[ozmidwifery] vbac/FYI

[Mary Murphy]

Reducing post-cesarean vaginal births has no effect on mortality Source: Annals of Family Medicine 2006; 4: 228-34 Looking at the effect of introducing more restrictive guidelines on vaginal birth after cesarean section on mortality rates. Although rates of vaginal birth after cesarean delivery (VBAC) decreased significantly after the adoption of more restrictive guidelines by the American College of Obstetricians and Gynecologists in 1999, there was no effect on neonatal and maternal mortality rates, suggest US study results. For the study, John Zweifler and colleagues from the University of California in San Francisco studied the records of 386,232 women who had previously given birth by cesarean delivery and subsequently had a singleton birth between 1996 and 2002. Although attempted VBAC deliveries fell significantly after the guideline revision, from 24.0 percent beforehand to just 13.5 percent afterwards, neonatal mortality rates per 1000 live births were no different for attempted VBAC deliveries from those for repeat cesarean among neonates weighing at least 1500 g during either of the two study periods. Neonatal mortality rates for attempted VBAC among neonates weighing less than 1500 g were higher than those for repeat cesarean deliveries, however, in both study periods. Maternal death rates per 100,000 live births were similar in the two study periods for attempted VBAC. "We recommend that a balanced presentation of risks and the encouraging outcomes found in this analysis be included in discussions with pregnant patients who have had a previous cesarean section," the team concludes." Posted: 2 June 2006 © Current Medicine Group 2006