VBAC home birth, 40yrs: Is there a chance with NHS?

[Yayaya2013]

I had a traumatic hospital birth for my first baby about 3 years ago.
my water broke early, waited for 3 days but no natural labor, gave in for induction, after 24hrs of starting induction - 9cm dilated but no further progress for 7hrs, which ended in c-section.

i am due in 4 weeks for my 2nd baby. i'm 40 now, healthy & fit, with no complications whatsoever so far. but i am starting to have a real nervous breakdown on the hospital birth again - fearing that it will end up with unnecessary interventions like the first.

i got a doula to support me this time, and live in 10min walking distance to the hospital. if i plan to go to the hospital as late as possible anyway, i really would like to give a chance to try a home birth this time. my husband is more traumatized by the first birth than me and i do feel going into the hospital labor ward again will NOT help me in any way for a successful VBAC this time.

from the beginning, the consultant just told me a few things:

• due to my c-section and age, i will be under consultant-led care
  
• i will have to deliver in labor ward with continuous fetal monitoring
  
• i won't be allowed to go beyond my due date & i cannot be induced (the result? never spelled out clearly as 'we want you to go for c-section')
  

so far (till 35wks), i have seen consultant 3 times, midwife twice. and no one seems to care about discussing the birth plan - possibly because i never met anyone more than once. yesterday i met a midwife who obviously thought i was not one of her responsibilities and did not want to discuss about any possibilities for home birth or use of birthing suite instead of labor suite (which does not provide any 'natural birth aids') and i strongly felt that she just wanted to rush me out of her room.

do you think i will have a chance to convince someone in NHS to support me for home birth at this stage? who should i contact? since my named midwife has been so uninvolved throughout (only met her once for the first appointment), i am not sure who to start convincing to get the home birth midwife team's involvement.

[FIS2016]

The nhs offers recommendations. They cannot refuse to attend you because of your age and previous sections. They can refuse on the day if they do not have resources available, however I doubt this would happen.

Have you considered a domino birth? A midwife come to check you at home and you go to hospital once you are in very established labour 6cm plus. I would opt to stay home if I could and you are very close to the hospital if you need to go die to lack of progress.

Being at home you may find you are more relaxed and birth better.

[emsyj]

If you are in an area covered by the One to One Midwives service they may be able to offer you a home birth. If you google I think there is a search function on their website to see if your area is covered.

I had a home VBAC with One to One. It was freely offered to me and they never suggested it was high risk. I had initially booked in for a hospital birth but was told I would not be allowed to use a birth pool and I would 'have to' have continuous monitoring. Mobile monitors are not available at my local hospital so I would have had to be lying on the bed. I knew I wouldn't be able to cope with this as I have to be upright and mobile in labour. In the end I had a very straightforward and uneventful vaginal delivery at home, with intermittent monitoring using a doppler from the midwife who was with me the entire time.

[Toria2014]

What does your Doula say? Can she not help you with this? It was my Doula who encouraged me to have a home birth, as I just assumed, being 40 and it being my first child I would have to go into hospital. That was not the case. I was under a consultant for a thyroid issue, but he was less than bothered at the prospect of having a home birth. It was one of the local midwives who was quite negative about it. And one consultant said, that due to my age, 'they like to induce' to which I replied, 'really, do I get any say in that?' And he said yes, of course, we won't do anything you don't want us to do. I hate hospitals, the mere thought of them make me feel anxious. I would never have felt safe and in control. Being at home was the best place for me. I had a fast intense labour and had my baby in a pool in my dining room. The midwives were very hands-off. They drank tea and ate biscuits! It was a wonderful experience.

In short, you have control over your own birth. If you want to have a home birth, tell the midwife thats what you want. The chief midwife came around to my house to chat with me and was perfectly happy with my wishes. Your Doula should be clued up about all this, she is there to assist you before, during and after the birth. They cannot refuse you.

[boloriabullet]

Always remember that what the consultant is offering you is based on recommendations... You don't HAVE TO do anything, particularly if it doesn't fit with your birth plan.
I went for a VBAC after 2 previous sections, which is actually what is recommended in the rcog guidelines but is not routinely offered by many NHS trusts. I also wanted to be as mobile as possible, use the pool and be intermittently monitored.
To get this I insisted on discussing it with my consultant. I didn't want to have to explain myself when presenting in labour, nor did I want to have to 'argue' my case when in a vulnerable position so I made sure the consultant wrote it in my handheld notes. Luckily, she was brilliant and wrote it and when I came in labour my wishes were respected.

If your consultant is reluctant to do this, make contact with the Supervisor of Midwives at your trust. They are assigned advocates for women and will help you navigate the system. Either that, or see if you have a consultant midwife at the trust. You can usually access a SoM or a consultant via the labour ward telephone number.

You can do it! Good luck!!

[Yayaya2013]

Thank you for all the encouragement and sharing your experiences!

Indeed my doula encouraged me that I don't have to accept every recommendation based on 'statistical risks' by the consultants, so I called the maternity help line, the home birth midwife team at my local hospital directly and firmly told them I wanted a home birth. I also emailed the consultant midwife who advise on the birth choices. In 2 days, I was visited by a midwife from the team who actually told me that her supervisor asked her to talk me out of it but she wouldn't do that as I already made up my mind and she's there to support it.

