Vaginal Birth After Cesarean Section: Outcomes of Women Receiving Midwifery Care in Ontario

Abstract

Providing care to women with a history of cesarean section is within the scope of practice of Canadian midwives, and midwifery care may be of benefit to women who plan a vaginal birth after cesarean section. This retrospective cohort study describes the birth outcomes of women with a history of cesarean section cared for by a midwife in Ontario between April 1, 2003 and March 31, 2008 (n= 3262). The primary outcome was cesarean section, and the secondary outcome was perinatal mortality. The overall rate of cesarean section in this cohort was 46.1%, but among women who laboured the rate of cesarean section was 28.8%. There was not a statistically significant difference in perinatal mortality (excluding congenital anomalies and stillbirth prior to labour) when women with a history of cesarean section (0.18%) were compared to those without (0.20%), p=0.99. This study demonstrates positive outcomes for both mothers and babies when midwives are primary care providers during the intrapartum period for women with a history of cesarean section. There is a need to explore the factors contributing to the high rate of planned repeat cesarean section in this cohort.