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.
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 they 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. 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.
And this becomes complicated because there is such a wide, wide range of experience and skills present among 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.
Certified nurse midwives (CNMs) have the most formal education and most clinical experience. CNMs are able to legally practice in all 50 states. Some are hospital-based, while others have birth centers and/or attend homebirths. Certified professional midwives (CPMs) have less formal education and clinical experience and the CPM designation is not recognized in all 50 states. As CPMs do not work in hospitals, 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). This gets especially tricky because it can be hard for a pregnant mom, who is not a medical professional or midwife, to properly evaluate a DEM’s knowledge or skills.
There are also OBs who rarely attend births at home. The CDC’s latest report on homebirth 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).
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. And if that hospital-based advanced medical care (i.e., drugs, surgery, etc.) is not reached in time, dire consequences could occur. This is the risk of homebirth.
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)? It’s a numbers game. The more births someone attends, the more complications they will see.
Dr. Bruce Flamm in Birth After Cesarean states,
Fifty years ago about three babies out of one hundred died prior to reaching one month of age. Today, this number has been reduced to about one in one hundred. But to attribute all of this improvement to the elimination of home birth would be ludicrous. Many of the life-saving methods we take for granted today such as antibiotics and blood transfusions didn’t exist fifty years ago. Today, in well-supervised home births, the risk to mother and baby is probably not extremely high.
He also speaks to VBACs in birth centers,
The decision about whether birth centers are suitable places for VBACs comes down to the risk of VBAC compared to the risk of any other labor. It has been shown that the risk of requiring an emergency cesarean section is no greater during a VBAC than during any other labor.
Counter all that with the fact that in the hospital, your wishes, desires, requests, and birth plan are subject to the policies and procedures of the hospital which will almost always prevail. What rules is their rules which were all created and enforced for expediency and convenience, not necessarily your safety.
And this is the compromise for having advanced medical skills and drugs available as well as a surgical suite down the hall. As I said, homebirth is not an easy choice and it’s not perfect.
Birth After Cesarean also 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?”
Please take the time to read. Read Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First
I never thought I would have a homebirth until I was face 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 Homebirth/HBAC (Homebirth After Cesarean)
My road to homebirth was a long one. With my first pregnancy, I contacted a CPM midwife, but wasn’t ready to take the plunge. I hired a hospital-based CNM and that pregnancy ended with a cesarean section for 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 homebirth.
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.
Point by Point Comparison of Homebirth & Hospital Birth
I looked for a home vs hospital VBAC comparison on-line and couldn’t find one that examined each variable individually, so I made one myself based on the common reasons women cite for choosing a homebirth.
The list below assumes that you have interviewed midwives and hired one who has the necessary experience and education to attend your birth including quickly identifying complications and coordinating transfer if necessary.
The list below also ONLY refers to low-risk women.
This list reflects what commonly happens in hospital births. There are exceptions, of course. What I have listed below is not true for all OBs or all hospitals, but I suspect it’s true for most OBs and hospitals.
Once again, this list reflects the common reasons women cite for choosing homebirth.
