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Why Homebirth?

The dilemma

Many women, especially those seeking VBAC, are between a rock and a hard place. Women are faced with hospital VBAC bans and don’t know what to do. They don’t want a repeat cesarean. Or their local hospital technically allows VBAC, but the requirements in place greatly diminish the likelihood of success. Or an OB will tell them that they “Do VBACs all the time” when the reality is, they don’t. Women simply want to birth normally after a cesarean. They want to labor in an safe environment that recognizes the inherent value of vaginal birth to mom and baby.

The American College of Obstetricians and Gynecologists (ACOG, 2010) says VBAC is a “safe and appropriate choice for most women” with one prior cesarean and for “some women” with two prior cesareans. The National Institutes of Health (2010) says “trial of labor is a reasonable option for many pregnant women with one prior low transverse uterine incision.” There was even a presentation at the 2010 NIH VBAC Conference discussing how there are not enough anesthesiologists in the United States to provide 24/7 coverage of all birthing units nationwide, but that VBAC could be offered safely nonetheless. There are hospitals and hospital-based care providers who actively support VBAC. Yet not all women have access to such facilities and professionals. So increasingly, more women are opting to birth at home because they feel like they have no other choice or due to the many benefits of home birth. As the CDC recently reported, “After a decline from 1990 to 2004, the percentage of U.S. births that occurred at home increased by 29%, from 0.56% of births in 2004 to 0.72% in 2009″ (MacDorman, 2012). Women feel like if they go to the hospital, they will be railroaded into another cesarean because their OB is not really supportive. That is the risk of hospital birth.

Types of care providers

And this becomes complicated because there is such a wide, wide range of experience and skills present among home birth midwives. A lot of women think a midwife is a midwife is a midwife and don’t realize the difference in (in)formal education and clinical skills. As I share in the article, I’m pregnant and want a VBAC, what do I do?:

The most important thing when interviewing midwives is experience. You need to know how many births she has attended and of those, how many was she the primary midwife (the responsible person at the birth as opposed to assisting a senior midwife.) I am a full supporter of non-nurse midwives, but please do your homework. If you have an inexperienced midwife with limited informal or formal education, you are taking on additional risk that is really unnecessary.

Additionally, you want a midwife who has enough experience to know when to go to the hospital as well as the professionalism to interface, and even take crap from, hospital employees. You and your baby’s well being should come well before her possible discomfort. In states where it is illegal for a midwife to attend a OOH (out-of-hospital) VBAC, your midwife is not likely to present herself as your midwife if you transfer and this is understandable.

CNMs are able to legally practice in all 50 states. Some are hospital-based, while others have birth centers and/or attend home births. CPM designation is not recognized in all 50 states and they focus on birth center and/or home births. You can read more about CNMs vs CPMs at Midwife International, this exchange from the Midwifery Today forum, and one CPM’s analysis. There are other midwives who are called direct entry midwifes (DEMs).

There are also OBs who rarely attend births at home. The CDC’s latest report on home birth stated, “Only 5% of home births were attended by physicians, and a previous study suggested that many of these were unplanned home births (possibly involving emergency situations)” (MacDorman, 2012).

The fact is, you can have a great birth in the home and you can have a great birth in the hospital. It really, really, really depends on your care provider. There are excellent CNMs, CPMs, DEMs, and OBs, but that doesn’t mean that all are supportive of VBAC and can safely attend your home birth.

Whoever you hired, there is a great benefit in hiring someone who has attended a lot of births. The more births someone attends, the more complications they will see, the more their skills will be tested. If your care provider hasn’t attended many births, it’s likely s/he hasn’t come across many serious complications. It’s likely his/her skills have never been tested. This can make some moms nervous.

Also be aware that sometimes in an effort to counter how VBAC has been demonized in the conventional wisdom, some care providers sometimes overcompensate by inaccurately minimizing the risk of uterine rupture. The midwife (or OB, but it’s generally a midwife) who gives false information that minimizes the risk of rupture is just as harmful to the VBAC mom. One Florida midwife told her client that since Florida was the “lightning capital” of the country, a VBAC mom was more likely to be struck by lightning that have a uterine rupture. This is false. Other midwives have told their clients that their risk of uterine rupture doesn’t change much due to having a cesarean. This is also false. Still more midwives misinform their clients by telling them that the risk of uterine rupture in a VBAC mom is the same as an induced, unscarred mom. This is also false.

It does not benefit anyone, least of which the mom, to receive inflated lies about the risks of post-cesarean birth options. But it’s horrifying that there are midwives, who attend home VBACs, and are giving their clients such inaccurate information. At the very least, women planning out-of-hospital birth should be given accurate statistics on the risk.

On the other hand, OBs are often vilified (rightfully so) for providing inaccurate information to women in regards to post-cesarean birth options as well as coercing, threatening to “force a cesarean,” or even outright lying. I’ve documented several examples over the years: Another VBAC Consult Misinforms, Scare tactics vs. informed consent, Hospital VBAC turned CS due to constant scare tactics, and A father says, Why invite the risk of VBAC?.

This is why it is very important for you to have a basic understanding of the risks and benefits of VBAC vs. repeat cesarean. How else will you know if your care provider is being straight with you?

For more on hiring a care provider, check out: The Three Types of Care Providers Amongst OBs and Midwives, Questions to Ask a Provider, Scare tactics vs. informed consent aka why I started this website, you can go to Finding a VBAC Supportive OB or Midwife.

First, understand how birth works

There are many benefits of birthing at home and in order to fully appreciate them, you really need to understand how birth works. I highly suggest you read any book by Ina May Gaskin. Sarah Buckley also has an amazing book about pregnancy and delivery. I really enjoyed her detailed discussion on the normal flow of hormones that facilitates birth. I agree with her that these hormones are interrupted in the hospital environment due to the release of adrenaline. It’s likely that this very basic interaction is the cause of (most? some?) of the “failure to progress” diagnoses.  For more on this subject, check out Buckley’s book or read Lowe (2007). (Check out the articles that have cited Lowe for more recent resources.)

The great “what if.”

Most women will be fine giving birth at home, but there will be women who have urgent, time sensitive complications at home that require immediate hospital transfer which is only possible if your care provider identifies the symptoms in a timely manner. And if that hospital-based advanced medical care (i.e., drugs, surgery, blood products, etc.) is not reached in time, dire consequences could occur. This is the risk of home birth.

How a complication plays out depends on many variables: the type and severity of complication, how quickly it is diagnosed (based on the skills and experience of your care provider), if it is something that can be managed at home (based on the skills, experience, and supplies of your care provider), if not, how quickly can you get to the hospital (based on the distance, driving conditions, etc), and how quickly the hospital personnel can respond to your complication. Does your home-based care provider have a good professional relationship with the hospital? Can s/he call ahead, inform them of your transfer, and have them ready the OR (if necessary)?

