancies) = 0.43/1000 to 0.63/1000
Hospital attempted VBACs* = 1.3/1000
Hospital repeat cesarean = 0.5/1000
The neonatal mortality rate for women attempting a VBAC with a midwife at home or in a freestanding birth center is an alarming, tragically high rate. Far too many babies dying preventable deaths.
* The hospital attempted VBAC group includes a higher risk group of women. It includes women with and without prior vaginal birth, with and without higher risk medical conditions and also includes fetal deaths - death of baby in uterus prior to onset of labor from 28 weeks gestation and beyond. Fetal deaths and higher risk pregnancies were not included in the home and birth center rates above (meaning, the mortality rates would be even higher for the home and birth center births if they were included).
Perhaps you are wondering if 1052 HBACs in the MANA study is a large enough sample to draw any conclusions?
In short, the answer is yes. In long, keep reading.