Home Birth after C-Section

[AvengingAngel]

I'm 33w pregnant with second child and planning a HB after a traumatic hospital experience resulting in a C-Section. The local hospital consultants are horrified and have waved the scary statistics in my direction, but my community midwife who has committed to the homebirth with me is experienced and confident.

Has anyone else had this experience? Any words of wisdom?

Here?

here

You need all the information you can get your hands on, to have a chance to read it and discuss it with your partner, and support once you make up your mind what to do.

Remember that hospitals often become much more flexible about their protocols if you are truly willing to have your baby at home. My local hospital has offered VBAC mums all sorts to try to persuade them to come in - access to the birth centre, a chance to labour in water, no continuous monitoring. And sometimes the involvement of a senior midwife and a really good care plan for labour can provide the reassurance you need that it's ok to go to hospital and you won't feel out of control once you get there.

Should add - as someone who's had a 'high risk' homebirth, I found it was better not to discuss my plans with too many people: the levels of negativity I encountered made me feel extremely upset and stressed towards the end of the pregnancy, which wasn't good for me or ds.

Thanks for the reply Shamundfreud and for the link.

I very much doubt I'm going to go back to the same hospital to give birth. I think I'd rather do it by myself with the cat on hand to offer support.

The MLU is a good 40 minutes away from the Hospital, whereas we are ten minutes... Plus two midwives on hand to constantly monitor, which in my experience would be a laughable luxery at hospital. So my thoughts are it would actually be safer to have a home birth in case of a scar rupture, which I think is the main concern?

My mw team gave me an absolute no to a hbac, which I was actually very happy with given the gravity of the emcs.

As it transpires #2 would've been emcs anyway although hospital less than 2 miles from home.

I had a horrible emcs first time, planned a hospital VBAC second time with v experienced IM to come with me as doula. As it was, DS just slipped out in the corner of the bedroom before we had chance to even think about getting to hospital. The hospital MWs were very disapproving! I planned to go to a different hospital second time - not going to let the butchers from the first one get their hands on me again!

If your MW is confident, that is most of the battle won. You don't need to share any more info about what you are planning with the hospital staff. The website Shagmund links to has a lot of very good info on it.

I've been given a firm 'no' to hbac this time, despite having had two successful vbacs since my cs. However, unlike you, I am at least an hour away from my nearest hospital, so in the event of an emergency, transfer time could be 90 minutes or more.

In your case though, you're so close to the hospital, I can't see how there's a problem, particularly as you have a supportive community midwife onside.

Yes, a lot of stats point to home birth being safer, as you say, 2 midwives looking after only you; a more relaxed atmosphere; less likely cascade of intervention etc. Plus the actual risk of rupture is incredibly low - about 1 in 300.

I am grudgingly going along with my Obstetrician, since we are out in the sticks,but in your position, I'd definitely be pushing for a home birth.

Best of luck to you! :)

I am planning an HBAC in the next couple of weeks. I have also doulaed for an hbac mum, lovely birth, despite a lot of pressure from the consultant (even on the day) for her to be in hospital.

They will say no, because that is the policy, but the choice is yours.

I had a horrendous time in hospital, and it was going to hospital which stalled my labour and ultimately led to me having a emcs I might not have needed, it was classic failure to wait. I have a slightly high BMI, but apart from that it is just the VBAC that makes me "high risk". Ultimately me and the consultant both wanted the same thing, a successful natural birth, but we disagreed on the best way to achieve it, she thought that being on a continuous monitor would be safest, I felt I would labour better (and quicker) in a home environment, and feel safer with 2 midwives monitoring me (rather than a machine) regularly.

Get a copy of "Vaginal Birth After Caesarean, the VBAC handbook". vbacfacts.com is also very good.

The 1 in 300 figure is also falsely high when you look at the studies that produced the figures, about half of those are dehiscience, where the scar splits, but not right through, this usually isn't diagnosed until afterwards. It also includes ruptures before labour starts, induced labours (much riskier in terms of rupture) vertical scars, close spaced pregnancies (less than 2 years), so it is not really an accurate figure in terms of your risk of catastrophic rupture. Of course there is still a risk, but it is less than is usually quoted.

The key with HBAC is to have your midwifery team on side. You will likely meet with your HOM or SOM to organise a plan. On their side they will make sure a confident, experienced midwife is rotaed in on call for you when you are due. They will suggest a schedule for monitoring, and the markers they will use to transfer in (for instance they won't want your second stage to go on for more than an hour, so if pushing is slow, they will suggest transfer, you can ask them not to direct you to push though, and see if your body does it on its own) you don't have to transfer at any point if you don't want to, but they will want to go through what they think is best in advance with you.

Be prepared for a lot of "informed consent". You will be repeatedly told the risks of the choices you are making (including when they arrive and find you in established labour), and the worst case outcomes, this is just so they know you understand, and ultimately they are likely to support you in your decision, unless there are lots of other risk factors working against you, in which case they will give you strongly worded "advice" against it.

