...to consider VBAC homebirth?

[Bibbo]

I am seriously considering this.... haven't discussed it with midwife or obstetrician yet though. expect they will tell me it's a ridiculous idea! I want a homebirth because I'm worried about unnecessary intervention, since I had a lot of unnecessary intervention when I had DD1 and I think that messed it up. Syntocinon drip whacked up high=foetal distress=em cs (have whinged on mumsnet about this before....)

I would be a lot more relaxed and in control at home, I think. I live about 20mins drive from hospital though.

Oh yes and I have a bicornuate uterus, as well as my previous cs, so no chance of me being classed as anything other than high risk.

DH originally thought I was mad, but is coming round to my way of thinking. Am I mad to consider this? I just want the best possible shot at a natural birth without all the horrible pain of dealing with the consequences of another cs....

I'm not entirely sure what that is, but if ou are high risk then yes, I think you are quite mad to consider a home birth

i don't think you're mad at all. although tbh i don't know what added risks you have from the bicornuate uterus?

if it was a simply vbac then i'd recommend it any day of the week.
with added complications? i don't know, depends on the risks involved.

AFAIK the bicornuate means a higher possibility of a) preterm labour, b) breech positions and c) problems pushing the baby out

However I carried dd to 38wks, her position was fine, and I came bloody close to pushing her out, so her hair was actually visible, so at the moment I'm inclined to think it doesn't make much of a difference to me at all

I think 20 minutes drive is too far tbh. Previous c-section puts you at risk of uterine rupture right? Now I know somebody that happened to and it's awful.
Because you've had a c-section before I think medics would be reluctant to induce labour anyway - because of the rupture risk - so you're unlikely to end up with the drip scenario.
Why was the drip put up in your first labour?

a) you;d go to hospital, so no issue
b) you'd presumably know about beforehand so could then decide whether to go for homebirth, hospital birth and whether or not to have a c-section (personally i'd only do a vbac for a breech birth if i could afford an IM with plenty of experience with breech babies)
c) could happen in hospital too i guess and only you can weigh up the risks of it i guess. at home with 2 midwives with knowledge of the issue i imagine they'd encourage you to transfer early enough if things didn't seem to be progressing?

20 mins would be less if bluelighted in ambulance, but yes, still something to consider

i guess i would be looking at how likely the risks are. so, how many people DO rupture during a vbac?
how many people with a bicornuate uterus have a breech baby etc

if the percentages are really tiny then a vbac is certainly sometjhing i would consider

have you looked on the homebirth.org site?

Honestly. I think you are tyaking a huge risk.

Have a really good chat with your mw/ob & go from there.

Tell them your fears. Maybe when you go in you can be monitored for a bit & then they can leave you alone.

Tell them how you'd like to birth.

Good luck.

Can you not persuade a MLU attached to a big hospital to take you. That was less chances of intervention but easy to get to theatre if need be. You might need to threaten to demand a homebirth and then try and get that as compromise.

FWIW I think you are a little mad. Much better to have 2nd CS than risk it at home. VBAC ok, but HBAC esp as you have with added risk factors?

re: breech, not sure VBAC is sensible for breech. Vaginal delivery for breech fine if you already had a straightforward vaginal birth before.

Less than 0.05% risk of a uterine rupture. I don't think your mad at all. I don't know what the additional risks are with a bicornuate uterus but might be worth chatting with an independent midwife if you can afford it?

www.rcog.org.uk/womens-health/clinical-guidance/birth-after-previous-caesarean-birth-green-top-45

I found this helpful because it details risks clearly. I had an induced hospital VBAC (1 hour drive!) and loved it. Good luck :)

Thanks all. Previous drip was because my contractions slowed after a long transition stage - midwives had it on quite low but when the ob came in she increased it massively - that was when things really started to go wrong

If it looked like a breech, then I'd definitely do it at hosp - am only thinking homebirth if everything looks OK presentation wise

I don't know, am I being bloody minded here? I take the point about the lower likelihood of induction with VBAC - that would help definitely - but I am really worried that I won't be able to relax in hosp after my experience last time, and I think not relaxing could make the whole thing a lot more difficult. Part of me wants full access to medical facilities if things go wrong, but part of me also thinks that things would be less likely to go wrong if I had enough space to relax.

Nothing constructive to add unfortunately, but just wanted to say thanks for starting this thread because it's something I've been thinking about a lot recently too.

Sounds like our first labours were similar. I ended up with an EMCS due to fetal distress, dropped oxygen levels in DS's blood and "failure to progress" (yes, that old chestnut...). I'm also about 20 mins drive from the hospital. The cause, as it was explained to me, was that the cord was wrapped tightly round DS's neck so no reason not to think that I can give birth vaginally next time.

