[ozmidwifery] article FYI

[leanne wynne]

Vaginal Birth After Cesarean in California: Before and After a Change in 
Guidelines

John Zweifler, MD, MPH; Alvaro Garza, MD, MPH; Susan Hughes, MS; Matthew A 
Stanich, MPH; Anne Hierholzer; Monica Lau

Ann Fam Med.  2006;4(3):228-234.  ©2006 Annals of Family Medicine, Inc.
Posted 07/07/2006

Abstract
Purpose: In 1999 the American College of Obstetricians and Gynecologists 
(ACOG) adopted more-restrictive guidelines for vaginal birth after cesarean 
delivery (VBAC). This study assesses trends in VBAC in California and 
compares neonatal and maternal mortality rates among women attempting VBAC 
delivery or undergoing repeat cesarean delivery before and after this 
guideline revision.
Methods: The 1996 through 2002 California Birth Statistical Master Files 
were used to identify 386,232 California residents who previously gave birth 
by cesarean delivery and had a singleton birth planned in a California 
hospital.
Results: Attempted VBAC deliveries decreased significantly from 24% before 
to 13.5% after guideline revision (P < .001). Neonatal mortality rates per 
1,000 live births for attempted VBAC deliveries were not different from 
repeat cesarean delivery rates among neonates weighing &#8805;1,500 g in 
either the study periods 1996 to 1999 or 2000 to 2002. Neonatal mortality 
rates for attempted VBAC deliveries were higher for repeat cesarean 
deliveries among neonates weighing <1,500 g in the same periods (attempted 
VBAC: 1996–1999, 253.2; 95% Poisson confidence interval [CI], 197.7–308.6; 
2000–2002, 336.8; CI, 254.3–419.4; repeat cesarean delivery: 1996–1999, 
59.1; CI, 48.3–69.9; 2000–2002, 60.5, CI, 48.4–72.5). Maternal death rates 
per 100,000 live births for attempted VBAC deliveries were similar for both 
periods (1996–1999, 2.0; CI, 0.1–11.0; 2000–2002, 8.5; CI, 1.0–30.6).
Conclusions: Neonatal and maternal mortality rates did not improve despite 
increasing rates of repeat cesarean delivery during the years after the ACOG 
1999 VBAC guideline revision. Women with infants weighing &#8805;1,500 g 
encountered similar neonatal and maternal mortality rates with VBAC or 
repeat cesarean delivery.



Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service  Mob 0418 371862


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