Uterine rupture and home birth

Some research on infant cord blood gases has suggested that if the baby isn’t delivered (almost always by cesarean) within 16 – 17 minutes of a uterine rupture, there can be serious brain damage or death to baby. This is something to consider especially if you live in a rural area far from a hospital. You can watch a presentation from the 2010 NIH VBAC Conference entitled “The Immediately Available Physician Standard” by Howard Minkoff, M.D. for more information or read his presentation abstract.

The myth of the “unmessed with” birth

Some women believe the very false and dangerous belief that nothing can go wrong in a spontaneous “unmessed with” birth. I’m here to tell you that you can do everything “right” and still have a complication/ bad outcome. While doing everything “right” decreases the risks that various interventions introduce (such as induction, augmentation, laboring in bed, purple pushing, etc), it does not eliminate the “naturally occurring” complications that are sometimes just the luck of the draw. Here is one mom’s story of placental abruption at home. She survived, her baby girl Aquila did not. Her midwife was a CPM who had attended less than 150 births. Her midwife did not recognize the symptoms and they did not get to the hospital in time.

I share Aquila’s story to illustrate how important is it to hire someone who has sufficient clinical knowledge and experience. In my opinion, the number one factor determining the safety and success of your VBAC is your care provider. It’s not enough for them just to be supportive of VBAC, they need to be familiar with the symptoms of uterine rupture and other serious complications so that they may facilitate a rapid hospital transfer.

Because I share Aquila’s story, I’ve been accused of being anti-home birth and even anti-VBAC. That is no more true than I’m anti-hospital birth because of some of the hospital birth stories I have shared. I myself had a wonderful VBAC home birth, but that does erase the fact that there are risks and benefits to home birth and hospital birth. To ignore those is to deny yourself the information you need to give true informed consent and to make an informed decision. Only you can decide which set of risks and benefits you are willing to accept.

The risks of hospital birth

Hospital birth comes with its risks as well and just because your care provider is an OB doesn’t ensure that you will receive accurate information or care that is in line with the latest ACOG VBAC Practice Bulletin. Here’s one doctor who was unaware and shocked to learn that 18 months prior, ACOG released an updated VBAC Practice Bulletin stating that VBA2C was appropriate in “some women.” You can read more poor outcomes from hospital birth here: Home birth vs. hospital birth for the number cruncher.

In the end at the hospital, your wishes, desires, requests, and birth plan are subject to the policies and procedures of the hospital which will almost always prevail unless you have a really wonderful VBAC supportive OB who is able to circumvent unsupportive hospital administrators. Unfortunately most women birthing in the hospital are subject to its rules which were created and enforced for expediency and convenience, not necessarily for their safety. And it’s these policies and procedures that women who choose home birth are looking to avoid. (Read more: OB lists reasons for rising cesarean rate, and Neonatal nurse has a homebirth VBAC.)

Not where, but how

As “Birth After Cesarean” points out:

Natural childbirth also has to do with the way the laboring woman is treated by those around her. Is she perceived as a healthy woman about to have a baby or as a hospitalized patient in need of intensive care?

Further resources

There are are variety of books that offer different perspectives on hospital vs. home birth. Read Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First by Marsden Wagner, MD. He talks a lot about home birth, safety, myths, and other countries where home birth is more of the norm. But note that in those countries, the midwives have training that is comparable to a CNM. Read The Thinking Woman’s Guide to a Better Birth by Henci Goer. She lists the pros and cons for medical interventions and has extensive endnotes. I also really enjoyed Birth by Tina Cassidy.

I never thought I would have a home birth until I was faced with my post-cesarean birth options. I am fortunate in that I had a wonderful birth and a good outcome. You can read my birth story here.

How I Decided to Have a Home Birth/HBAC (Home Birth After Cesarean)

My road to home birth was a long one. With my first pregnancy, I contacted a CPM, but wasn’t ready to take the plunge. I hired a hospital-based CNM and that pregnancy ended with a cesarean section for single footling breech presentation. Within a few months of my daughter’s birth, I started researching VBAC and while trying to conceive our next child, I started to entertain home VBAC (HBAC).

But I quickly reached a point where I was afraid to birth at home and I was afraid to birth in a hospital. I did not feel completely safe in either location. What if something went horribly wrong at home? So, I should be in the hospital. But there, I have no control, no privacy and in the face with hospital protocol, I would likely have to battle my way through my labor. . . and I just didn’t want to fight while in labor. I looked at everything I had to give up, everything I had to compromise, and everything I had to fight for to birth in a hospital . . . just to hedge my bets. And that is the rub. Most women find that compromises must be made in order to deliver in a hospital (assuming that your local hospital allows VBACs and you can find a provider who is actually supportive.)

I emailed around and found a wonderful OB who was truly supportive of VBAC. I interviewed him and he took the time to answer my questions and everything he said made me feel confident that I would VBAC. The stage was set. But I still felt that nagging feeling. The more I thought about it, the more I realized that a supportive OB is only part of the equation.

As much as I really liked this OB, I would still have to deal with the nurses and hospital policy. While I could interview my OB, I couldn’t interview the nurses. And since my OB wouldn’t be there for my entire labor, I could just see myself saying to the nurses, “Well, my OB said that XYZ was OK,” and them telling me “That’s not what we do.” And then being stuck. And then being in the hospital, in labor, and wishing I could go back in time and plan a home birth.

Who knows? Maybe the nurses would have been fantastic… and I have read birth stories where they are, such as this wonderful birth story of a woman who VBACed at a Southern California Kaiser: The Birth Story of James Liam. But knowing what a huge impact nurses can make on your labor, I didn’t want to leave it to chance. Was this the right decision? I don’t know. It was the right decision for me at that time and fortunately, I had a good outcome.

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72 comments to Why Homebirth?

  • Bonnie Hansen

    Thank you for making this list!! It is awesome. I have had 3 hospital births, 1 birthing center birth and 2 homebirths. Everything you have summarized here is exactly what I have experienced. I’ve bookmarked your page and will share it with others who are trying to decide what to do or for those who question my homebirth decision. Homebirth rocks!!!

  • This is a wonderful, easy-to-read compilation of all the points to consider when choosing where to give birth. Bravo!

    Two things I thought of which could be added to your list:

    1) Who is in charge? In the hospital, you have to do as the nurses say because the nurses have to follow what the doctors say. If you want something, you have to get permission. At home, you are Queen for the day. Everyone present is there to serve you. They ask your permission for things.

    2)Changing your mind: If you decided while in labor you’d rather be in the hospital, you can go any time you want! If you’re already in hospital being monitored it’s almost impossible to leave.

    I thought of one more:
    3)Baby can sleep in your bed if you wish and breastfeed at will: more rest for both of you.

