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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

To consider a home vbac

74 replies

allotmentgardener · 11/07/2018 17:40

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....

OP posts:
tenbob · 11/07/2018 21:31

Sorry amazing
Think you've posted the wrong graphic
There is nothing on there about risks for VBACs at home, which you've told OP is lower risk despite the very real risk of uterine rupture

AmazingGrace16 · 11/07/2018 21:31

@ tenbob I don't need to validate anything. You're being unnecessarily nasty. I do think the OP will ace whatever birth she chooses based on how level headed and informed she comes across so far. I don't think that's bullshit.

tenbob · 11/07/2018 21:33

Haha, so you admit you've got it very wrong then? And are indeed spouting uninformed bullshit

Just out of interest, I was very well informed and level headed before my first birth. Why didn't I 'ace it'? Wast something I did wrong?

AmazingGrace16 · 11/07/2018 21:33

😂 please read my posts. I've nowhere said that home births after vbac are safer at home. Nowhere. Read my posts. I've said that in general home births show greater normal births compared to in hospital. Another poster told me that's because low risk people generally choose home birth at which point I agreed and said the research was based on two groups of the same risk factor.

LoopyLou1981 · 11/07/2018 21:34

Another vote for vbac - yes, home birth - no.
I had a lovely ‘normal’ birth after an emergency section with my first but the hospital setting definitely gave me the security to relax into it.
I hope you get the birth you’re hoping for xx

AmazingGrace16 · 11/07/2018 21:34

I've said nothing wrong.

AmazingGrace16 · 11/07/2018 21:39

I seriously do not see the harm in me posting encouragement no matter what birth the op choose a by telling her she will ace it.

Would you rather me say "well you might ace it but then again you might not and yes it might all not go to plan and you might have rare complications so let's just focus on all the negatives rather than trying to stay positive eh"

Bearfrills · 11/07/2018 21:45

I had an EMCS for DC2, my first section, and when I was pregnant with DC3 I wanted a VBAC. I went overdue and so was offered the choice of induction or elective section. I ended up choosing elective section and ultimately I'm glad I did as the surgeon told me afterwards that my previous scar was in poor condition, it was stretched thin and had a lot of adhesions. In her professional opinion it would not have stood up to the strain of labour and I'd have been very likely to have a rupture.

DC4 it was recommended I have a section no later than 38wks in order to minimise strain on the scar. At 36wks we found out she was transverse (sideways) so I was admitted to hospital as transverse presentation in itself is very high risk but it was also going to put extra strain on my scar. I asked the consultant if I had to be in hospital, could I not go home, and she said "if you go home and it's ruptures or your cord prolapses, it'll be 30 minutes minimum before I can get your baby out. If it happens while you're here in the hospital, I can have her out in 3 minutes."

The risk of rupture is small, yes, but if you happen to be the unlucky one then you're far better being close to the relevant medical support.

You don't really have to make any immediate decisions. You can see how the pregnancy progresses and decide later, or change your mind later. Best plan is to look at as much research as possible and discuss it with your care providers so that you can make as informed a decision as possible.

FWIW, a planned section is a world away from an emergency one. When I had DC3 I was (slowly) walking around the shopping centre when he was five days old and went for a pub lunch, plus you can plan for it when you know it's happening so can put measures in place ahead of time to help make things easier for yourself.

AnElderlyLadyOfMediumHeight · 11/07/2018 22:01

She might 'ace it'? What kind of language is that, in relation to birth? Hmm

OP, never having had a CS, I don't know enough about VBAC to offer my views on that, but, having had two (very different) ventouse deliveries and one extremely precipitous (induced) labour and delivery, I wouldn't recommend a home birth where there's been anything that you needed to be in hospital for previously, iyswim.

AmazingGrace16 · 11/07/2018 22:04

My intent for positivity surrounding your choices are being wildly taken out of context or misunderstood.

DancingLedge · 11/07/2018 22:16

The incidence of uterine rupture is v small.
The consequences are potentially enormous.

The rupture of the wall of the uterus, and possibly the consequent placental abruption, are described medically as an abdominal catastrophe. You know, like a major stabbing. Will you survive? In a hospital, very probably. At home, quite possibly not.
Will your baby survive? Hospital, possibly ; home, massively less likely.

Some women will lose their babies, their uterus, and maybe even their lives.

I'm massively in favour of home births- had 2 in my forties- and not unnecessarily medicalising birth -but home birth after a CS?

I guess if your birth experience is more important to you than being a parent to your existing children, and worth risking your babies life for, that's fine.

