Birth
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In the United States, the number of planned home vaginal births after cesarean (VBACs) has increased. This study describes the maternal and neonatal outcomes for women who planned a VBAC at home with midwives who were contributing data to the Midwives Alliance of North America Statistics Project 2.0 cohort during the years 2004-2009. ⋯ Although there is a high likelihood of a vaginal birth at home, women planning a home VBAC should be counseled regarding maternal transfer rates and potential for increased risk to the newborn, particularly if uterine rupture occurs in the home setting.
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Recent data indicate that more than half of high-income industrialized countries have a cesarean delivery rate of > 25 percent, which is higher than the appropriate level considered by most health professionals worldwide. ⋯ A higher cesarean delivery rate is associated with higher infant mortality rate among these high-income industrialized countries. One of the mechanisms by which cesarean delivery affects infant mortality is through iatrogenic prematurity.
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To offer vaginal birth after cesarean (VBAC) in a hospital setting is recommended in international guidelines, but offering VBAC in out-of-hospital settings is considered controversial. This study describes neonatal and maternal outcomes in mothers who started labor in German out-of-hospital settings. ⋯ There was a high rate of successful VBAC in this study. The high nonemergency transfer rate for women with VBAC might mean that midwives are more cautious when attending women with a prior cesarean in out-of-hospital settings. Further studies are necessary to evaluate which women are suitable for VBAC in out-of-hospital settings.
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Meta Analysis Comparative Study
Nonpharmacologic approaches for pain management during labor compared with usual care: a meta-analysis.
To assess the effects of nonpharmacologic approaches to pain relief during labor, according to their endogenous mechanism of action, on obstetric interventions, maternal, and neonatal outcomes. ⋯ Nonpharmacologic approaches to relieve pain during labor, when used as a part of hospital pain relief strategies, provide significant benefits to women and their infants without causing additional harm.
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High rates of primary cesarean internationally continue to create decision dilemmas for women and practitioners about birth in subsequent pregnancies. This article explores values and expectations that guide women during decision making about the next birth after cesarean and identifies factors that influence consistency between women's choices and actual birth experiences. ⋯ Strategies are needed to support practitioners to expand discussions beyond clinical algorithms about physical risks and benefits of birth options and to actively integrate women's values and preferences into decisions about birth.