    OH, and furthermore:
    4)The baby joins the family at birth, rather than separating you from the family for the birth and hospital stay.
    (I’m on a roll!)
    5)Less disruptive to the family as there are no babysitting arrangements to make for any other children

  • Leticia Martinez

    How far apart was your VBAC to your C section? The reason I am asking is that I have had 4 Home births, 1 emergency c section due to problems with the baby. Baby passed shortly after birth. And I am now pregnant, the due date is just 15 months after my section. I am really wanting another homebirth but I am trying to find more info since it is so close to the section. Thank you for any information.

  • Jennifer

    Hi Leticia! Congratulations on your pregnancy!My HBAC was about 3 1/2 years after my CS. I recommend joining the ICAN email support group as there are many women on their who have VBACed at different intervals. You might also get a definitive answer on if studies exist showing the ‘safest’ interval. You can join by going here: http://health.groups.yahoo.com/group/ICAN-online/
    Best of luck with your pregnancy and VBAC!

  • Hillary

    I think this is a great list, though it is clearly biased. I am also biased towards homebirth, but my husband is NOT. He still thinks that VBAC is much safer in the hospital and is pretty set against HBAC. I probably need a more neutral comparison…but you have definitely provided a lot that I can pull (especially the stats and figures…that will probably go a long way in helping to convince him). THANKS!!!

    Hillary, If you find a neutral comparison of home vs hospital birth, I would love to see it. I don’t know if it exists. Your comment actually prompted me to finish a post I started months ago. Maybe your hubby would read it. I would be interested to know what he thought. Best, Jen

  • Cindy

    How about management of third stage? At home, you have the option of natural delivery of the placenta, cord clamping after it has stopped pulsing, immediate breastfeeding to help clamp down the uterus, etc … instead of managed “care” to include immediate cord clamping, cord traction, fundal massage, etc.

  • Juliana J

    I have been interested in having a homebirth for my 3rd baby. While there are many good points about it and it looks a lot more peaceful and relaxing, I don’t think its fair to give only the cons of having your baby in the hospital. I had my first 2 babies in 2 different hospitals, and while there were things that I was unhappy with, the nurses in both hospitals were courteous, and listened to my wishes, even without a birth plan. I was not put on meds because my labor was taking a long time, and was offered the tub. It wasn’t a nuisance to them. I was not repeatedly offered meds even when I was having very strong contractions.

    This is not a fair comparison.

    Juliana, Thank you for leaving a comment. The descriptions above ring true for some people and not for others. I believe they are accurate descriptions of most hospitals, but I know there are women who have had very respectful and even wonderful hospitals births. It is possible to have a good hospital birth, but it can be harder to achieve, depending on the hospital. So much of a laboring woman’s experience depends on the hospital amenities (birthing tubs, squat bars, showers in rooms, etc), hospital policy (the actual availability of those amenities), OB policy (do they permit you to use them?), L&D nurse attitudes (do they permit/encourage/discourage you use them?), the laboring woman’s expectations (does she want a “standard epidural birth” in which case, she may not care about using the birthing tub, or does she want to go drug free?), and the presence or absence of complications (in which case birth plans, rightfully so, go out the window.) I hope you share your birth experience with your friends, family, and on-line and give out your hospital and OB’s name when requested. I really believe that we need to “reward” OBs and hospitals that support non-interventionist, vaginal birth by going to those hospitals and giving them our money. I wish you the best Juliana! Jen

  • Chandra

    Thank you for this. It’s exactly what I needed right now, while I’m facing the decision of a homebirth or a hospital fight for my upcoming VBA2C. You took the time to write out my own thoughts for me – everything I knew but needed to see side-by-side. This is the very best site I’ve found for making the HBAC choice!

  • lina40

    HI — i just was laughing and nodding at your post because even though this is baby #1 for me, everything you are saying about your research is ringing true for me.. my hubby is NOT for homebirth, but I really think that I will have to print your chart out for him to see. Thanks sooo much for reading my thoughts and putting them here. I appreciate the hospital I am assigned to for my L&D, but I just feel so possessive about releasing my control over the birth when it is recommended to labor at home as long as possible to avoid C- section.. I might as well stay there and have the baby then!

  • Dee

    This is a great resoure. Thanks for starting your site. My first delivery was normal and with midwives in a birthing center; my second ended in c-section because my son would not tuck his chin. I still have regrets over that one even though it would seem I didn’t have much choice. I need to work through that before any other pregnancies. I didn’t realize at the time that this c-section would doom me to hospital births for the rest of my reproductive life. My next and future deliveries will be HBAC because I would be required to labor & deliver in the hospital for any future pregnancies if I go with the Birthing Center I used for my son. The hospital was great by the way, AAMC, I just don’t want to be in a hospital unless I am gravely ill. I’d recommend it to anyone considering hospital birth. The midwifery practice I used uses it when their patients prefer a hospital setting (Special Beginnings Birth Center). But you do not get ANY rest as people are constatnly coming in to check BP and do tests. I was there for 5-long days. For me there is nothing like being at home. So I am trying to prepare mentally for my HBAC. Your site and the recommended reading will do this for me. Thanks for this resource.

    • rluck

      i had a midwife in a hospital for my first birth, which ended in c-section as a result of my son not tucking his chin.. i had never heard of this as being an issue, and haven’t since ( my little guy is 7 months old) until you.. thanks for sharing..i have regrets as well that i am also working through, and also always wonder about the reasoning for the c-section.. like you, i’m definitely desiring a vbac or hbac for future births.. thanks again..

  • Meg

    I had an HBAC in 2007, and it was the best decision I ever made. I sincerely believe that my chances of being able to birth my 10 lb son naturally in a hospital, with the threat of Pitocin and everthing else hanging over me, was about like the proverbial snowball’s.

    There is a reason why, once you HBAC, you never go back.

    Since I live in a state that is fourth worst in the USA for hospital support of VBAC, it turns out that my instinct about homebirth VBAC being the most likely to succeed was right.

    And to my midwife, VBAC is “just another birth” so long as all other things are equal such as a healthy pregnancy, and no inductions or interference with nature taking its course.
    For me, it was not only “just another birth” but it was the first time I had experienced natural labor and birth, and in this I discovered that my hunch was right the first time, when I felt that the unbearable pain of the induction couldn’t possibly be how bad childbirth would be naturally. Just getting to 4 cm with that awful induction ending in section, hurt more than the entire labor and birth at home of a 10 lb baby, unmedicated.
    If more women knew that the hospitalized, induced version of labor makes it 10 times more painful than natural childbirth, they would think twice before allowing it to be done to them, especially for a reason as ridiculous as convenience. There’s nothing convenient about recovering from major surgery while caring for a newborn, and epidurals and inductions are not nearly as “safe” as people are led to believe.

  • Ruth

    You saved me hours of painful and stressful research. Thank you, thank you. I will be going over the list with my husband. Because of our miscarriage, he is doubly concerned and protective, but I think some of the facts will help calm his (and my) concerns.

