To consider a home vbac

[allotmentgardener]

I'm pregnant with number 2.
I wanted a homebirth with ds1 but I never went into spontaneous labour. Ended up with an induction on + 14. Then a section on +15 due to foetal distress.
At the time i was sad about the section, but the main thing is that ds1 arrived healthy.
I want to try for a vbac this time round. Running about after a 23month old after a section doesn't fill me with joy.
Am I crazy considering a vbac? Especially a home birth? I suppose it all depends on whether I go into spontaneous labour....

Depending on where you are, a home VBAC may not be offered to you as an option: I had a VBAC with number 2 but because of the increased risk of rupture my hospital insisted on continuous monitoring on the delivery suite. I was still allowed in the pool etc with wireless telemetry but wasn't considered a candidate for home birth or birth centre.

I don't think YABU to consider a VBAC at all, but personally I wouldn't go for a homebirth VBAC. I say this as someone who has only ever given birth at home. I think the risks would be too high in your case. Your midwife should be able to talk you through the risks of any option though

Thanks for your honest opinions. There is a lot of information available and it will be tough to make a decision. I'm worried about being strapped down for monitoring.

YANBU there is a brilliant VBAC group on Facebook with loads of information and birth stories including home births.

I attempted vba2c and wasn’t strapped down, I was able to move about, use a ball etc. I also stayed at home as long as I could.

Trying for a straightforward vaginal delivery following a CS, go for it, works for many women, cheering you on.

At home? I'm, really trying not to be brutal here, but no , no, no.

Rupture of the uterus in labour is a very very rare complication - but it does happen.
In hospital, you both stand a chance, as you can be rushed into an operating theatre within minutes.
At home, waiting for an ambulance, which may not be available for some time, loading into ambulance on a stretcher, getting to hospital, unloading, etc etc. You'll be lucky to make it.You owe to the DC you already have not to opt for this.

Go and visit the hospital,. good straightforward hospital birth can be a very different experience from a complicated one; you can request things according to your wishes.

Best wishes, hope all goes well.

You will probably find that it would be recommended that you gave birth on a consultant ward with continuous monitoring however that does not mean you HAVE to do that. Any woman has the right to give birth at home. Your trust may suggest you speak to a consultant and senior midwife about it, but it is still your choice. AIMS and BirthRights are useful organisations who can talk you through your rights if you encounter problems. I have a friend who had a successful home VBAC after a classical caesarean (a vertical uterine incision) which has a much higher rate of rupture. The Positive Birth Facebook group may be a good place to ask for people's experiences of home VBAC too

It is also worth asking for second opinions when it comes to consultants. It amazed me how the three consultants I had appointments with had very different opinions on vba2c.

I have had 2 straightforward home births following a crash section with DC1. I was freely offered the option and didn't have to fight for it. I had intermittent monitoring during both births - i think there is research to show that continuous foetal monitoring doesn't offer improved outcomes as compared with intermittent monitoring so you should be able to get information about the relative risks and benefits fairly easily. However, my situation was different from yours in that my section was for severe foetal distress and no reason for this was identified. This means it was categorised as a 'baby related' reason and was not likely to recur. My understanding is that if you don't go into labour or progress through the stages of labour, this is a 'mum related' reason and much more likely to happen again. This is how it was explained to me when I discussed the prospects of a successful VBAC with my midwife. I would recommend getting more information to help you decide.
Best of luck with your birth whatever you decide.

Rupture after CS is not that rare. It happened to me 3 times and at least one of my kids owes her life to the hospital setting I was in. Why take the risk?

As people have said, the major increase in risk with a VBAC is re. uterine rupture (also though if the placenta sticks to the old scar then massive bleeding is a risk too). In hospital if this happens you will be in theatre in minutes and the situation managed. It might be fine to do it at home, or it might be a complete disaster an ambulance ride away from anyone that can help. I know where I'd rather be.

Uterine rupture - seen about 6 times in an 18 yr midwifery career. But once seen, never ever forgotten 😞

I’ve had 5 sections and sure they can be hard. I also know someone who has had 5 natural deliveries and lose one baby during a home birth because she was low risk, opted fo home birth and it still went tragically wrong. Heartbreaking. Birth is about two people, two lives, VBAC why not? At home? Crazy in my opinion. Why take the risk.

