...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....

ever ask yourself WHY so many Victorian women died in childbirth? and why this does not happen now.... Maybe you shoud

Some reasons: puerpural fever caused by doctors going straight from handling cadavers to delivering pregnant women. Semmelweis realised that this could be vastly reduced by introducing hand washing and was vilified by the medical profession for it.

Poor general health e.g. pelvises deformed by rickets
multiparity -families of more than 10 children were not uncommon
Lack of ante-natal care - so pre-eclampsia etc. not picked up
Lack of sanitation and clean drinking water added to which lack of anti-biotics to treat infections

And have you ever asked yourself why the USA, despite its higher intervention rate has the worst maternal mortality rate of the western world www.amnesty.org/en/news-and-updates/usa-urged-confront-shocking-maternal-mortality-rate-2010-03-12

And no, it's not just because African,native and hispanic Americans don't have access to pre-natal care but that is one the factors.

I have never been in the Bibbo's position but if I were, I would try to find a midwife/obstetrician that I felt I could discuss my health with, and see what sort of care plan we could put in place, (which I think she already plans to do). I don't think that there is any place for telling Bibbo that she is crazy, stupid etc. etc.

I can't help myself but comment again! LaVolcan has very valid points. Funnily enough it was more common in hospital births than home births. I'm trying to find an article I read that says it's on the rise again too.

Bibbo
Get yourself armed with the RCOG and Nice guidelines.

Get an appointment with the Consultant Midwife/VBAC midwife in your area.

Ask her/him for the most sensible Obstetrician and see her/him together.

Have an agreed birth plan signed off by both of them AND the labour ward Sister/Charge Midwife and I would think you will be treated much better than last time. I hate that some women have to go to these lengths to have a better birth but it seems to work.

The benefits of homebirth have to outweigh any potential risks.

Some women are ideal for it, most would probably be fine if they had to do it, you most likely wouldn't (your baby would be most at risk). Being calmer won't protect you or your baby from the very real physical risks that some women, like yourself, are prone to due to medical conditions and medical history.

You sound crazy and reckless given your circumstances. This is your baby's life at stake here, nothing is worth risking that.

I would not.
In your circumstances, I'd do what the professionals say. The priority is to deliver you child safely and if things happen the way you want, then that's bonus.

I was allowed a vabac after 2 sections which i believe is unusual.However i did end up with a section as mt womb just wasnt working properly and the conractions were ineffective and the baby was getting distressed. I thought that was a big enough risk tbh and id be reluctant to have a home birth vbac as there is so much that can go wrong not least a rupture of the uterus.
Can you get a nice relaxed birthing centre instead so at least you have medics nearby?
I had my 4th section 12 months ago,managed to get a sympathetic obstetrician and had an absolutely beautifull experience,very natural and we have it all on film.

If you're high risk then yes, you are being unreasonable. I personally would love a home vbac with my next child, but its not safe for either of us, and not worth the risk at. all.

I personally might risk an actual rupture, as it is so rare.

What I wouldn't risk is the fetal distress that comes just before the rupture as the uterus thins. Probably because that scares me more.

It's your risk at the end of the day, if you are ready to take it and live by your decisions - well then it's your choice. My advice would be to be absolutely certain you are aware of the risks and what those outcomes can mean.

Then you can know that, whatever happens, you did what you wanted to do.

Good luck and congratulations on your pregnancy.

I wouldn't. Honestly; baby doesn't care if it's born in a hospital or on your living room floor surrounded by candles and your entire family tree. You are having a baby, NOT a birth. The birth is ultimately, such a small part of having a child. In your shoes (and with your last experience) I would go with the safest option; at the hospital.

Many of the arguments on this thread to dissuade the OP from attempting a homebirth, are no different from the arguments currently used by many care providers in the US as a justification for refusing allow women to attempt a vbac, even in a hospital setting. Shameful.

IMO the shameful thing going on here is arguing that the OP takes a far riskier option, in line with beliefs rather than a proper appreciation of her risk.

As someone said earlier:

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

Do you really think anyone here has told the OP she should definitely have a home birth? It's pretty clear that most of us are just trying to argue a balanced, considered approach vs. hospital being the only way hysteria.

