Betty-Anne Daviss, RM, CPM, MA, The Midwifery Collective of Ottawa, 36 Glen Ave, Ottawa, ON K1S 2Z7, Canada, 613 730 0282, midwife@istar.ca and Kenneth C. Johnson, PhD, Epidemiologic Consultant, 36 Glen Ave, Ottawa, ON K1S 2Z7, Canada.

In the past two years two studies have emerged in the literature that have been used politically by medical authorities to deny a woman's right to have a vaginal birth after cesarean (VBAC) to mothers seeking this option. Three meta-analyses published in the 1990s, providing a wealth of evidence in support of VBAC, are increasingly being ignored. After reviewing the evidence and conclusions of the meta-analysis, we will report on the published concerns about the two recent studies. We will then present further data about the frequency with which rupture occurs, the perinatal morbidity and mortality among VBACs, and the outcomes of low intervention birth, by drawing on data of Certified Professional Midwives (CPMs). CPMs offer choice to women and avoid medically-imposed limits on birth including choice of birth place and time limits in labour. Sucess rates for VBAC at home (80-90%) are contrasted with those in hospital (60-70%) and medical intervention rates are compared. We are curently attempting to create a collaborative effort with other investigators of prospective databases to examine care and outcomes in larger prospective samples of VBACs at home and will report on out sucesses and findings.

Learning Objectives:

• To better understand the importance of meta- analysis in evidence-based maternity care.
• To better understand the shortcomings of recently published VBAC studies that have impacted on maternity practice.
• To become knowledgable about the risks and benefits of VBAC at intend homebirths with midwives.

Keywords: Infant Health, Birth Outcomes

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.