I love the idea of being at home but not sure if the reality would live up to it?

I think I would want to focus on how a hospital birth could work for me tbh. Yes a home birth is geat but you are at higher risk of problems and transferring in with you or the baby in trouble would be a very hard outcome. I know the risk of rupture is small - I would just want to run that risk considerably closer to an operating theatre. What about a MLU birth? Given the choice between that or you opting to hbac I think most clinicians would want to see you do the former and that might open doors which can otherwise seem shut.

Nobody can tell you whether you should or shouldn't - it's such an intensely personal decision.

We all have our comfort zones around risk-taking when it comes to birth.

I had a home birth with an independent midwife following a diagnosis of gestational diabetes, and after a scan which suggested my baby was over 10lbs (he was 11lbs at birth). For me it was the right decision, but I wouldn't have made it if I hadn't had the support of my midwife and the support of a consultant midwife at a large teaching hospital. But then I trusted my midwife absolutely - she's a friend and a colleague and if she'd said to me that I really needed to be in hospital I would have listened.

What sort of input have you had from the VBAC midwife at the hospital?

"Yes a home birth is geat but you are at higher risk of problems and transferring in with you or the baby in trouble would be a very hard outcome."

Actually I'd say you are at less risk of having a difficult labour at home.

As for the issue of transfer - most women who transfer don't find it a particularly traumatic experience, but then most transfers in labour aren't 'blue light'. A catastrophic rupture would involve a huge kerfuffle on the other hand - whether at home or in hospital. A transfer in these sort of circumstances would be stressful.

Some really good advice on homebirth.org website also yahoo vbac group very good, ladies on there are very knowledgeable about HBAC. I am VBACing soon, in hospital but refusing continuous monitoring so that I can be more active. They might consent to you being in MLU if you tell them you are going to have a homebirth unless they do :)

I had an hbac.

But I didn't have any other complications, and I also lived 5 mins away from the hozzie with the nee naws on.

I had to fight all the way for it, and even at the last minute after hbac was agreed, the midwife who came out to assess me rang the hospital and the consultant said i had to go in even though the unit was closed... Meant driving 45 mins to next unit! Mental.

I still refused, and all went well... Baby went plop onto the living room floor, and i was tucked up in my own bed that night. Midwives did have to shine MASSIVE torches at my fanjo tho to sew me up! That was fun.

Oh and I also would recommend talking to a sympathetic doula (not a militant hb one, but one who will be supportive in any situation). Mine was great.

nice article here

I don't think AIBU was the right place for this

Have you joined the Yahoo VBAC/HBAC group? If not, you should :)

And no, I don't think YABU to consider it, as long as you educate yourself about the risks (and benefits) of each setting to give birth in and decide on balance what is right for you and your baby, not your DH, and not MN.

Shagmund - sorry I know that wasn't very clear. I didn't mean the OP's risk of problems was greater by being at home. I meant that her basic risk - with uterus and previous c-section - puts her at higher risk than a mother wanting to birth at home who doesn't have the complications. I agree that home may be a calming and conducive environment but if she needs a transfer the potential for serious problems is increased by her distance from the hospital.

I think you would be taking a huge risk and would be better off thinking of other ways that you could gain control over things and enable yourself to relax.

Oh, and as someone who has given birth in an ambulance, you really don't want to have to labour in an ambulance. Ambulance beds are not nice places to be when in labour.

Would transferring to a different hospital be a possibility or something that may make you feel more in control?

I have just given birth to my 2nd after a similar experience to yours first birth sounded-I went for vbac if I started naturally and a elcs if i went a week overdue. I had the elcs on the end-my son was 13lb, labour never started naturally. I am so glad I did-recovery was a bit rough but not the worse thing ever and 3 weeks down the line (today) were up and about, driving and doing great.

I won't have any more children but If I did i would have an elcs rather than go for vbac-you just never know. Imagine if i had tried to birth my son at 13lb? My dd got stuck and she was 9.4lb

ARE YOU CRAZY?

You are in a high-risk category for pregnancy - that means the risk of you or your baby DYING is higher than the normal. If the shit hits the fan, mere minutes can make the difference between life and death - twenty minutes away from a hospital is over a 40 minute round journey by the time an ambulance gets to you and then drives back, assuming there's one available.

I just want the best possible shot at a natural birth without all the horrible pain of dealing with the consequences of another cs....

I'd prefer the consequences of a CS rather than dealing with the pain losing or damaging my baby.