Mothers Who Had a Previous C-Section Should Not Attempt Home Births | New Research

Recent research from Amos Grunebaum, MD, and Frank A. Chervenak, MD of the Weill Cornell Medical Center in New York finds that women who have had a prior C-Section and who opted to have a subsequent home birth have a much greater risk of their children having serious complications (including seizures and neurological dysfunction).

Home Births After C-Section Increase Baby’s Risk of Adverse Health Outcomes

A large analysis (comparing 4,544 planned midwife-assisted home births and 2,404,505 hospital births from 2007-2013) of CDC birth certificate data reveals that planned home births after C-Section were associated with a more than ten-fold increase in risk of babies suffering neurological issues such as hypoxic-ischemic encephalopathy (HIE), a brain injury caused by oxygen deprivation. The only available treatment for HIE (hypothermia therapy) must be administered within six hours of birth (the sooner the better) for it to be effective.

The research further found that home births – even those attended by midwives – were linked to a higher rate of infants being born with Apgar scores of 0 for five minutes in comparison to hospital births. This means there is an increased likelihood the baby will be non-responsive, not breathe and have no heartbeat, requiring medical intervention and/or resuscitation.

U.S. Midwives Have Not Established Guidelines Regarding High-Risk Home Birth, Potentially Placing Mothers and Children at Risk

According to an interview with MedPage Today, Dr. Grunebaum states that he had conducted prior research into the recent trend of women choosing to undergo VBACs (vaginal birth after C-section) and presented his work at the 2016 Society for Maternal-Fetal Medicine meeting. He emphasized that OB/GYN guidelines in Europe and Australia stress that midwives should exclude women with a prior C-section history from home birth due to increased safety risk. Unfortunately, no such guidelines exist in the United States. He elaborates:

“”American midwives have refused for many years to establish any guidelines for which women may be at higher risk [for planned home birth] and which are not,” he said. “As a consequence, women with twins, with breach and with prior cesarean section continue to be delivered by midwives in planned home births in the U.S.””

Complications More Common with Midwife-Assisted Home Births than Hospital Births

While the overall incidence of complications was low with midwife-assisted home births, it was still substantially higher than with hospital births:

Complication Incidence in Women Attempting Vaginal Birth After Prior C-Section (in instances per 10,000 live births)
Apgar score of 0 for more than 5 minutes Seizures/neurological dysfunction
Hospital birth 0.93 1.92
Midwife-assisted home birth 6.6 19.8

Although the adverse event incidence is still comparatively low in the study, women who undergo VBACs (especially in the home birth setting) can be at risk for life-threatening complications such as uterine rupture (a condition that can cause massive hemorrhage and potentially expel the baby into the mother’s abdominal cavity). This can threaten the lives of both mother and infant, but hospitals can do an emergency C-Section to prevent adverse effects. Home births don’t have that option.

In regards to the practical implications of this study, Grunebaum stated that he would urge OB/GYNs to discourage mothers who have had a prior C-section from having a home birth. He drew a parallel to the current practice of warning pregnant women against smoking or drinking alcohol during pregnancy, and stressed that issuing a warning against home births after C-Sections would be no different.

Legal Help for VBAC (Vaginal Birth After C-Section) Complications

If you had a vaginal birth after a prior C-Section, and your child has developmental delays or a birth injury from oxygen deprivation, please reach out to us to get a second look at what may have caused your child’s birth injuries. In some cases, birth injuries from oxygen deprivation were preventable. We can review your case to see if you would be able to secure your child’s future. We never charge fees upfront and do not charge anything unless we win. We can be contacted in any one of the following ways:

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