Plus it's highly offensive to suggest a woman interested in exploring all birth options (aside from hospital) is cavalier about her baby's health.

Of course any woman would prefer a c-section to losing her baby but I think we've made the point a few times now that that's not necessarily the OP's choice. Who says a c-section is her best option here? I'm not sure even the doctors are recommending it. C-sections can be life saving surgery. Unnecessary c-sections can be life risking surgery.

I considered this with dc3 (which would have been a vba2c) and I decided on the hospital as we were about a 20 minute drive from the hospital too and uterine rupture can be fatal, however small the risk.

I can understand why you would think a home birth would be better though for less intervention etc

For what it's worth I got to 10cm and pushing stage but was told at that point that I had a narrow pelvis and the head would not fit through(the reason for my previous 2cs finally explained, a little late!). So emcs again. Half of me is glad I tried, the other half just wishes I'd had the elcs! Very glad I didn't go down the home birth route though as that would have been a nightmare.

"IMO the shameful thing going on here is arguing that the OP takes a far riskier option, in line with beliefs rather than a proper appreciation of her risk."

Exactly the argument that's been used for 20 years in the US to dissuade women from having a hospital VBAC.

Thank you for proving my point.

Nobody is 'arguing' that the OP should do anything. Except those people telling her she should go to hospital.

"rather than a proper appreciation of her risk"

Actually none of us here are in a position to make a 'proper appreciation' of her risk. Which is why some of us have held back from telling her what she ought to do.

If I were you, I would opt for either a HBAC or an ELCS.

I would not opt to labour in hospital, because the one time I did, it was hellish, and I will not put myself through it again.

That's just me though.

Only you can judge the risks effectively, and weigh them against the benefits. Find a supportive, non-judgemental MW if you can (I found one by standing in reception crying because nobody would help me ) She was able to talk all the options through with me. I got an extra scan (at 42 weeks) which showed very clearly that all was well - baby not too big, placenta great, fluid levels fine etc.

I had a different set of risks, obviously (no previous C-section, but recent asthma attack, was on steroids and antibiotics already when labouring, baby 42+3 etc) but to me the benefits of being at home for both me and the baby far outweighed the benefits of hospital when compared to the risk of the CLU (no MLU in the area.)

It's worth talking to Beverly Beech if you can, AIMS I had a long chat with her when waiting for DS2, she was fabulous. (Not HB at all costs, either - balanced and rational.)

IMO the shameful thing going on here is arguing that the OP takes a far riskier option, in line with beliefs rather than a proper appreciation of her risk.

Not one single poster has told the OP to homebirth regardless, some of the more empathetic posters have told her that she isn't mad to consider it, but that she needs to speak to her midwife and doctor before making any decisions.

Others have just accused her of being selfish and not caring if her baby lives or dies. Which is an disgusting way to respond to a scared and vulnerable women.

Having been involved with a vbac uterus rupturing at home I personally think you are mad to have a HBAC. BUT, its your baby, your body and your risk. Only you can decide if the odds are acceptable to you. Ultimately its far more likely not to rupture than to rupture (about 1 in 200) but the potential consequences are massive. If your uterus ruptures at home you would be looking at least at a very difficult postnatal recovery, at worst one without a baby and yourself in a very bad way. Sometimes there are warning signs and you have more time to head to the hospital, often the signs are later and by the time they are apparent you are in a life threatening situation. A 40 minute round journey plus 10 mins to actually get the baby out is a long time.
The choice is yours op, but you will need to accept that (nearly all) obstetricians and midwives will advise against and will need to discuss thoroughly with you the possible outcomes, even though they arent pleasant to hear.
Bear in mind about 70% of vbac end in vaginal birth, the other 30% dont all rupture bviously but there are plenty of other reasons why women end up with Csections regardless of previous births and all women have about a 1:5 chance of an section. With a bicornuate uterus you also have additional risks. Also the info on safety of home birth is based on a pretty much all normal population of homebirthers so isnt representative of high risk homebirthers.
Consider how hospital birth could work for you. Lots of women have very normal satisfying births in hospital environments and some of the 'trappings' of vbac (such as continuous monitoring of baby) dont have to impact on your ability to be active etc. Vbac's can be a really positive empowering experience regardless of the four walls and decor, but in my personal opinion without the healthy baby and mum at the end of it the whole 'experience' counts for nothing. Noone EVER has a positive birth without those two things.

she isn't mad to consider it

What is wrong with considering what might seem to be outlandish or stupid propositions? You do it all the time at work but there it's called 'brainstorming' (or the more PC 'ideation'). Sometimes from this process a completely new way of doing things emerges, sometimes it helps to clarify existing ideas.