    It is amazing how many scenarios that you described I saw my sister go through. She was scheduled to deliver with her midwife in the hospital, but her midwife was injured so she was dumped onto OB’s and nurses who didn’t know/care about her. Induced labor, petocin, broke her water, epidural (done wrong) then after her “time was up”, c-section (b/c of mistake w/ epidural, she had to be totally put under and her husband wasn’t able to be with her). We kept saying that everything went wrong except that the baby was so healthy. It was so scary to watch.

    All of that to say, I will be passing along your information. My sister wants to do a VBAC with her next baby, and I’m sure this info will help her as well. Thanks again!!!

  • BELINDA

    I belive that the doctors are wrong about my due date! I’ve had two ultrasounds but I feel I’m further along then what they tell me. My due date is july 19th. From what I remember my LMP was sept 21 but i got it again oct 4th 5th 6th and 7th.???? dec 1st they told me I was 7 weeks. WHAT DO YOU THINK?

  • [...] doesn’t take much. For others, they have to fight tooth and nail or even hire a midwife and HBAC (homebirth after cesarean), which by the way, is not risky contrary to popular American [...]

  • Lauren

    The chart very accurately describes my birth experience #1- it was very traumatic for me. I now understand that the trauma was due hospital policies, and not being allowed to labor naturally. I was certainly treated like the “pain in the butt” patient b/c I wanted to birth naturally. I am now considering a HBAC…it sounds so appealing…husband is skeptical. Thanks for the reading!

  • Rebecca

    Thank you so much for this easy to read and valuable information. I definitely want a HBAC for my next, but how in the world will I be able to do that if all the midwives I’ve called refuse to do VBACs at all? Does anyone know of a Midwife in the LA/Venutra/Santa Barbara area that will do a HBAC?

  • Ali

    Hi, I am expecting #2, 18 mo after my c-section. Colorado has a law that a HBAC must be 18mo post c-sect. Luckily we got pg on our first round. I am now considering HBAC. I am scared but really tempted. My first baby was found to be breech at 41 weeks!! We tried to get her to turn naturally, but no luck. Spontanious labor- Hospital wouldn’t deliver except for c-sect. What I’m looking for is to face the risks of HBAC head on. I want to know all the risks of HBAC- yes- all the negatives- and I feel facing them will help me make a final decision. I want to know the worst of the worst stories & situations and at least have that in my educated mind. I know focusing on the negative is not the best plan , but I think I will feel more empowered if I can say I know this side.

  • Cicely

    Hi,
    I want to thank you very much for your insight and detailed information. I plan to use this site and some others to justify my reasoning for a HBA2C. I’ve always thought it was crazy to attempt a birth at home, but seeing as how CNM’s are truly focused on one patient and have intimate knowledge of the mother, I think this is a logical and reasonable way to birth.
    I have had two CS’s, while my first attempt at a “natural birth” in the hospital was thwarted, and ended in a CS, and many of the things in your article and chart happened, I don’t think that’s always true. I think some of the things you puport in your differences between a home birth and a hospital birth are not exactly as you say. While I hesitate to say my second scheduled CS was a much better experience, it was, in comparison to the first time around. Baby stayed with me the entire night and I even co-slept with him, though nurses informed me the hospital’s policy was against it–they did little to sway me otherwise but state the policy. The other thing that happened was that one of the neo-natal nurses told me the baby would wake to nurse–well baby was too doped up I’m sure and didn’t wake, as a result my breasts engorged and I developed mastitis. At the time, I remember feeling I should wake him to nurse, but didn’t follow my instincts….argggh!!! Anyway, I am engaged in my first 10 weeks of my third pregnancy and want to avoid going under the knife for a third time. Unfortunately, I live in a remote area of Northern California and none of the hospitals offer VBAC let alon VBA2C…from what I’ve read so far it sounds like it would be impossible to VBAC in a hospital anyway. Nor do I believe there are any birthing centers within 45 miles of our house. What a tragedy for all of us who know that women give birth naturally all over the world, each and every day!!!
    Again, thank you for all of your time and dedication to the issues regardin home births and hospital births.

  • Albert Wells

    Exquisite, good post. I just bumbled upon your blog and wanted to say that I have truly enjoyed reading your blog posts. Any way, I will be subscribing to your feed and I hope you post again soon.

  • Valerie

    I wanted to say thanks for your post. It is apparent that you took much energy and work into it. I was wondering if you could point me in the direction to finding a midwife. I would like to try a HBAC when I become pregnant again. I had my first child April 16th, 2009. I had an emergency c-section pushed on me after pushing five hours on my back. My son was coming down my birth canal until the doctors made me go onto my back and he never budged after that. The doctors said the OB (who I never met) would not let me labor on my hands and knees which felt more natural and instictual for me. I was told I had HELLP Syndrome and given general anestisia and cut open. I awoke to the nurses pushing formula down my son’s throat. I had to fight the next four days to keep formula away from my son while recovering from the c-section and mourning my natural birth. I am afraid to have a homebirth but I am aslo afraid to go to the hospital. My doctors told me to wait a minimum of 2 years before I try for another baby because of my dificult labor and delivery. I am also worried about developing HELLP again, which would put me into high risk. My son was born a week late also and he weighed 8lbs 14 oz and was 21 inches long. I am a little worried that the next will be bigger or just as big. Thanks for the information.

    • Jen from vbacfacts.com

      Hi Valerie,

      I’m so sorry about your son’s birth and hope that your next birth is different. I suggest getting a copy of your medical records and surgical report so that you may review it with your next care provider.

      Please read I’m pregnant and want a VBAC, what do I do and Finding a Supportive OB or Midwife.

      Warmly,

      Jen

    • Jenny

      Valerie, Your post made me sad b/c it reminded me of the loss of my first chance at birthing vaginally. I have a similar c/s story. However, I had a VBAC last May and I can’t tell you how wonderful it was. My second son was bigger (9 lbs. 3 ounces & 21 inches) than my first. There was only 16 1/2 months between births. The birth went very, very well! Keep the faith! I’m hoping for an HBAC next time around.

    • Carrie B.

      Hi Valerie,

      I felt compelled to post because my son was born on April 16, 2009 – he was a VBAC born at home, 9 lbs 4 oz. He is only 16 and 1/2 months younger than my daughter (she is a bit over 2 years old). I became pregnant with him when she was just 7 months old (I was still nursing). My VBAC journey began with ICAN and Jen’s awesome website here http://www.vbacfacts.com so you are in the right place. Find a local ICAN chapter meeting and attend. You will find strength among those women. Jen’s VBAC was around the same day as my daughter’s birthday (late Nov 2007) and I remember how inspired I felt when I saw that her VBAC had happened near my daughter’s birth.