| Homebirth | Hospital Birth | Benefits of Home | ||
| Your Provider | Midwives specialize in normal, vaginal birth. | Obstetrics is a surgical specialty. | Birth is normal. Avoid unnecessary surgery. | |
| Your Wishes | … are discussed with your midwife beforehand and are honored. | You will likely have to debate and defend your decisions to nurses and doctors. | You will not have to fight during your labor. You have peace. | |
| Birth Plan | Since you have discussed the pros and cons of various interventions with your midwife throughout your pregnancy, and within the midwifery model of care less interventions are typically used, there is no need to create an official birth plan. | You will need to create a birth plan because the L&D nurses don’t know you and don’t know what you want. | You will not have to fight during your labor. You have peace. | |
| Unmedicated Birth | This decision is respected and supported by your midwife. | L&D nurses rarely see unmedicated births. | At home births, unmedicated births are the norm. | |
| Comfort of Home | You are in your surroundings with your favorite food, in the clothes of your choosing, using the restroom with complete privacy, with complete control over who is with you. | You are not permitted to eat or drink, you wear a hospital gown, you have little to no privacy, and you have no control on who enters your room or when. | You are comfortable. You have your privacy. | |
| Continuity of Care | Your midwife provides your prenatal care, which average about 60 minutes per appointment, supports you during your labor, provides your post-partum care, as well as your annual well-woman care. | Typical prenatal appointments are significantly shorter. You are seen by your OB as well as the other OBs in their practice, so you can get to know them in case your OB isn’t on call when you go into labor. During your labor, you are attended by L&D nurses. Your OB shows up for the last few minutes. | You are comfortable. You know your midwife. | |
| Monitoring | One midwife whose eyes, ears, hands, and doppler are focused entirely on you | Multiple nurses who are caring for multiple patients most of whom are monitored via continuous external or internal fetal monitoring. Your nurse changes when the shift changes, typically every 12 hours. | Your midwife’s attention is not divided amongst many patients and she doesn’t leave you because her shift is over. | |
| Safety – Maternal & Infant Mortality | In the Netherlands, 30% of babies are born at home and they have one of the lowest infant and maternal mortality rates. In fact, the countries that use midwives for low-risk pregnancies and OBs for high-risk pregnancies, have the best outcomes. | In the US, 1% of babies are born at home and only 8% of births are attended by midwives. The US has the second highest newborn mortality rate in the developed world. We rank 41st in the world in maternal mortality rates (meaning 40 countries have fewer moms dying) and 29th in infant mortality rates (meaning 28 countries have fewer babies dying.) | It was very surprising to me that somehow our mortality rates are higher than countries that follow the midwifery model of care. (It is important to note that the midwives in the Netherlands are similar to American CNMs.) | |
| Safety – Cesarean Section | If you NEED a cesarean section, you will be taken to the hospital. This is where the skills and experience of your midwife comes into play. | 1 in 3 women in the US have cesarean sections. | Avoid unnecessary surgery. | |
| Safety – Overall Outcomes | “Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.” (Johnson 2005) | “Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.” (Johnson 2005) | The midwifery model of care results in fewer interventions and their associated risks. | |
| Safety – Emergencies | Of 5,418 women in the Johnson 2005 planned homebirth study, 185 (3.4%) women needed urgent transfer to the hospital. Please read more here. | 30 minutes is the guideline, but not requirement, for operating room readiness.¹ Only 17% of emergency cesarean sections occur within 10 minutes of the decision to cut and one third occur after 30 minutes (Bloom 2006). | You are less likely to have unnecessary emergency surgery however, if you do have a complication like a placental abruption or uterine rupture at home, time is of the essence and you could have dire consequences if you do not get surgical intervention within 17 minutes (Leung, 1999). | |
| Complications | “Naturally occurring” unavoidable complications rarely occur such as uterine rupture, placental abruption, umbilical cord prolapse, and placenta previa with hemorrhage. | In addition to “naturally occurring” unavoidable complications you are also at risk for otherwise preventable complications resulting from routine interventions. | Avoid unnecessary interventions and surgery. | |
| Inducing Labor | If your midwife feels that you need to be induced, she will transfer care to an OB. Induced labors in the home are not safe as they have additional risks and require close monitoring. The risks are weighed against the advantages. | 40% of women in the US are induced, most unnecessarily. (“Born in the USA” by Dr. Wagner) | Avoid unnecessary interventions and their risks. You are involved in the decision making process and your decision is respected. | |
