Many women wish to have a normal, natural birth after a cesarean section, often in an out-of- hospital setting. Two guidelines are authoritative on these questions:
1. S3 guideline: vaginal birth at term.
2. criteria on births in the home environment
What does the S3 guideline say?
The woman should be informed about the "possibilities of vaginal birth after sectio caesarea [cesarean section], ... and other aspects". (3.2)
These topics, important for parents, are only briefly covered in the guideline, why? Because criteria for out-of-hospital births are considered here as well. That is why we rather refer to the "criteria for births in the home environment" - which also include births in the birth center.
The criteria are binding for the billing of midwives with health insurance companies (as of 2022).
What does the criteria say about births in the home environment, in relation to births after cesarean section?
(Sectio caesarea = 1 x cesarean section - Re-sectio = 2 x cesarean section).
- If the first child was born by cesarean section, birth at home or in a birth center is possible thereafter.
- In case of "status after re-section without subsequent vaginal birth", an out-of-hospital birth is not billable with the health insurance (p.3).
“status after re-section “means that the woman has already had 2 cesarean sections. If the woman subsequently wants to give birth at home, the midwife cannot settle this with the health insurance company.
- Due to her right to self-determination, the woman is "allowed" to strive for a home birth even after two c-sections, but all professional societies position themselves against this because of the increased risk of a uterine rupture.
The midwife may decide with the mother on a case-by-case basis what she can and wants to support (as a self-pay service).