As others have said you may not have the option. I didn’t. I had an emcs with my first and I was told a home birth wasn’t an option due to the risk of uterine rupture (not that I’d have wanted it anyway). It’s rare but if it happens you need to be in a hospital. I just wouldn’t take the risk.

I think it's too risky, sorry. I love homebirth and i've experienced both homebirth and attempted vbac. I would be looking at ways to make labour in the consultant led labour ward with continuous monitoring as homely and relaxing as I could.

Find out if there's a consultant midwife to speak with in your local hospital.

No obstetrician would advise VBAC at home from what's already been outlined but some units are more supportive than others, shop around if you can.

I worked on a unit v supportive of VBAC and women had the option of going in the pool with telemetry for monitoring

Don't do it. If something goes wrong, it will go really badly wrong and you might both die.

VBAC - yeah, absolutely, if that’s what you want.

HBAC - I certainly wouldn’t. I don’t know any trusts that would recommend one, although they cannot ‘deny’ you one as such (thank God). Try as hard as you can to find objective figures on the risk and decide yourself whether this is something that you are willing to accept. I would steer clear of some of the home birth groups as I’ve found that they can be quite single minded in terms of advocating HB even really quite risky situations, without proper risk acknowledgement.

I hope you get the birth that you want

I had a home vbac. It was amazing. I wasn't offered it. I had to tell them I'd considered everything carefully and made the decision that I wanted to try and stay at home for as long as possible and ideally have him at home. I had two midwives who barely came near me as they had no need to, 12 hrs star to finish and no issues, no pain relief, all good. I had a doula and she helped the most. I can honestly say it was amazing and I hadn't gone into labour at all with my dd. He was 11 days over too. I would have gone to 15 days over before opting to go into hospital. I did have to meet with the supervisor of midwives but that was no problem. I don't think I would have had such an easy calm birth in hospital.
Thing is birth is so emotive. You have to decide with your partner and with advice, but do your own research too. I found it easy not to be told what to do by overbearing midwives and consultants as I'd done my research and I was confident we were making the right choice. You'll get very strong opinions on here especially in aibu and most people have their own feelings and agenda, you won't get impartial advice, especially from me as I want everyone to experience a calm, easy, amazing birth like I had! Good luck whatever you decide!

From personal experience, a resounding no. There are 22 months between my children and following a uterine rupture after Vbac i am only here thanks to a very skilled surgeon who happend to be on duty and blood donors because I needed 8 pints plus plasma to keep me alive.
I then spent two days in critical care so missed those first days with my baby. The physical scars have faded but the psychological effects at still with me many years later. I was diagnosed with PTSD and have suffered flashbacks, nightmares- the whole range to the point of being suicidal. To this day I still suffer symptoms if I come across certain triggers.
I don't mean to put the frighteners on you but you need to know. If I had been at home for the delivery I would vertainly not be alive today.

Yes to VBAC. Absolutely no to HVBAC.

I'm pro home birth, had a lovely one myself with DC3, but without a history of straightforward previous births I wouldn't have considered it.

I know it's not what you want to hear but I wouldn't do it in your situation. If you are two weeks late again you'd be advised against it anyway.

Sorry this is said with kindness but
YABU.
Your first little one went into distress. What I'd heaven forbid the same thing happens again and you're not at the hospital.

At the hospital I had DS at there was a midwife led unit next door to the main labour ward (as in inside the hospital on the same floor) I'm not sure if you'd be allowed to use it for a vbac but perhaps something to consider if you have a similar set up nearby? Perhaps a compromise?

It’s not out of the question at all if labour happens spontaneously. I wanted a midwife led unit for Vbac following a zero intervention hospital birth with my second (where I refused continuous monitoring having researched and found there was no evidence of improved outcomes with it) and the consultant midwife asked if I’d considered a home birth. I had no issue or argument to go down that route but unfortunately my dc3 didn’t engage at all and had quite a lot of fluid so I was taken off the home birth list at last minute, hoping to go back on but dc3 started his arrival and was a totally straightforward midwife unit birth.

ive had two homebirths and unless you live 5 mins from a hospital or less, then id not risk it.

I doubt they’ll let you, I was monitored throught a subsequent labour as there’s a risk of the prev c-section scar rupturing during a vbac.