Home VBAC - advice and thoughts?

[emsies]

I had an emcs with my first, after having planned a homebirth I went over 2 weeks overdue, induction, waters broke with meconium, failure to progress, then about to c section and realised I'd magically "progressed", then only allowed to push for 30minutes, then attempted forcepts then emcs....!! I was terrified most of the way through (what didn't help was my waters gushed at 5am and I was left on my own with contractions and midwives attending to a birth on the antenatal ward so I'd already worked myself up into a state at the beginning!

Anyway - I told my midwife I wanted a homebirth and she is cautiously supportive. I have no other risk factors and I'm sure birth 1 wouldn't have been a c section if I'd been in a supportive environment. We're not far from the hospital (10mins by normal car) so I could get there in case of difficulty and I'm happy to be monitored regularly.

The big fear is a scar rupture but I've read its only 1% and that includes those induced (which if I managed to stay home I wouldn't be) and also includes all those that are gradual rather than serious.

I realise IMs do them all the time but we are really not in that price bracket. We have got a trainee doula for support. She has only done a couple of births but as my husband works away I thought it would mean I'd definitely have support whether at home or in hospital and I'd be less likely to get into a state.

I have to see a consultant in 2 weeks who I know will try and talk me out of it, but that's because they only see abnormal births... I don't want to do anything risky at all but it does seem that there is so much more chance of things going "wrong" in hospital in my case than at home.

Any thoughts or advice? Any other VBACers out there? How did you deal with the consultants etc? My midwife has said I'd have to talk to the supervisor of midwives and sign away something about my risks...

[MrsHoolie]

Hi.I tried for a Vbac a year ago.For my 1st I also tried for a homebirth and ended up with a section for FTP.
I didn't consider a HB for my vbac as I was pretty sure i'd need pain relief but obviously that's a personal thing.
The uterine rupture risk is very small but it does happen. Personally I would rather be in hospital as as a vbac there are risks however small. Not just for that risk but many other things.

[Tangle]

I can't give you any direct advice on home VBAC, but I can sympathise - we opted for a HB for DD1 (DC1) knowing that she was breech. Going against the NHS recommendations wasn't easy and didn't make things as relaxed as they could be, but after doing a LOT of reading and thinking we felt that this was the best thing for us and so we did it.

A few suggestions though:

• have you had a dig around the //www.homebirth.org.uk site? They have a section related to VBAC (go through "Can I hae a homebirth if...?)
  

• you might want to join the homebirthUK mailgroup and ask on there - I know there are a lot of members who have had HBAC, both on the NHS and with IMs, along with some very experienced MWs, and as a group they have a huge experience of managing situations to achieve a well supported HB.
  

• These phrases by Mary Cronk are great for helping you to remember that it is YOUR decision what happens - and also for politely reminding the consultant of that fact should he seem to have forgotten it
  

• AIMS can offer support and advice.
  

• whereabouts are you and have you talked to any IMs? We wound up with IMs for DD1 but didn't book till 36 weeks - by then we felt like no-one in the NHS was prepared to discuss things with us as intelligent adults and we'd had enough. The price tag may seem high, but many/most will do payment plans or will barter (I think one of ours got some electrical work done, had her freezer stocked and was desperately hoping for a decorator to offer an exchange of services). It may not pan out, but if you don't ask you'll never know. If nothing else all the IMs I've talked to have been very happy to offer as much advice and support as they can without having access to your medical history - they may well have worked with the consultants at your hospital and be able to advise which are more likely to be sympathetic to your cause.
  

Good luck - and I hope you can organise a birth where you feel supported and can remain relaxed and calm :)

[charlottery]

I'm struggling with this at the moment (now 33 weeks so need to decide soon). The thing I can't get my head around is that having read the vbac handbook, it seems your chances of achieving a vbac are higher if you stay at home as long as possible, whereas the hospital would want continuous monitoring. So, if I stay at home for a long time for a planned hospital birth, I would have no monitoring at all in that time, whereas if I had a booked home birth I'd have midwives with me and they could listen in with a doppler. If I go in early, I'm just worried I'd end up in the same cascade of intervention as last time (induction, failure to progress, epidural , c section) and would almost rather just go for an elective section.
Sorry - no help to you whatsoever, but I'd also really appreciate peoples thoughts!

[Tangle]

Charlottery - I think you've got to what we felt was the crux of the home/hospital decision. Are you and your baby "safer" at home with the dedicated care of a (probably) experienced MW, or in hospital with often overstretched resources and a greater reliance on technology - the use of which may introduce other risks into the equation. It is possible to decline the use of that technology of course, but its not necessarily easy to have those discussions with the MW on duty while you're in labour :(

Unfortunately, I don't think there's a universal right answer as we all evaluate and perceive risk so differently - and even for the individual, the experiences we have will change our perceptions such that the decision that was "right" in 2005 may no longer be "right" today .

