Prior cesarean section--an acceptable risk for vaginal delivery at free-standing midwife-led birth centers? Results of the analysis of vaginal birth after cesarean section (VBAC) in German birth centers.

Objectives: Is out-of-hospital vaginal birth at a birth center safe for women with a previous cesarean section? Do their maternal or neonatal outcomes vary significantly from those of a "non-cesarean" control group?

Study Design: Retrospective evaluation of prospectively collected data on documented singleton births (cephalic presentation, >34/0 weeks of gestation), all of which were second births, occurring between 2000 and 2004 in 1 of 80 German birth centers. Births that occurred in the birth center or when labor had started in the birth center prior to transfer were included for analysis.

Results: Three hundred and sixty four women (5.3%) had a previous cesarean. The control group included 6448 parae II with no previous cesarean. Significant differences (p<0.05) between these two groups included: the transfer rate of mothers from a birth center to a hospital clinic during labor, the number of emergency transfers, the method of delivery (repeat cesarean), and the Apgar score at 5 min
Conclusions: At best, vaginal birth after cesarean (VBAC) is possible at a birth center if good cooperation exists with an emergency birth clinic near the birth center, allowing for a responsible and timely transfer to this hospital. Because serious maternal and neonatal complications are rare, further continuous observational studies with larger sets of data are necessary to determine safety of free-standing birth center care for women having VBAC.