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http://www.scribd.com/doc/34065092/Critique-of-a-meta-analysis-by-Wax

Critique of a meta-analysis by Wax and colleagues which has claimed that there is a three-times greater risk of neonatal death among babies without congenital anomalies planned to be born at home

Gill Gyte, Trainer in Research Methodology, NCT; Mary Newburn, Head of Research and Information, NCT; Alison Macfarlane, Professor of Perinatal Health, Department of Midwifery and Child Health, City University London.

SUMMARY - Along with other previous researchers, Wax and colleagues found no difference in the safety of planned home birth and planned hospital birth for women without known risk factors when comparing perinatal mortality rates, the usual measure of safety. They found a two-fold increase risk for all planned home birth babies in what they called neonatal mortality, rising to a three-fold risk for those without congenital anomalies. Is there really evidence that there is a three-times greater risk of neonatal death among ‘non-anomalous’ babies planned to be born at home, based on the Wax et al meta-analysis (2010)? In summary, NCT has found that this study has serious methodological limitations, including …

http://womenshealthnews.wordpress.com/2010/03/14/sunday-news-round-up-nih-vbac-edition/

Summary: First up, some posts on the NIH VBAC Consensus Conference: CNM at Midwife Connection: A Midwife’s Take on the NIH VBAC Consensus Conference. Science & Sensibility: Do women need to know the uterine rupture rate to make informed choices about VBAC? – asking whether the oft-mentioned uterine rupture risk is the main issue. Momotics: a round-up of coverage there and links to coverage by others. The Unnecesarean: NIH VBAC Consensus Development Conference: Gift Horse or Trojan Horse?, By Courtroom Mama on the refusal question. PinkyRN is not sure she wants anything to change: Vbacs, sea glass and peacefullness – “I do not think Vbacs are going to become assessable to women. I don’t agree with it but I understand the mechanisms…Not sure I personally want to go back and take those risks anymore. Not sure I want to worry not only about my patients health but the legal risk and the insurance burden that I will incur.” ...

http://www.amnestyusa.org/dignity/pdf/DeadlyDelivery.pdf

Abstract: The report analyzes the barriers to health care that result in our country's troubling maternal mortality and morbidity statistics. Among other issues, the report examines discrimination; financial, bureaucratic and language barriers to accessing care; information about maternal care options; participation in care decisions; staffing and quality questions; and accountability and oversight. This report is based on research carried out during 2008 and 2009 by Amnesty International USA (AIUSA). Amnesty International conducted over 100 in-depth interviews and 17 focus groups with women, their families, activists, advocates, public health experts, support workers, service providers and health workers in central Wisconsin; Memphis, Tennessee; Boston, Massachusetts; Washington, DC; Baltimore, Maryland; and New York City; as well as people from across the USA involved in maternal health care. The names and other personal details of some of those who spoke to Amnesty International have been withheld in order to respect their requests for privacy.

Read Jennifer Block in Time Magazine about Amnesty's Deadly Delivery report here.

http://www.medscape.com/viewarticle/717992

Abstract: The healthcare reform discussion now includes the problem of increasingly expensive maternity care in the United States, and troubling outcomes for women and newborns. Childbirth and birth-related conditions are the most common reasons for hospital care, accounting for one-fourth of hospital discharges in 2007. In that year, cesarean delivery was the most common operative procedure in the country, comprising 31.8% of births. Meanwhile, the incidence of vaginal birth after cesarean (VBAC) has declined to 9.7% (from 35.3% in 1997).^[1,2] In the past 2 decades, rates of preterm birth have increased to 12.7%, and low birth weight to 8.2%. In 2006, charges for "mother's pregnancy and delivery" and "newborn infants" were $86 billion -- far exceeding charges for any other hospital condition.^{[3,4] ...}

http://www.medscape.com/viewarticle/717516

Saraswathi Vedam, CNM, MSN, SciD(hc); Patricia A. Janssen, RN, BSN, MPH, PhD; Ronnie Lichtman, CNM, PhD - Rates of planned home birth in the United States have remained at less than 1% for several decades, but current public discourse suggests that women are increasingly interested in this option. International investigators have defined "planned home birth" as the care of selected pregnant women by qualified practitioners within a system that provides for hospitalization when necessary. Safety of birth in any setting is of utmost priority and has been the focus of home-birth research and current professional and public debate. Many women and their families are aware that, in national and international settings, home births conducted in environments of multidisciplinary communication and integration of resources are associated with similar perinatal outcomes and fewer obstetric interventions compared with hospital births. ...

http://www.medicalnewstoday.com/articles/178088.php

Abstract: New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology has found that women with three or more prior caesareans who attempt vaginal birth have similar rates of success and risk for maternal morbidity as those with one prior caesarean, and similar overall morbidity (adding vaginal births and emergency caesareans together) as those delivered by elective repeat caesarean. ...

http://www.medicalnewstoday.com/articles/178088.php

American College of Obstetricians and Gynecologists - New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology has found that women with three or more prior caesareans who attempt vaginal birth have similar rates of success and risk for maternal morbidity as those with one prior caesarean, and similar overall morbidity (adding vaginal births and emergency caesareans together) as those delivered by elective repeat caesarean. Planned vaginal birth after caesarean (VBAC) refers to any woman who has experienced a prior caesarean birth who intends to try for a vaginal birth rather than to deliver by elective repeat caesarean. Although relatively low complication rates, including uterine rupture, have been demonstrated among women with two prior low-transverse caesareans who attempt vaginal birth, there are very limited data available on outcomes among women with more than two prior caesareans. Neither the American College of Obstetricians and Gynaecologists (ACOG) nor the Royal College of Obstetricians and Gynaecologists (RCOG) currently recommend planned VBAC attempt in women with three or more prior caesarean deliveries....

http://inscribe.iupress.org/doi/abs/10.2979/FAB.2009.2.1.140?journalCode=fab

Meditations on the rising cesarean rate

ABSTRACT: As the cesarean rate rises in the United States, it is sometimes hailed as a move toward increased safety or increased autonomy. But the industrialization of birth may have consequences which actually decrease women's autonomy and strip choices away.

http://www3.interscience.wiley.com/journal/122323202/abstract
CONCLUSION: This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.

www.socresonline.org.uk/14/1/5.html

CONCLUSION: ... The kind and quality of maternity care available to certain groups of US women (and not others) is influenced by historical developments, the portrayal of childbirth in the mass media, the way in which both the health care system and the accompanying health insurance system is organised, the risk of litigation experienced by obstetricians, and by inter-professional conflict rather than collaboration.

http://www.docguide.com/news/content.nsf/news/852571020057CCF68525754E0079DC2E
Repeat cesarean deliveries are an obvious concern. "There is a growing concern about the increase in cesarean births because there is a body of evidence showing that they are associated with higher rates of maternal and infant complications," said lead author Emmanuel Bujold, MD, Department of Obstetrics & Gynecology, Universite Laval, Laval, Quebec. "There are far fewer complications to the mother and infants as a result of a vaginal birth, so it is important to determine when a patient with a history of prior cesarean section can have a vaginal birth safely."

http://www.ncbi.nlm.nih.gov/pubmed/18978106?dopt=Abstract
CONCLUSION: Labor before the primary cesarean delivery can decrease the risk of uterine rupture in a subsequent trial of labor. A history of primary cesarean delivery preceded by spontaneous labor is favorable for VBAC.