      My daughter’s cesarean birth was very traumatic and I’m still healing from it.
      Good birth kharma abounds, and it will come back around to you. I’ve gotten to a place in my healing where I’ve started to see that I was meant to have had that experience (her traumatic unnecessary cesarean birth) so that I could come from my son’s birth wanting to help other women to have a positive birth experience.

      Hugs to you

  • Lauree

    Thank you so much for all this helpful information. This is more helpful than any of the other sites I have been to. I feel compelled to tell my birth story. My son was born via c-section a month early because I developed an very MINOR case of preeclampsia. He was breech so I was immediately told I would have a c-section. They would not even begin to consider a natural breech birth. The moment I was given a spinal block my son’s heartbeat dropped dramatically. I could not see my doctor or anything that was going on because of the drape they put up. Also they strapped my arms to the operating table. After delivery my son was waved in my face for 3 seconds before being whisked away to the nursery where they immediately gave him formula even though I had repeatedly said I wanted to breast feed. This resulted in my son refusing to directly breast feed he would only drink breast milk from a bottle.When they finally brought me my son i noticed the doctor had cut his back with the scalpel during surgery. She had no reason for this. After delivery the nurses were so rude. I was told i needed to get up and walk 4 hours after surgery….it took 10 just for my legs to get feeling again. The nurses repeatedly came in an took my son away while i was sleeping even though I repeatedly asked for them not to. Also they gave him a pacifier every time they took him even though I told them not to. It reached the point that I was throwing all the pacifiers away. They made me keep and IV in for 3 days even though they were not giving me fluids. Also because of the IV they would not let me shower. It was overall a miserable experience(other than having my son of course) and a prime example of how insensitive hospital staff is to your personal feelings and opinions.

    • Jen Kamel

      Lauree,

      Thank you so much for sharing your story. I am so sorry for how you were treated. I think our personhood and the validity of our requests are sometimes lost in the process of hospital birth.

      Warmly,

      Jen

    • Brittany

      LAUREE,
      That sounds similar to my first C/S just 3 months ago. I’m a military wife in Northwestern Florida, and was under military insurance w/ freedom to choose provider when this happened.

      My water broke exactly on the 33 week mark, I’d been planning a home waterbirth, but due to the preterm, had to transfer to the hospital. I was put on the fetal monitor, hooked up to IV for antibiotics (basically strapped to the bed), and unable to get up/move around “in case of cord prolapse” at only 1 cm. I was in the hospital like that for 10 hours, and during that time, my arms and legs went numb, and my husband couldn’t be there till 4-5 hours prior to the section (he was in a different state the week leading up to). I was on my back or sides, neither of which helped my numbness, and it resulted in the baby having a short period of “distress” as the monitor showed it. That happened about an hour prior to my section. It took the nurse turning the bed to the point I was upside down, and actively having contractions on top of heartburn, and staying like that for 5 minutes or more (hard to remember, I was scared from the beginning of something like that happening, and my fears were coming true before my eyes). The Dr my midwife had transferred me to got there, looked at the strip, and suggested that we do a C/S because I was only 1-2 cm; he said if I were closer to say 8 or 9 we could wait, but that obviously wasn’t the case, and from my research before and after, I know why. After they cut me open, they found him face up, and they commented I have a “narrow pelvis”. Well, duh, my pelvis hadn’t been able to open up, it was still pre-birth size!!

      I had told the nurses I wanted to breastfeed, and ended up having to accept that even though I was pumping every 2 hours, (my son was in NICU for 10 days, and didn’t latch on at all till the second day home) they had to give him the 22 cal premie formula with my breastmilk or by itself either b/c there wasn’t enough for the amt they wanted him to take, or b/c I was at home sleeping/recovering and didn’t pump at night. My son breastfed consistently during the day, and took the formula for his 1 or 2 feedings at night until he was 6 weeks old, and refused to latch on anymore (and I restarted menstruation). He’s been on formula ever since =/.

      I just found out my only options for my next pregnancy/birth for the area I live in is either HBAC or repeat C/S (this one being my only option for this area and under complete military medical care now), and believe me, I want my VBAC, more importantly my HBAC next time around!

      On the positive side, my boy is perfectly healthy and acting like any other 3 month old, and I love him to pieces!

    • Linda

      Lauree, your story about the breastfeeding really hits home with me! Same thing happened to my first born. I pumped breast milk for 13 months for him. My second baby was born at home after my similarly miserable hospital, “emergency” c-section experience. It took me a long time to get over that awful experience. Hopefully, by you and I sharing our stories with other women, we can help them avoid these miseries and focus on a healthy, natural, non-interventions birth! Thanks for sharing! I thought I was the only one who had this problem with breastfeeding! BTW, my second baby breastfed beautifully! :)

  • Rachel Loshak

    Jen, thank you so much for your work and writing. I don’t fit totally into your target group, as I had a long, but healthy labor and birth at home with my son, now just over 2, and am pregnant again and planning on a second home birth with the same midwife. I have never been in a hospital, and am happy that I was able to have a home birth once, and am looking forward to doing it again. However, I am currently terribly saddened by the difficulties being faced by home birthing midwives in NYC (I gave birth the first time in Brooklyn) and have been searching the internet to see if there is a website that gives real facts about home birth and birthing with midwives – something the rest of the western world knows is healthy for women and babies – to see if there was a need there. I came across your site, and was very impressed with the thought and detail you go into, and hope that it will help many many women to choose a healthier safer option for themselves and their babies. Good luck to you, and to all the women you have inspired and helped.

  • [...] baby’s cord is long enough this time and that other factors go in my favor for a successful HBAC (homebirth after [...]

  • Loralee

    I just had my HBAC in May and it was so incredibly empowering for our whole family. My husband was amazed at everything. The midwife was so respectful and encouraging. Our 20-month-old was supportive and loved seeing the baby right after she came out.

    As I found out, I’m a private birther. Having people in and out during labor for our first really slowed me down, I figured out in retrospect. And so I ended up with ALL of the interventions, right down to the c/s.

    This time, since it was just the five of us (including the baby), labor was pretty fast. It was NOT pain-free, but man, it was a beautiful process and outcome.

  • denise

    fantastic article – this sums it up really well – bless you for putting so much effort into this. I had two homebirths after an atrocious hospital birth, atrocious prenatal care and decided I’d never be anywhere near that place again! However, here in the UK you hav no choice who attends your birth – homebirth means you get the duty MW and she’s a cow, well, you’re stuck! (Or like me, you can resort to offensive behaviour to get her off your back)…!

    I also think it’s interesting how expensive homebirth stuff is – my birth pool cost £25, but many go for £250 upwards for a couple of weeks rental!!! This makes my blood boil, captive market = massively hiked prices.
    If homebirthing is to become the norm once again – and I sure hope it is – then material costs need to be addressed too.
    The NHS does like to contain it’s hormonal, pregnant, outspoken women a bit, lol, so another aspect of homebirthing is the cost – I’m coming across like a real breadhead – I’m not – but I do think it should be an argument used often – Torquay in devon recognises this and encourages HB, as it’s about a tenth of the cost!
    RE VBACs – there is alot of scaremongering going on – without wishing to downplay the risks, but a lot of women seem to have more than one Csec here in the UK, horribly enough. Grr. Give us back our bodies!!!