She only asked me to agree with the blood pressure and heartbeat monitoring at a set interval and let her know if there is any unusual pain, which I am happy to accept (obviously she witnessed a rupture when a mum refused any checkups by midwives and not informing the constant pain during labor when giving a home birth).

I cannot believe the world of difference in the attention and care by the home birth team, compared to the so-called 'consultant-led' care that I had received: I will have the same midwife visiting me from now on, and she will actually discuss the birth plan with me!

I have one more appointment with 'a' consultant at 39wks for membrane sweep (it was scheduled without even much discussion). I plan to let them know that I don't want it to be done till 41wks.

I definitely wish I had this attitude with my first birth. I deeply felt that I lost control over my body last time, but realise now that it was because I didn't claim it!

[Yayaya2013]

FIS201 : I never heard of 'domino birth' but that sounds quite sensible. It would probably save the cost for NHS quite considerably as well. But my local hospital doesn't seem to offer such an option so it's either going full-on with the home birth plan or just going with the hospital birth. Many people advised me to book the home birth because going to the hospital in the emergency is an open option available any time.

[sycamore54321]

I read this thread a few days ago, tried not to sat anything but have been genuinely worried about it ever since.

You have a number of very serious risk factors, which you seem to be in denial about or perhaps don't quite understand, and I am shocked to see a series of posters simply cheerleading your decision. Yes, a home birth is an option for you, simply because that is the legal situation for every birth in the UK. That does not in any way mean it is the right or sensible decision for you. Your age, your obstetric history and in particular your scarred uterus from your previous section are all very serious risk factors for the lives and health of you and your baby during labour. Of course, you and your baby might, indeed probably will be perfectly safe and well if delivered at home. However, the risks of something sadly does go wrong are enormous. There is simply no way of knowing if you will be one of the 1in 200 VBAC women to experience the horror that is uterine rupture, risking your baby's life and your own life and fertility. 1 in 200 might not look like much but in medical terms that is a HUGE risk considering the consequences. For example, you would never get insurance for any activity that had anything close to that risk of occurrence. Refusing continuous monitoring means that warning signs of rupture will be much harder to detect. If you are happy with these risks, then so be it but you really should be fully informed about them rather than blithely hoping for the best and listening to an echo chamber on the Internet.

You say your first birth was traumatic and I am very sorry to hear that. However I would question your characterization of the treatment you describe as unnecessary. Prolonged pre-laboyr rupture of membranes is a serious risk factor for infection which can have terrible consequences. Obstructed labour can cause distress to your baby and cause damage to your pelvic organs and continence. Honestly, from what you have said of our first labour, the interventions you describe sound to me to have been necessary indeed, as proven by the healthy delivery of our baby.

Honestly, the most highly qualified people who have seen your file - the consultant and the supervisor of midwives - are concerned. Ask yourself have you really listened to all they have to say? Or are you going with the answer you want to hear, incidentally from people with lesser qualifications and experience and from randomera online (I know I am a randomer online too). Honestly if you are comfortable with this level of risk, go ahead - there are strong chances everything will just be fine. But if they arent - and there is no way at all of knowing whether you will or will not be the 1 in whatever number but you do have a lot of risk factors - the consequences are enormous.

From your posts, I don't think you fully understand the circumstances of your first birth and out don't fully understand the risks for our second. That is not a personal criticism - the healthcare professionals should have done a much better job communicating and listening to you. But that does not mean you should go blindly into a very risky situation. Please talk to them and listen to them. Then decide.

I genuinely wish you the very best. I am sorry for my lengthy post but I could not have it on my conscience if I read a subsequent post from you with anything less than a beautiful healthy baby and a healthy you.

[SofiaAmes]

13 years ago I had a VBAC at 39, but had it on the Natural Birth floor of Hammersmith Hospital. My first delivery was extremely traumatic and I was really scared to repeat it. I switched hospitals and found the head midwife at Hammersmith and asked her for help in having a VBAC but with a very different protocol to the first delivery (ie minus the trauma) and she agreed to personally deliver my baby, which she did and was wonderful. However, I did have a postpartum hemorrhage and might have bled to death if I hadn't been in hospital. Having said that, I didn't get the impression that the hemorrhage was related either to my age or that I had previously had a CS. You can have a "natural" delivery in some hospitals, you just need to find the right one (and bully them into letting you deliver there).

[Oly5]

OP, I don't mean to scare you but there are very real risks here and surely you want to put your child first?
Of course it could all go swimmingly but it might not. My best friend had Vbac after deciding her first caesarean was unecessary, had a doula and a home birth that went very wrong. They didn't get her to the hospital in time, there were problems with the (very necessary) second c section and the baby was starved of oxygen.
Pls think very carefully.
I know you want to have your choice but there is a reason why consultants are wary. They will have seen far too many complications and suffering

[Mollcat]

OP, there is a very supportive Yahoo! group called UK VBAC/HBAC which you could join. Lots of experience in that group of all sorts of VBACs. I wish you all the best with whatever you decide.