APMom · 11/07/2018 22:51

I had a uterine rupture during a c-section, my fifth birth but 1st section. It was rather traumatic but that was mostly due to ineffective staff. I'd previously had a homebirth and this one was due to be a HB too but he was a very large breech so decided on a section. Because he was meant to be a HB I left hospital 18 hours after delivery so avoided transfusion but built up my iron by eating well and taking extra iron. I then went on to have a VBAC at a different hospital, it went smoothly without continuous monitoring and DS was born safely. I wasn't happy to risk a homebirth at that stage but was lucky the hospital staff were incredibly supportive.

BertieBotts · 11/07/2018 23:15

One other point to look at with risk is whether the particular intervention they want to do which you're not keen on is actually shown to reduce risk or not.

It seems like it would be obvious but it's not always the case. This is a good article about continuous monitoring but unfortunately it only has the following paragraph mentioning uterine rupture specifically. That's what I'd want to know the numbers on - does it really reduce the risk of rupture/speed up emergency help if it did happen, or not? And what's the difference? Is it worth the difference that [I perceive] free movement to bring? Additionally is there any form of monitoring which allows for more movement?

It's clear that home vs hospital presents a difference in the event of a uterine rupture because in hospital you're much closer to theatre, crash teams, etc. Similarly with waterbirth, I could understand that the risk is different because in the event of a rupture it could potentially be difficult for medical staff to remove you from the pool.

Do bear in mind the linked article is based on the US where it is much more common to have continuous monitoring during labour, in the UK intermittent monitoring with a doppler is more usual unless you are high risk.

"Most guidelines recommend continuous EFM for people in labor who have had a prior Cesarean. This is because the most common sign of uterine rupture is fetal heart rate abnormality. Abnormal fetal heart rate patterns occur with about 70% of cases of uterine ruptures (ACOG 2017, #184). We only found one study that compared continuous EFM versus hands-on listening in people with a history of Cesarean, but unfortunately this study was too small (100 mothers) to offer any useful evidence about EFM vs. hands-on listening and the risk of uterine rupture (Madaan and Trivedi 2006). You would need about 12,000 people in each group in order to find a difference in the rate of uterine rupture between groups (Bujold et al. 2005)."

evidencebasedbirth.com/fetal-monitoring/

BertieBotts · 11/07/2018 23:22

If it wasn't clear (sorry) these kinds of conversations about risk, about options, about studies and evidence - these are the things you want to bring to the table with your midwife/consultant and discuss with them. It's in their interest for you to be happy and confident that your birth plan is including options which are safe and likely to lead to the best outcome for you. I do think that possibility for movement is an important aspect if you know that's an important coping mechanism for you particularly if one of your aims is to avoid a repeat c-section. I don't think it's merely about having a "fluffy birth experience", movement can really aid not only in the perception of pain for the woman, but it can also help the baby to descend effectively and enable a smoother birth without interventions which may carry their own risks.

RailReplacementBusService · 11/07/2018 23:26

I would say

  • nobody can make you do anything. You are an autonomous person
  • however you should ensure you avail yourself of all the relevant information and take into account personalised medical advice from experienced practitioners so you are fully appraised of the situation
  • bear in mind people people who hang around Home birth vbac groups will largely be those for whom it has all gone well. You are therefore unlikely to hear of many of the cases that didn’t end as planned, particularly any that ended very badly.
  • statistically birth is pretty safe today compared to any other point in history. Even with the enhanced risks the chances are that both you and baby would be ok. The key thing you have to decide is whether the increased risks you’d be running and the consequences of it goes wrong are acceptable to your risk appetite. Personally it would be well outside my own risk appetite and I would feel uncomfortable if a friend told me she was planning this. But at the end of the day I support you as a woman to make the decisions for yourself.
allotmentgardener · 12/07/2018 07:04

I think my main concern about being at the hospital is the constant monitoring and people who want to put their hand up your foof, and what I considered, the lack of control I had over the situation.

Looking back I wonder if part if the issue last time was that I got frightened. Despite all the research I'd done, hypnobirthing classes, antenatal classes etc etc I was petrified of the outcome.
Perhaps this is normal in first timers?
Labouring in the pool was an amazing empowering experience but once they got me out for monitoring and poking, it all went to rats.

I hadn't needed pain relief until then, but suddenly I couldn't cope. I felt out of control. I don't criticise the care I received, the staff were great.

I'm not daft enough to expect a pink and fluffy childbirth, but I want to feel in control, and get a healthy baby at the end of it.
I presume that is all anyone can hope for......

OP posts:
BertieBotts · 12/07/2018 07:47

Absolutely and I think feeling in control is so massively important. That's why it's imperative to be able to have these discussions.