  • Megan

    Great post I do agree it’s a touch bias towards homebirth however probably quite true for the majority of cases! I had a great natural birth with #1 who was 9lb 11oz in a maternity home and have decided to HB this time! My partner took a bit of convincing but instead of shoving facts down his throat I asked why he thought it wasn’t a good idea most of his concerns turned out to be things that my midwife can still do at home as 99% of my replies were “Liz can do that here” he is now fully supportive!

  • Stacey B

    Great post! I just had my baby at home and it was the most beautiful thing I have ever done! My labor was incredible and I was comfortable. I agree with what you have written. I don’t think I could have had a more perfect birth for me!

  • [...] article about the process one woman went through before choosing to birth at [...]

  • hmm

    I’m sorry, im all for homebirth, but many of these hospital facts are so far from truth I barely made it to the bottom of the list…. it actually made me a bit angry :(

    i had my daughter at the hospital 9 days past my due date and my ob/gyn never spoke about induction once… only 1 doctor and 1 nurse attended the birth (not the room full of strangers for sure) and the baby was immediately put on my chest (not taken away as you suggest). Also – nobody ever told me when to breastfeed my baby, we always had her in the room and fed her whenever she seemed hungry to us.

    i;m currently pregnant with twins. 40wks to be exact and nobody scheduled a c-section yet, nobody put me in high risk and nobody is talking induction yet. We are all waiting, me, my family and my ob/gyn until these babies are ready to come out (vaginally!)

    • Jen Kamel

      Hmm,

      There are some wonderful hospital-based OBs currently practicing who support VBACs, vaginal twin deliveries, and non-interventive/”normal” birth.

      Right above the comparison chart I clearly state:

      This list reflects the prevailing “standard of care” which is the care that most OBs and hospitals provide. There are exceptions, of course, but, they are very few and far between. What I have listed below is not true for all OBs or all hospitals, but I do believe it is true for most OBs and hospitals.

      And there are women who have satisfactory hospitals in the hospital, such as this wonderful birth story of a woman who VBACed at a Southern California Kaiser: The Birth Story of James Liam. So much depends on your hospital, your OB/midwife, and the nurses on staff during your hospital stay. There are a lot of variables.

      This is my personal perspective and the thoughts that were going through my mind while I was considering my options.

      I am so thrilled that you found one of these supportive OBs! They really can be hard to find and I hope you share his/her name with all your friends!

      Warmly,

      Jen

      • Cynthia Peterson

        I agree. I’ve had three children, three epidurals and a good experience at the hospital for all three. Birthing plans are dumb anyways. Everyone forgets about them when you’re in labor anyways, including the nurses and the mother. Just decide if you want drugs for the pain and know when to head for the hospital and everything else will get all changed around whether you like it or not. One plan I looked at had me decide whether I wanted an episiotomy. How the hell should I know if I need one? I can’t even see down there. Truthfully, the last time I just asked the nurses “So, does it look like there is enough room down there?”.

        Believe it or not, I actually enjoyed being away from my home to have kids. It gave me time to relax. If I was home, I would feel like I had to make dinner and fold laundry.

        I don’t think there is anything wrong with homebirth. It’s a choice, like everything else in life.

  • hmm

    oh and my twins are estimating close to 9lbs EACH – so yeah. nobody is afraid of big babies here!

  • Jenny K

    Dear Jen,

    Thank you for this clear and detailed article – it really means a lot to me. I am not even pregnant with my second yet, but I want to be well educated when and if my husband and I are blessed with a second pregnancy.

    My husband was brought up in a home birth culture, but I wasn’t convinced it was the best route. After my hospital experience, we’ve now switched roles! My OB professed to be very much against intervention, but when I exhibited possible preeclampsia symptoms at 39.5 weeks, she thought it was best to induce me BEFORE I could get sick.

    For me, one intervention snowballed into another – first induction, then popping my water (your list of possible complications above certainly wasn’t discussed with me!), then finally c-section because my daughter was facing up and couldn’t progress down the birth canal. Having never been a hospital patient before, I had no idea how cold and sterile the environment really is, even if you have kind and attentive nurses like I did.

    I had a happy, healthy baby that breastfed like crazy! So moms out there, I hope that helps. Even with the c-section, I still remember and cherish my baby’s first cry and I still got to be the natural-style parent that I wanted to be.

    God willing, I’ll get to repeat those positive experiences and a whole lot more at home!

    Much love,

    Jenny K

  • Kim

    Your article was very well thought out, and gave me some confidence back. I had a c-section 2 years ago because my fourth baby was breech. I was convinced, by my doctor at that time, that trying to turn him could be dangerous, and put my baby and I at risk for the dreaded uterine rupture!!! I was scared to death, so I had the c-section. I also had my tubes tied to ensure this was the last time I would feel this scared. I did not want a c-section, it was my first ever surgery, I was convinced that I was going to die. Somewhere toward the end of the surgery I actually started having pain, and at that moment I knew it was over. When they knocked me out I thought I was dead for sure. When I woke up I was happy to have lived, and that having had a tubal, there would be no more surgeries for me!

    Now I sit here writing this 35 weeks pregnant. I don’t know why the tubal didn’t work, but I am joyful at the thought of welcoming my fifth baby in to the world. However, the fear that comes with this baby is overwhelming. The fist thing I thought when I found out that I was expecting was, “No way am I going to have another c-section,” now I am convinced that no matter how I give birth the outcome will be awful. C-sections carry risks to her and I, but mainly to me. Home birth carries risks mainly to her. A hospital VBAC will most likely be a c-section (just going by our areas c-section rates).

    I have seen a midwife throughout my pregnancy. I have planned an HBAC. Everyday I wonder if something will go wrong. Is it something that will make me regret having her at home? Will I chicken out and schedule a c-section and then regret that? Will she die, or will I? I was not afraid in the beginning, but as the due date approaches my fear is taking over.

    You article does not have information that is new to me, as I have been researching obssesively. However, this article puts all of the information in one place. Maybe I can become more confident, maybe not. I do not know how to have this baby, but I do know that I do not want to be cut open unless there is no other option.

    No one should tell a woman how she should birth her baby, but the fact is everyone thinks they have the right to do just that. No woman enters into these decisions lightly. Why does it have to be so hard?

    • Jen Kamel

      Kim,

      I hear you. I had those same fears. No matter what choice you make, there is a risk that something could go terribly wrong and that’s a really awful feeling.

      For what it’s worth, the fact that you have had three vaginal births increases your chances at a successful VBAC.