| Augmenting Labor | If your labor needs to be augmented, you will transfer to the hospital as augmented labors need to be closely monitored. Will only be performed if medically indicated. The risks are weighed against the advantages. | It is common for labors to be augmented (typically this is done by giving you Pitocin) if it is not progressing “fast enough” as defined by your L&D nurse and/or your OB. | You are able to labor as long as you and the baby are healthy. You are involved in the decision making process and your decision is respected. | |
| Artificial Rupture of Membranes | Your water is broken only if there is a medical indication. The risks are weighed against the advantages. | The bag of waters is commonly broken. Often the risks are not discussed such as cord prolapse, a malpositioned baby, or increased risk of infection. Once your water is broken, you are now “on the clock” meaning that they expect your baby to be born within 12 or 24 hours (differs based on hospital/provider policy.) | Avoid unnecessary interventions and their risks. You are involved in the decision making process and your decision is respected. | |
| Vaginal Exams | Can be declined you if wish. | If you wish to decline, your nurse may or may not be ok with that. | Your wishes are respected. You are involved in the decision making process and your decision is respected. | |
| “Stalled” Labor | Is fine as long as you and baby are ok. This is your body giving you a chance to take a nap and relax. | Will likely be considered abnormal. You will might be pressured to receive drugs to speed up/augment your labor or have a cesarean section. You are “on the clock” especially if your water has already broken. | Your baby will be born when they are ready. | |
| Eating and Drinking | You can eat and drink as you want from your fully stocked pantry and fridge. | It is the standard of care to provide ice chips or nothing by mouth. When you become dehydrated, they give you fluids via your IV. | Eat and drink if you want. | |
| IVs | Very rarely needed. Will only be used if medically indicated. The risks are weighed against the advantages. | Most hospital providers require an IV or heplock during a trial of labor. | Your movement will not be restricted. You will feel like a woman in labor, not a hospital patient. | |
| Episiotomies | Very rarely needed. Will only be performed if medically indicated. | Many OBs still routinely perform episiotomies, especially on first time moms, despite evidence that it does not improve outcomes or shorten second stage (pushing) while increasing the chances of a 3rd or 4th degree tear into the rectum. You are not informed of the risk, so when you tear into your rectum, you think it’s just “one of those things” and you are so thankful that your skilled surgeon is there to sew you up. Meanwhile, you don’t realize that your episiotomy was the reason why you tore so severely. | Avoid unnecessary interventions. You are involved in the decision making process. Easier recovery. | |
| Fetal Monitoring | Periodic monitoring is utilized. Some midwives have underwater dopplers, so they can still monitor the baby’s heartbeat while you are in the water. | Most hospital based providers require continuous internal or external fetal monitoring and/or intrauterine pressure catheters, restricting you to bed and increasing the chance that you will have an unnecessary cesarean section. | Avoid unnecessary interventions and their risks. Your movement is not restricted and your risk of unnecessary cesarean section is lower. | |
| Going “Overdue” | 42 weeks, one day is considered overdue. | Often women are pressured to schedule an induction or cesarean section even before they are 40 weeks. | Your baby will be born when they are ready. | |
| “Big Babies” | Your midwife understands how unreliable ultrasounds are at estimating size. You have the option to deliver on your hands and knees or on the birthing stool which are great positions for birthing big babies. | You will likely be pressured to schedule an induction or cesarean section despite the fact that is contradicts ACOG’s Practice Bulletin No. 22. If you are “allowed” a trail of labor, it’s unlikely you will be given the option to deliver on your hands and knees since this inhibits viewing for the OB/nurses. Most hospitals do not have birthing stools. | Avoid unnecessary surgery. | |
| Weight Gain | Your midwife teaches you about nutrition and you keep a food diary so you can fine tune your eating habits. The focus is on what you eat, not on the weight you gain. | Very little to no nutritional counseling. | Have a healthier pregnancy and thus a healthier baby. | |
| Breech | Is viewed as a variation of normal. Some midwives attend breech births. | Is a quickly disappearing skill set, yet there are rare providers who have the experience. It’s likely you will be scheduled for a cesarean section. | Avoid unnecessary surgery. | |
| Time Limits on Labor | No limits as long as you and your baby are ok. | It’s common to perform a cesarean section 24 hours after your water breaks, if not sooner, regardless if an infection as developed. | Your baby will be born when they are ready. Avoid unnecessary surgery. | |