I do think unfortunately sometimes the language used around birth, particularly for first timers can create fear - whether it's fear from people saying oh, you know, childbirth is awfully risky and dangerous and extremely painful - or whether it's fear of intervention, fear of surgery, demonisation of anything other than a "natural birth". Ironically the latter type of fear is usually induced by people attempting to squash the first type of fear! Like anything it can swing too far the other way.

I'd love to see a narrative about birth which puts women and informed choice at the centre. Not a narrative where intervention is always needed because birth is too risky, not a narrative where intervention is always bad because women must do it themselves, but one where intervention, monitoring, and pain relief methods (medical and physical and psychological) are all considered neutral tools each with their own indications, risks, benefits, etc and which all contribute towards the goal which really ought to be the same for everyone - a healthy, safe baby and a healthy, safe mother - and recognition that for the mother, healthy and safe means avoiding unnecessary trauma and anxiety, which usually means ensuring that she remains feeling informed and in control of what is happening.

Obviously there is a hierarchy of urgency, and I wouldn't expect medical staff to wait around to explain and reassure in a life or health threatening emergency - but the vast majority of interactions between labouring women and medical staff are not life threatening emergencies and it does not take much time or effort to explain what you want to do for her and why. In the event that intervention must be undertaken without her consent and/or understanding, an explanation/debrief should be offered as soon as appropriate and understanding given that this kind of experience is traumatic.

Usually, monitoring is happening for a reason and staff can explain to you what they are looking for and what it would mean if they found it, and you should in that case have the chance to decline. Intervention these days is usually done when it is fairly likely that outcomes would be poor without the intervention, but again, it is not usually the case that time is so short that the intervention and what they hope to prevent can't be explained.

Have you considered hiring a doula? They can act as a sort of mediator between you and medical staff so that you don't feel all of the monitoring, examinations etc are foisted upon you. I do think sometimes medical staff get into such a pattern and find what they are doing so routine that they forget to stop and ask, and it makes such a difference. Likely of course you'd agree to examinations, monitoring etc particularly when it's the case of checking things are going okay, but it's just being consulted which keeps you in the picture.

TillyMint81 · 12/07/2018 08:05

No one can make you do anything they can only advise.
Please check out the hb pages on fb. They are amazing for advice and support. I had a hb with my third baby but not after a cs. It's an amazing experience. X

northernlites · 12/07/2018 08:38

You should discuss all your options freely with a consultant midwife, or senior midwife, and then make a plan with obstetric team.
Uterine rupture is very rare, but you have to weigh up risks and benefits.
Take into account your history, reasons for previous c/s. How long ago was last birth? How big was your last baby?
If your more concerned with interference and loss of control there are ways you can overcome that.
Make a birth plan with senior midwife.
Have the baby on birth unit with intermittent auscultation, won't have Doctor's fiddling, home like environment and relaxing.
Don't have vaginal examinations, any midwife can read external and emotional signs of labour progressing and doesn't have to fiddle every 4 hrs to assess progress
...and so on
Take back control
It's your body you are in charge, yes make wise decisions, but do what's right for you

eeanne · 12/07/2018 08:49

I wanted VBAC for my second (first was planned section for breech) but baby never came out on her own and I ended up with another section.

I have a friend and two relatives who are OBs and they all said if I get to 40/41 just have a planned section. All had the same reason - uterine rupture is rare but having seen one they would do almost anything to avoid it given the chance.

putonyourdancingshoes · 12/07/2018 09:04

@allotmentgardener just because you're in hospital doesn't mean you have to accept whatever it is the HCPs offer/suggest.

Yes they will advise you as they think it's appropriate at the time I.e continuous monitoring or internal examinations but it is their duty to provide you with informed consent.

If you don't feel comfortable, you can decline. You can still be in control of your birth.

Good luck, whatever you decide.

cheesenchips · 12/07/2018 09:55

I had an attempted vbac and ended up with a uterine rupture. If I wasn't in hospital we both would be gone. It was touch and go with dd. Not wanting to add fear, just my experience. I had to have ds 3 weeks early to decrease risk of natural labor starting.

AgentJohnson · 12/07/2018 10:06

You’ll have as much control as the situation allows, wether your at home or in a hospital. If intervention is needed then you will be reliant upon the medical professionals and equipment available to them. Talk to someone about your concerns because there’s no guarantee a hb will alleviate your control issues, especially if intervention is needed.

TinoTheArtisticMouse · 12/07/2018 19:49

There was an interesting segment on radio 4 about home birth stats a few weeks back:
www.bbc.co.uk/programmes/p06925ls
I wouldn't risk it personally.

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