      I recently wrote this article in response to another comment: Nervous About Planning a VBAC which you may or may not find it helpful.

      Warmly,

      Jen

  • Tami

    Thanks for this- its very helpful and interesting. I’m not a proper VBCA/HBAC candidate but am being treated as such due to some surgery I had 5 years back to remove fibroids. There is no data relating to natural birth after a myomectomy so I’m relying on VBAC/HBAC stats to inform my decision.
    I’m in Canada where I have a fabulous midwife. We had a midwife hospital birth with our son 3 years ago which was fabulous. There were none of the L&D/OB/hopsital policy issues that you mentioned impacting on our choices and birth plan. In fact I did not ever see the OB on duty or any L&D nurses!
    This time round (we’re due in April) I would like a homebirth. My midwife is on board but my husband is concerned about its safety. What I’m looking for is exact data on birth risks during VBAC (ie chances of uterine rupture and any other risks assoc with VABCs). Also what the exact dangers are should any of these dangers occur, eg what is the best and worst case scenario with uterine rupture. I’m finding it hard to find any such data and wondered if you had come across any links I could use, during your own research.
    Thanks again and all the best,
    Tami

    • Jen Kamel

      Tami,

      Much of the research that you are looking for can be found here. There you will find specific statistics as well as links to a variety of supplemental materials. A comprehensive list of the published medical research I reference can be viewed in the bibliography.

      Warmly,

      Jen

  • Ali

    Hi … I posted ages ago wondering if I should consider HBAC– I am a very skeptical person and very pessimistic.
    After a lot of consideration… I had a WONDERFUL HBAC … 28 hours of labor… but we were successful and what a BEAUTIFUL experience!! I prayed Phil. 4:13 during my contractions and said the word “DOWN” a hundred times in various tones… lol.
    We did it.
    We loved it.
    I am a believer!!!!!!!!!!!!!!!
    Go for HBAC!!
    Ali

  • melanie

    Hopefully, it will be usefull in convincing my husband to consider a HBA2C! The last place I want to be the delivery is the HOSPITAL (especially after two probably unnecisary C/S)!!!

    I am due shortly and very nervious about things… But I think that is part of the teritory with a VBAC especially when the OB’s tell you the risks of VBAC and act like a RCS is “safer”, which if you do any research at all you will quickly learn is NOT the reality…

    I would like a HBA2C, Possibly a WBA2C!!!

    If there is a REAL need we will transfer to hospital, but i am confident that a midwife(even under the table as I would get someone out of area) can handle most medical emergancies that may arise…

    Now I need my husband to agree…

  • I just posted your chart and some links off this site on my blog: http://lifeforamiller.blogspot.com. What an incredible resource. Thank you for sharing!

  • Tammie

    I’m planning on having a HBAC for my second child. My first pregnacy resulted in a csect for breach birth. My midwife came to the hospital and offered to still deliver the baby if I would leave. I feel comfortable with my midwife but everyone at the hospital looked at me like I was crazy because I had no prenatal records. I was not followed by a MD, and she does not work under a MD. I’m trying to convince my husband that everything will be ok with trying the HBAC, but do you think I need a CNMW or do you think a midwife that isn’t a nurse is ok?

  • ou saved me hours of painful and stressful research. Thank you, thank you. I will be going over the list with my husband. Because of our miscarriage, he is doubly concerned and protective, but I think some of the facts will help calm his (and my) concerns.

    It is amazing how many scenarios that you described I saw my sister go through. She was scheduled to deliver with her midwife in the hospital, but her midwife was injured so she was dumped onto OB’s and nurses who didn’t know/care about her. Induced labor, petocin, broke her water, epidural (done wrong) then after her “time was up”, c-section (b/c of mistake w/ epidural, she had to be totally put under and her husband wasn’t able to be with her). We kept saying that everything went wrong except that the baby was so healthy. It was so scary to watch.

    All of that to say, I will be passing along your information. My sister wants to do a VBAC with her next baby, and I’m sure this info will help her as well. Thanks again!!!

  • Sylvia

    I have seen over thousand births in my function as a pediatrician/neonatology attending. I am a breastfeeding advocate, a certified lactation consultant. Some of my best friends are midwives. I am not a mainstream physician. My belief is that birth is a natural process when there are no complications, but in all these years I have been called numerous times for acute life threatening emergencies. When you choose a homebirth, you have to be aware of the fact that there is no immediate help for you or your baby available. The comfort of a homebirth is undisputable, but by choosing to forego immediately available rescue, you risk death for yourself and/or your baby. Like the one mother in the second post above described. Her baby died after a home birth. In my over 15 years of experience I have seen babies with severe brain damage after uterine ruptures at home. If you had a previous C-section please do not choose a home birth, especially not if you are carrying twins. I have cared for severely ill infants after they were born under water at home. Infants make gasping breathing movements during birth and can aspirate a water/feces mix that leads to severe life threatening pneumonia. Infants who are born after their due date do not tolerate labor so well and are at higher risk for meconium aspiration. I have taken care of infants with meconium aspiration who died despite maximal therapy including ECMO. Please ask yourself if your birth experience or the health of you and your baby should be considered first priority. If a complication like death or permanent brain damage occurs in your baby, you will regret your decision for a home birth for the rest of your life. Please choose a homebirth only if your pregnancy is considered a low risk pregnancy and even then keep in mind that there will be no immediate rescue if something goes very wrong unexpectedly. Instead you can look for a baby-friendly hospital near you where midwives, OBs and OB nurses are considerate about your wishes and neonatologists support natural infant care after birth and are breastfeeding advocates. Please talk to people like me who have worked with mothers and babies for many many years.

    • Sylvia, I was just researching HBAC because I really, really hate the hospital, but I think you’ve won that battle in my mind. Ultimately, my comfort means very little compared to the life of my baby! I’m pretty sure that I’d be one of the lucky ones if I tried a home birth, since my last birth was a vbac, and he came out pretty easily. But what if it wasn’t? If something goes wrong, I want to be next door to OR, not 30 minutes away.

  • Judy

    I am a physician and have had 2 hospital births; one in the seventies and one in the eighties. The above table totally misrepresents actual experience. Obviously the quality of the hospital you chose will have an impact on one’s experience. I had natural childbirth in a birthing room and natural setting in a hospital – I know birthing centers have since flourished. Also nursing support was wonderful and totally attentive. I am afraid too much skewed propaganda is out there concerning home birthing, especially downplaying the risks of VBAC at home.

    • Karen

      I just have to laugh. You must live near one of those unicorn hospitals. Even the best hospital for natural birth and VBACs here is much more like the chart than your “normal” experience. I labored in a hospital with a CNM in a major metro area for my first birth and the experience was almost 100% awful.