| Movement | You can move as you like. | Your movement will likely be limited to some extent as most hospitals require you to have continuous external/internal fetal monitoring and/or an intrauterine pressure catheter which can restrict you to bed. In addition, you could have a blood pressure cuff on your arm, a pulse oximeter on your finger, an IV in your arm so they can give you Pitocin, narcotics, sleep aids, antibiotics, blood anticoagulants, and/or acid-reflux drugs and, if you opt for an epidural in your back, you will also have a urethral catheter. | Baby is able to move and turn into the best possible birthing position and labor is able to progress normally with the assistance of gravity. You are in control. You are a healthy, normal laboring woman, not a sick patient. | |
| Noise | If you want it quiet, your midwife and support people will be quiet. If you want to yell and scream, you can. | With multiple labors on your floor, hospitals can be noisy. | You have peace. You are in control. You have privacy. | |
| Private Room | You are in your house. Only people you invite are there. | You might have to share your room with other laboring women, their husbands, their family. | You have privacy. | |
| Being Naked | Not a big deal. You are in your home surrounded by people of your choosing. | People you don’t know walking in and out of your room. | You have privacy. | |
| Clothes | You wear whatever you want. | You wear a hospital gown that opens in the back. | At home, you are yourself. You have control. You have privacy. At the hospital, you are a patient. | |
| Travel | Your midwife comes to you. | You drive to the hospital… either to soon (before contractions are 5 min apart, lasting 60-90 seconds, for an hour) making your hospital stay longer than necessary and opening yourself up to “standard hospital policy/procedures” OR you labor at home “as long as possible” and then endure contractions on the road. | Your labor progresses naturally without the added stress of driving, changing locations, and enduring the hospital’s “standard of care.” | |
| Shower | You can labor in the shower. | It’s likely you won’t have a shower in your room. And you probably couldn’t shower anyways, because they have you hooked up to continuous fetal monitoring or they don’t permit laboring in the shower. | You have options. | |
| Labor in the Water | You can labor in your bathtub, your midwife’s birthing tub, or you can rent one. | Very rarely does a hospital permit labor in the water. Usually only if your membranes are still intact. | You have options. | |
| Water Birth | You can deliver in the water. | It is very rare for a hospital in the US to permit water birth. | You have options. | |
| Pushing | You push with the urge in the quiet of your home surrounded by people you love and who support you. | It’s likely you will push with a crowd of strangers yelling, counting to 10, and telling you to hold your breath. | You have peace. You have control. You follow your instinct. | |
| Delivery | You deliver in the position that feels right to you. | It’s likely you deliver in the position that feels right to the nurses and/or OB. | You have control. You follow your instinct. | |
| Your Baby | Nothing happens without your consent. | A whole new set of policies and procedures are enforced per hospital protocol. | You have control. | |
| Routine testing and medications for your baby | You and your midwife discuss the pros and cons of all procedures beforehand and you make an educated decision. | Possible debate ensues as you decline routine procedures. | You don’t have to fight. You are involved in the decision making process and your decision is respected. | |
| Nursery | There is no nursery. Only your comfy bed. | It is quite common for hospital policy to dictate that baby will be taken to the nursery where routine procedures will be performed. Sometimes women are encouraged to send baby to the nursery so they can get some sleep. | You have control. | |
| Skin to Skin | Once your baby is born, they are immediately put on your chest. | Once your baby is born, they are taken to a warming table, cleaned, suctioned, wrapped up like a burrito and returned to you. | You have control. | |
| Breastfeeding – Getting started | You breastfeed immediately afterbirth and your midwife assists if necessary. | Despite maternal request, babies are often given pacifiers, sugar water, and/or formula while under the care of the nurses. It’s often perceived as not a big deal. | You have control. | |
| Breastfeeding – Scheduling | You breastfeed on demand. Your baby wakes when they are hungry. | Breastfeeding schedules are often used in the hospital, so nurses are likely to wake you and your baby, every two hours, day and night, to nurse. | You follow your instinct. | |
| Baby – Health – Gut Colonization | “Term infants born at home and breastfed exclusively had the highest numbers of bifidobacteria [good bacteria] and the lowest numbers of C. difficile and E. coli [pathogenic/ bad bacteria] compared with any other group of infants.” (Penders 2006) | “Each day of hospitalization after birth was associated with a 13% increase in the rate of colonization with C. difficile.” (Penders 2006) | Your baby is not exposed to high levels of pathogenic bacteria. | |
| After Delivery | You eat your own your food, you sleep in your own bed, and use your own bathroom. | You are in the hospital. | You are in your comfort zone. |
