Care in a birthing women with a previous caesarean section is not recommended

Women with a previous caesarean section should not be supported in a birthing center, only managed by midwives, because they pose a risk of complications requiring hospital care, according to a study published in the journal "Obstetrics & Gynecology".
The first birthing accredited in the United States was born in 1975 in New York, welcoming pregnant women not a priori risk of obstetric complications.

Following the recommendations of the American College of Obstetricians and Gynecologists (ACOG), arguing for the attempt vaginal delivery in women with previous caesarean section, the committee of the American Association of Birthing ruled in 1990 in favor of the home in these centers, all patients are in this situation.

He associated this recommendation the following conditions: informed consent of patients, ensuring a close support doctors and partner institutions and to initiate emergency care in less than 30 minutes.

Dr. Ellice Lieberman of Brigham and Women's Hospital in Boston (Massachusetts) and colleagues analyzed data collected prospectively on 1,913 women who intend to attempt a vaginal birth after cesarean section in 41 houses of birth between 1990 and 2000 .

Of these, 1453 were presented to the house of birth in labor. A quarter was transferred to hospital during labor, 87% were able to deliver vaginally.

Recencés were a total of 6 uterine rupture (0.4%), hysterectomy (0.1%), 15 newborns with a 5-minute Apgar score less than 7 (1.0%) and 7 fetal deaths or neonatal (0.5%).

"Despite a high rate of vaginal births and few uterine rupture among women attempting a vaginal birth after cesarean in birth centers, a scarred uterus is associated with an increase in complications requiring hospital care" the authors write.

"Based on these results, we recommend the birthing as well as women previously delivered by cesarean section not to attempt a vaginal delivery in non-hospital settings," and more for women over 42 weeks of pregnancy and suffered more a caesarean section, they write.

"We also encourage more hospitals to offer the vaginal birth after cesarean, so that women who want to avoid another cesarean section can have a safe place to give birth."