  • jessica mcguire

    I just found this page and am SO happy I did. I had a hospital birth 20 months ago. It was a disaster. My OB said that she was on my side until i was 38 weeks then she was trying every scare tactic in the book. It worked because I ended up having a c-section after 5 days of laboring in and out of the hospital. I went home once because I didn’t want to stay there. I am just now at the point that I want to have a 2nd baby but not for a few years. I went through bradley classes and did so much research. I now have an amazing OB but I do wonder about just having our next baby at home.

    Your article above is spot on. It made me think about so many things that I really didn’t like about being in the hospital. I’m going to be doing lots more research between now and when we do get pregnant again.

    THANK YOU!!

  • Kristin

    This is very well written! I too had to make that mental leap from c-section to Homebirth, and look forward to experiencing my first homebirth any day now! I used to think women who chose homebirth were CRAZY! But after educating myself on the risks of repeat c-sections vs. VBACs from sources like the Mayo Clinic, I realized it would be crazy not to attempt a VBAC given my pregnancy continued to be low-risk. After more research, I realized my chances of successful VBAC were very low considering the 3 closest hospitals to me had c-section rates of 30% and 40%.

    I agree with everything you listed; they were the primary reasons for my decision, too. I don’t think I could do a HBAC without proper support from an experienced midwife. Although she is not a nurse midwife, she is licensed and has 40 years experience! She also has provided more home VBACs than the certified nurse midwife’s in this area. Trusting her judgment and seeing the results of her previous outcomes was a big factor in my comfort level choosing a homebirth.

  • Question… in the case of an emergency such as cord prolapse at a HBAC, what happens? does baby end up with cerebral paulsy? And what if your uterus ruptures?
    Clearly I’m worried… could you help me see what happens in these cases? Those are the things I worry most about since my last baby had a cord prolapse and I had a c-section. I understand all of the things that you said above are true and I feel confident that I could have had my baby at home if I had choosen to go that route with her, but since I didn’t and ended up with a c-section I wonder about the safety at home due to those risks. I DONT want to deliver by c-section at a hospital if I don’t have to, and I know just being in a hospital brings those chances up significantly.

    • Jen Kamel

      Hi Samantha,

      Great question! I am not a medical professional, so I posted your question to my Facebook page to get more feedback.

      Come join our conversation!

      Best,

      Jen

  • Izzy

    My friend attempted an HBAC back in november. She was considered low risk. There was a complication during labor, the baby was taken to the nearest hospital then transferred to another hospital. Too much time had gone by without oxygen to the babys brain and so she was declared braindead upon arrival to the acute care center. The parents placed the baby on comfort care a few days later and took her home. She died on new years day a month later peacefully in her mothers arms. In this particular situation I believe a hospital and a cesarian would have had a different outcome but that is my personal opinion. I know the chances based on the data are slim but is it worth it? You have to ask yourself that I guess.

    • Jen Kamel

      Izzy,

      How completely horrible for your friend. I can’t imagine how one copes with losing a child. It is every parent’s worst fear.

      Neither VBAC or repeat cesarean are inherently risky or safe, but each offer their own set of risk and benefits. Fortunately, the risk of dire complications is low, but they do happen as with your friend. And it doesn’t matter one bit how rarely something happens when it happens to you or someone you love.

      And this is why I talk about homebirth the way I do. There are risks to birth. And the skill set of midwives vary greatly. And there are many variables that go into how quickly a laboring mom can be transferred to the hospital. Sometimes there is just not time. And sometimes, the same outcome would have happen in a hospital because there are situations where babies die there as well due to oxygen deprivation.

      I’m so sorry for your friend’s loss. Has she had a chance to connect with other moms? Here is a list of resources she might find helpful.

      I am so very sorry.

      Warmly,

      Jen

  • Caroline

    I lost my little boy during a home water birth (HVBAC) attempt attended by an experienced CNM. I considered many of the things you listed above in the table and concluded that a home birth with a conservative midwife would be a great option for us. I never imagined we would be the 0.5% of VBACs that result in the death of an infant. In short, I never REALLY considered what I was risking (my baby’s life and my own). My uterus ruptured, my placenta abrupted and our boy was gone within minutes. I will always wonder if he would be here in my arms right now if I had been monitored in a hospital. One day, I’ll have to explain to his big sister why she doesn’t have the little brother she used to feel kick her hands. I supprt choice, I support VBACs, but if you’re considering the home VBAC option please seriously consider the fact that 0.5% still could be your baby.

    • Jen Kamel

      Caroline,

      I am so very sorry about your sweet baby boy. How devastating.

      Statistics represent real women and babies. I am so sorry that you were that statistic.

      This is the risk of homebirth.

      I suspect that if VBAC bans were lifted, and women had more access to VBAC supportive providers and hospitals, fewer women would feel forced into a homebirth. For many women, it is their only real option if they want a VBAC and with that real option comes real risks.

      I am so sorry,

      Jen

  • Jasey

    I think home births are a wonderful thing but this is not a completely true view of all hospital births and some of the listings under hospital birth are skewed, it truly depends on the hospital and you will find with baby friendly hospitals they very much support a more patient focused experienced. I’m not saying hospital births are better or worse, I am saying that either home or hospital can be a wonderful experience if you find a good, supportive place to birth.

  • Jasey

    I also agree with Jen that VBAC bans should be lifted and hospitals should become more accommodating because it limits choices and every woman should be able to choose where she brings her child into this world.

  • Amandela

    Hello – I love the article. Its very helpful. I am 25, healthy and active. I have a 5 year old daughter who was born from an emergency c-section after the cord was wrapped around her in the womb. I was 6 cm dilated at that point and could have possibly had a normal vaginal birth had the doctors been able to turn her. Maybe not, I’m not sure. But since then, I’ve had an ectopic pregnancy about 3 years ago, and one of my tubes has been removed due to that. My question is, how high risk do you think I am? My husband and I are trying for a child and we are 100% sure we’d like to have a home birth with a midwife, but we both have questions and concerns about how risky it is for me. My c-section scar was minimal, and healed very fast and normal, I’ve had no complications from that pregnancy whatsoever. Would you consider my situation ‘high risk’?

  • Well written article on the difficult decision of where to birth! Thank you for this excellent website and for the great information you provide to mothers and providers here.

  • Yolande Maritz

    Hi! I am a midwife from South Africa doing HBAC’s…. In South Africa just the idea of a homebirth is still fairly new…not even to mention a VBAC at home. I have guided, attended and done several VBAC’s at home. One mom had 2 previous C/Sections due to breech presentations and baby no 3 turned Vertex on 35 weeks. She believed this is a sign and she decided on a HBA2C. She did it and was overwhelmed for weeks. It is important for midwives to stick to the rules of safety during VBAC’s in order to be successful in the trial of labour. One OB contacted me and asked me if I would come and show her what I do, because more and more patients are demanding VBAC’s and she admitted that the OB’s are not trained to handle a VBAC. This is exactly where everything boils down to. Lack of knowledge and experience leads to fear.

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