1. “The 30-minute guideline was published in the fifth Edition of Guidelines for Perinatal Care, which was published jointly by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists in 2002″ per Medpage Today. A major medical study looking at 11,000 women defined “Emergency procedures . . . as those performed for umbilical cord prolapse, placental abruption, placenta previa with hemorrhage, non-reassuring fetal heart rate pattern, or uterine rupture. . . Approximately one third of primary cesarean deliveries performed for emergency indications are commenced more than 30 minutes after the decision to operate” with no adverse effects on maternal or infant outcomes. Only 17% of emergency cesarean sections occurred within 10 minutes of decision to cut and 27% within 20 minutes. It’s also interesting to note that of the 994 “emergency” cesarean sections that occurred after 30 minutes, 991 of those were for “non-reassuring fetal heart tones.” Clearly, since it’s taking them more than 30 minutes, the doctors can’t be that concerned, the condition of the baby can’t be that dire, and thus we can’t possibly consider the situation an emergency. This also illustrates the connection between continuous fetal monitoring and the rise of “emergency” cesarean sections. (Bloom 2006)
Please note that I am not a medical professional and this site does not offer medical advice, just information for you to discuss with your healthcare providers.
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
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.
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!
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
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.
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. However, I do believe that they are the rare exception. It is possible to have a good hospital birth, BUT it is harder to achieve, especially if you are seeking a VBAC. Just to take one example from your experience: I wonder how many hospitals, like the ones you went to, have birthing tubs? And of those, how many actually encourage women to use them? And of those, how many encourage VBACing women to use them? I suspect that number to be very low. 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. For me, the one OB who I thought I had a fighting chance to hospital VBAC with had privileges at two hospitals. One “didn’t do VBAC” and the second had a 96% repeat cesarean rate. I didn’t think I stood a chance, so I had a homebirth. I wish you the best Juliana! Jen
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!
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!
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.
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..
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.
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!!!
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 [...]
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!
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?
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.
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.
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.
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.
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
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.
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
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.
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 lost in the process of hospital birth. I’m sure things move more smoothly and it’s more efficient for everyone to be treated the same way, babies to be fed formula and be comforted with pacifiers, but it’s not good care.
Warmly,
Jen
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!
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!
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.
@Rachel – This is a relative new website that has great information and resources about homebirth:
http://bringbirthhome.com/
[...] baby’s cord is long enough this time and that other factors go in my favor for a successful HBAC (homebirth after [...]
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.
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!!!
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!
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 [...]
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!)
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:
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
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.
oh and my twins are estimating close to 9lbs EACH – so yeah. nobody is afraid of big babies here!
Hmm,
That is awesome!
Warmly,
Jen
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
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?
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
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
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
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
Ali,
I am so thrilled for you! Congratulations!
Jen
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!
My pleasure Kristi!
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?
Tammie,
I think this is really a personal decision. Look into the differences of CNMs vs. CPMs, that might help.
Warmly,
Jen
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!!!
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.
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.
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.
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!!
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.