You could say that we have been doing this. OP makes it clear that she is worried about unecessary interventions which she believes caused problems the first time, but at the same time she has got a health issue which could significantly affect the birth. Would having a home birth be a solution to these?

We have all those 'you're crazy, you're a fool' type suggestions - so we group those together...

Then we have talk to your midwife, consultant midwife and discuss your options' suggestions which we group in another corner

Then we have a group of 'have an ELCS -it's not as bad as all that' suggestions.

Ultimately it's up to Bibbo to decide - she is the one who has to live with the decision, to bring the baby up, to live with any issues affecting her or the baby's health. She isn't saying 'I am having a homebirth come what may' and absolutely no one has suggested that she should do that. I fail to see why she isn't allowed to even think of all the options.

I'd be surprised if they let you do it, actually. Legally, they can't stop you but I would guess that the medics will try to discourage you very actively from attempting a home birth - home births are usually for women perceived as low-risk.

I'm not going to give an opinion on what you should do, just saying that you could have a battle on your hands, and it's a question of whether you feel like fighting it.

hackmum There is no 'let'. I am high risk (not the same situation as the OP) and have been supported fantastically in my plan for a home birth.

Rather than battling with a high-risk woman, it is far safer for the MWs and consultant to work with her and support her in her plan than it is for them to say 'we don't support you' and her phoning up on the day and saying that she's not going in and there being no management plan in place.

it's been a really interesting discussion. Well, it would be v unreasonable of me to come to mumsnet for mollycoddling wouldn't it?! I don't mind people saying exactly what they think, I mean, that's what mn is for.....

I do find it interesting that hbac is considered so reckless. I'd like to know more about the 30 per cent of attempted vbacs that end in c/s - of course they'd all be emergency situations, but how many of would be uterine ruptures or similar extreme emergencies where life or death is a matter of minutes?

Anyway, the point is (and I think I did mention it somewhere) that I'm not actually looking to endanger my baby's life! it is my single greatest concern (funnily enough). I just wouldn't mind avoiding a repeat c/s, you know? Not that unreasonable surely?

Anyway. lots to think about. there have been some really encouraging experiences on this thread that have made me think that perhaps it wouldn't be impossible to have a quiet, calm birth in hospital without having to constantly fend off consultants... that's all I want really.

thanks all :)

If it was me (and it could have been - I have ended up with 2 EMCS) I wouldn't be looking for HBAC but instead just staying at home as long as whilst coping with pain etc.

You can speak to people and make your feelings clear about being mucked about with etc

my attempt at a vbac in hospital I put that I categorically wouldn't be pinned to a bed etc, and the MW's were fab, encouraged me to be active as much as poss - only popped in every hour or 2 for a quick monitor of baby, when I did need to be monitored for a bit longer, I was put on a mobile one so I could still do what I wanted.

oh and I didn't have to fend off consultants at all - was in hosp around 24 hours prior to c-section, they were fab. Only reason it went to that again was DS in distress (and my fecked hips which apparently can't fit a babies head in so they can't descend properly)

Hi, I just stumbled across this thread. I realise its a year old but I was wondering if OP is still about on mn? I am also carefully considering my vbac options (lots of food for thought on this thread) and also have a bicornate uterus. I really hope all went well for you in the end

Better to send her a personal message than resurrect an old thread, v unlikely she'll see it - with personal message she'll get email telling her message from mumsnet for her. I saw this thread the first time and I don't understand why anyone would take that level of risk.

Thanks for the tip

I don't think you're mad to want it but after a c-section that was a combination of planned and emergency and very very straightforward and simple then hearing all the horrific stories from the women on my ward I think a VBAC is a brave choice.