Surprise!
Attempted vaginal birth after Cesarean (VBAC) at home has a horrific mortality rate.
That’s what Melissa Cheyney, CPM and promoter of home VBAC was forced to acknowledge in a new paper in the Lamaze “journal” Birth: Issues in Perinatal Care. The paper is Planned Home VBAC in the United States, 2004–2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making.
Cheyney and colleagues analyzed the MANA Statistics, a self-reported survey of homebirth midwives in which only 25% of eligible midwives participated.
[pullquote align=”right” color=”#BD014D”]The perinatal mortality rate is more than 300% higher than hospital VBAC.[/pullquote]
Cheyney reports two confirmed cases of uterine rupture and 2 additional cases of suspected uterine rupture for a uterine rupture rate of 3.8/1000.
Cheyney acknowledges:
Given the high proportion of women in our study with a prior vaginal birth and/or a prior VBAC, we expected the rate of uterine rupture to be low. The recent Agency for Healthcare Research and Quality VBAC systematic review described pooled relative risks of uterine rupture of 0.26–0.62 for women with prior vaginal delivery and 0.52 for women with a prior VBAC.
So the rupture rate at home was 630% (7.3X) higher than in the hospital.
Of those 4 ruptures, 50% of the babies died.
Overall, the attempted VBAC group had a perinatal mortality mortality rate of 4.74/1000 compared to a mortality rate of 1.24/1000 in women who had not had a previous C-section (and compared to a perinatal mortality rate of 0.4/1000 at low risk hospital birth).
Cheyney notes:
Compared with the overall rate of combined intrapartum stillbirth at term and neonatal death (1.1/1,000) in Landon et al multicenter study of women who attempted an in-hospital TOLAC, there is some evidence that TOLAC in out-of-hospital settings demonstrates increased fetal/neonatal risk.
Indeed, the death rate at home VBAC was 330% higher than for hospital VBAC.
Why did these babies die?
This is expected in a setting where decision-to-cesarean delivery time in the event of a uterine rupture is presumably greater than the 18- to 30-minute interval at which evidence suggests neonatal risk increases.
In other words, they died because their mothers chose to give birth at home, far from lifesaving medical technology and personnel.
Who could have seen that coming?
Certainly not homebirth midwives and homebirth advocates who have promoted home VBAC (HBAC) as an ideal way to avoid a repeat C-section in the hospital. They rail against obstetricians who “play the dead baby card” and routinely discount the increased risk of perinatal mortality.
For example, Jen Kamel of VBACFacts participated in an Interested Parties Meeting held by the Medical Board of California that discussed, among other things, whether CPMs should attend VBACs to support her contention that home VBACs are safe.
Kamel insists that only 6% of uterine ruptures are catastrophic and quotes a perinatal death rate of 1.3/1000 at hospital VBAC.
According to Kamel:
What determines if a baby dies or has brain damage? Some research on infant cord blood gases has suggested that if the baby isn’t delivered (almost always by CS) within 16 – 17 minutes of a uterine rupture, there can be serious brain damage or death to baby…
Kamel, like most homebirth advocates, likes to take hospital safety statistics and pretend that they apply at home. As Cheyney’s data (which almost certainly undercounts the real risk of home VBAC) demonstrates, hospital statistics don’t apply at home for a very simple reason. The lifesaving technology and personnel that MUST be available to achieve those statistics are not available at home.
The bottom line is that home VBAC is dangerous.
The rate of uterine rupture is more than 600% higher than hospital VBAC.
The rate of catastrophic outcome is 8X higher than hospital VBAC.
The perinatal mortality rate is more than 300% higher than hospital VBAC.
When will we see homebirth advocates acknowledge these figures? When will MANA (Midwives Alliance of North America) begin counseling women about the dramatically increased risk of home VBAC? When will Jen Kamel and others like her change her woefully erroneous statistics?
I’m not holding my breath.
Home VBAC is dangerous, but I predict that the industry that profits from home VBAC won’t reveal that information to American women any time soon.