I'm still drawn to HB, but now I have DD1 to consider and have had things not go-to-plan with DD2 I'm not sure I'll want to stay at home for the duration with DC3. I think the current plan, though, is to make everything ready for a HB and get MWs here whilst I'm in labour - if we want to stay, great. If we want to transfer in, we've got medical professionals to help us decide when the best point to make the transfer is. Planning a HB doesn't mean you can't change your mind at ANY point.

[emsies]

We really can't afford an IM unfortunately but I've been reading some of their websites and thoughts on HBAC and they seem to be very pro. We are struggling financially at the moment to a silly degree (unplanned child number 2 but very excited) otherwise it would definitely be the way to go.

I think as the poster above said I would be happier having my own midwife at home (initially one then a second come out to you for a homebirth) than on a stressed labour ward. I am also more than happy to transfer if there is the hint of anything going wrong so its not that I would be refusing intervention or anything silly, just wanting to stay at home as long as possible.

People at playgroup seem to think I ought to go for an elective c section but I would so like the chance to deliver natuarally and at home - there's so many risks (for baby and mother) with a c section and it just seems so much more likely to happen if I go in... Also I've already got a toddler this time and so don't want the 2 weeks of hardly walking, 6 weeks of not lifting after a section if I can at all avoid it.

Thanks for the replies... still a while to go! Only 19 weeks now.

[Babieseverywhere]

I would try and not set your heart on any one ideal labour.

So much of labour depends on things outside your control to a certain degree, position of baby, type of labour, support etc. I would get all the advice you can and weigh up the relative risks and plump for whatever labour situation is best for you and your baby.

I really wanted a home birth, three failed home birth attempts later (and three healthy hospital arrivals), I still do in a way but the type of labours I had did not lend itself to home births and I now accept it was never meant to be for me.

Lets hope your baby pops out with minimum of fuss wherever and however you decide :)

[MrsHoolie]

Actually my hospital told me to stay at home as long as possible even though it was a vbac. But they are much more supportive of vbac generally,for example they are fine with a water birth which is a no no for vbac's in other hospitals.

[mercibucket]

thoughts and advice wise it sounds like you're doing all the right things - making an informed decision and building a team around you to help it happen.
as charlotterie says, one of the ironies is that for a hospital vbac you might well do almost all your labouring at home (I arrived with an hour to go) whereas for a planned homebirth you might call the mw team out much earlier (mine were there for seven hours - bit of a difference to the hospital vbac)
if you decide on a hbac, the consultants just want you to sign that you won't sue, basically, because they have told you the risks. so you just sign and they are happy enough. there is a great deal of benefit to repetition - choose a few phrases and just repeat - no need for any argument or discussion (once you are sure you've heard all the risks for and against of course and have made your mind up)

[carlyvita]

Hi there

I've just had a fantastic VBAC and can reccommend the purchase of the VBAC Handbook published by AIMS. It contains all the risks and stats and info, and is also nicely referenced so you can look up the studies for yourself if you want more details. It was my bible for 9 months!

I didn't get my HBAC as it turned out, but my labour was almost exclusively at home, and I think I progressed well because I was in my own space. Nipping in and out of the pool, up and downstairs, swinging off bannisters etc I think were crucial in getting my baby moving again, wheras in a labour ward I would not have had this amount of freedom (and props!) and I would have been well on my way to another section by the time things picked up.

No time constraints was crucial- I stuck for about 5 hours- something that is quickly diagnosed in labour ward as FTP, but time was all baby needed and he entered the world without assistance, shortly after arriving on the ward, despite the general opinion being that I'd need a section. Thank goodness it was a busy day in theatre- that extra 45 mins was all baby needed!

[charlottery]

carlyvita - what stage did you ring the labour ward? Were they OK about you staying at home?
Congratulations!

[emsies]

I think my hospital would want me to go in really early for "continual monitoring" although they are pushing VBACS in general (But not water pool). Its partly that thats put me off.They prefer to continuously monitor than every 15 minutes but I kind of think if I get an experienced midwife that day I should be ok. Like carlyvita - I was thinking if I could labour mainly at home (with a midwife) even if i had to eventually go in it would be better :)

So don't want to be rushed into a c section in a panic however I do it though...

[shipsladyg]

Oh gosh. I hadn't realised VBACs were so contrived in terms of how much monitoring they want to do. I am SURE all the monitoring last time led to my EMCS because they wouldn't let me move. I really want a HBAC. Only 8wks at the mo.

[emsies]

Absolutely what I think shipsladyg! I want to be able to move this time!

[carlyvita]

Yeah, I'd say personally that monitoring is my biggest enemy!

My IM called the ward after being stuck for 5 hours and then we decided to ARM at home, as this would be what they'd try first on the ward anyway.

We then waited another hour before transfering. I was hooked up to monitors but took them off several times as was feeling pretty cross and stroppy by then!

In retrospect, the transfer served no point, but I had decided that things couldn't continue at home, so in we went. I went in on my terms and and laboured on my terms once there. This is the most important thing for me really.

Good luck!