Vaginal Birth After Cesarean Section: Outcomes of Women Receiving Midwifery Care in Ontario
Elizabeth K. Darling, BAS (Hons), BHS, MSc, RM, PhD Candidate
Providing care to women with a history of cesarean section is within the scope of practice of Canadian midwives, and midwifery care may be of benefit to women who plan a vaginal birth after cesarean section. This retrospective cohort study describes the birth outcomes of women with a history of cesarean section cared for by a midwife in Ontario between April 1, 2003 and March 31, 2008 (n= 3262). The primary outcome was cesarean section, and the secondary outcome was perinatal mortality. The overall rate of cesarean section in this cohort was 46.1%, but among women who laboured the rate of cesarean section was 28.8%. There was not a statistically significant difference in perinatal mortality (excluding congenital anomalies and stillbirth prior to labour) when women with a history of cesarean section (0.18%) were compared to those without (0.20%), p=0.99. This study demonstrates positive outcomes for both mothers and babies when midwives are primary care providers during the intrapartum period for women with a history of cesarean section. There is a need to explore the factors contributing to the high rate of planned repeat cesarean section in this cohort.
Vaginal birth after cesarean, VBAC, midwifery, cesarean section, Ontario
This article has been peer reviewed.