[Birth in Out-of-Hospital Settings--Differences in Maternal and Neonatal Outcome of Women with their Second Child and a Prior Caesarean Section Compared to First Paras].

Background: Vaginal birth after Caesarean (VBAC) in out-of-hospital settings is controversial. With increasing Caesarean rates, more women with a prior Caesarean will decide to give birth in midwife-led birth-centres or at home. Therefore the study explores the question about maternal and neonatal outcomes in German out-of-hospital settings.

Method: A retrospective study of German out-of-hospital data from 2005 to 2011 was undertaken. Included were 66,437 singleton pregnancies in cephalic presentation at term. This study describes the outcome parameters of first paras compared to mothers with their second child who had a prior Caesarean.

Results: The VBAC rate was 77.8%, and the first para vaginal birth rate was 89.8% (p<0.001). The intrapartum transfer rate of women with a prior Caesarean section was significantly more than for the first paras (38.2 vs. 27.2%; p<0.001). A prolonged first stage was the most frequently documented indication for intrapartal transfer in both groups. There were no significant differences in rates of maternal postpartum complications, or in postpartum hospital transfer rates. Also, neither neonatal transfer rates nor Apgar scores were statistically different between the groups.

Discussion: These results are consistent with other studies which reported that an out-of-hospital setting is an alternative to the clinical setting for women with a prior Caesarean. However, the fact that the intrapartum transfer rate of women with a prior Caesarean was almost 40% should be included in antenatal counselling about the place of labour and birth.