In light of U.S. policymakers' efforts to lower the rapidly increasing primary cesarean delivery rate and recent national guidelines encouraging trial of labor after cesarean, researchers find encouraging outcomes at a Wisconsin Amish birthing center.
Analyzing data on 927 deliveries in this nonhospital setting, the authors found a cesarean rate of 3.8 percent (compared with the cesarean rate of 33 percent in the United States in 2009), a TOLAC rate of 100 percent, and a vaginal birth after cesarean rate of 95 percent (compared with the VBAC rate of 8 percent in the United States in 2006).
There were no cases of uterine rupture or maternal death, and the neonatal mortality rate of 5.4 of 1,000 was comparable to that of Wisconsin (4.6 of 1,000 in 2008) and the United States (4.5 of 1,000).
The authors conclude these findings demonstrate that in the right circumstances and practice environment, cesarean rates can be decreased and VBAC rates increased in a safe and evidence-based manner.
These results, they assert, support a low-tech approach to delivery.