A few years back, a friend of mine was given a firm "no" to a hbac after an emcs. So she employed an independent midwife, and had a perfectly calm, safe home birth. I was there, it was amazing.

Thanks for the advice. I will absolutely get that book. Also that is very reassuring knowing the rupture statistics are skewed....
I'm not sure they can say "no" to a home birth. After I kicked up a stink the Consultant admitted to me, the NHS have to support your birth choices, no matter how risky or against policy....
I've also got a waterbirth planned too. I'm very grateful my community midwife has pledged her support. She's even giving up her annual leave on and around my due date. I should get her some flowers or something actually!

Recommend joining the Yahoo group HBAC/VBAC and homebirth UK.

The MWs have to support your choice, as long as it is an informed decision.

Go to see a Supervisor of Midwives if you need more help arranging your homebirth

I booked a homebirth after a traumatic crash section. In the end, I transferred in for another section but there was no rush and I was fully informed all the way and happy with the decisions we made throughout.

It's funny: my last baby was so quick she arrived within 30 minutes of arriving at hospital - I only lived 5 minutes away at that point.

Speaking with my midwife about it at my last appointment, she offered to go over delivery with my dh in case we don't make it to the hospital! It seems daft that they won't consider a home birth on the one hand, but are advising me on how to deliver at home without any medical presence on the other!

Festiemum....Call their bluff as I did. I said fine, if you won't support me in a home birth I'm doing it on my own anyway. That's when the truth came out about the NHS having to support a home birth after c-sec. I find it incredible they won't consider it. It's your body/baby/birth! And you are a woman in their care. They surely HAVE to support you!

I am going to go against the grain here. I had a failure to progress emcs with dc1. When pregnant with dc2 i did a lot of reading about home birth and really considered it but eventually decided to opt for vbac in hospital as we were about 50 minutes away.
I went into labour naturally and went to hospital. During labour i suffered a complete uterine rupture. I had a crash emcs within 12 minutes of them suspecting a problem. DD was outside of the womb in my body cavity. She went straight to nicu and thankfully we are both here 2 years later and she is fine. If i had been at home she would have died. That is the stark truth. Yes the risk is small but what is being risked is so immense. The same thing happened to my friends neighbour but she was at home and the baby died.

I am sorry if this seems like a harsh reply to your op. I suppose for me i feel so grateful that i was in hospital that night. To think that i came so close to losing my precious dd is frightening. I just wanted you to know that although the risk is small , it does happen and i am a real person that it happened to. There was no reason why i should have ruptured, everything was normal. But i did. I think there is a safe middle ground here and that is a hospital vbac. And creating your own 'mental enclosure' to enable you to cope in the environment. I do wish you luck whatever happens and hope this reply isn't too upsetting.

Zoonose, I appreciate your reply. That is my real worry. But but but, the care in the hospital during my first delivery was sooooooo bad, if I had had a rupture noone would have know about it for maybe two hours or so. My community midwife said to me catagorically she would know if there was a problem before I did, ten mins to hospital and a crash section waiting for me when I get there. This is why I have opted for a home birth because I actuallysee it as a safer option. But yes, you are quite right, it is a worry. Shame the fuckers mucked up my body the first time around or I wouldn't be having this choice to make. :o(

That was supposed to be a sad face by the way. Not a great big grinning one at my dilemma created by poor maternity care!

I had a hbac and also previously a hospital vbac where I just laboured at home and turned up with 30 mins to go. The hbac was probably safer tbh
So long as you are comfortable with the various risks of home vs hospital, just keep repeating 'I'm having a hbac' and it will be arranged. I had a pool and a good midwife plus a doula

I'm really sorry to hear of your experience, zoonose. I am glad you were in hospital.

The thing my midwife said which resonated was that in the case of precipitate birth such as my last, it's very rare for complications to occur, since the body very efficiently goes through labour. As this is my fourth child (third natural labour) I'm hoping for another quick one. Maybe, as you say angel, it'll be case of just getting on with it when the time comes!

As for you though, you're ten minutes away. Midwives will pick up on problems before you're even aware of it and in the case of a major emergency, theatre will be prepped and ready while you're transferring. You'll be in as quickly as you would have been had you been in hospital!

I'm just going to have to play it by ear! :)

She said she was 50 minutes away... but presumably didn't have a history of precipitate labour to contend with.

Sorry, confusing posters - I will shut up.

I'm in the same position as AvengingAngel. The supposed care I received at my local hospital for my first birth was laughable until the point where they realised that I was fully dilated and DD's knee and hand were poking out. They fully knew when I turned up at the hospital that DD was breech and that my waters had gone in a big explosion and yet it still took them two hours or so before they did an internal - this in spite of the fact that the statistical risk of cord prolapse in a non-frank breech presentation woman who's waters have gone is significantly higher than that of cord prolapse 1 in 50 as opposed to 1 in 200 (I take my figures from NICE guidelines or RCGO greentop papers, can't remember which). When they did realise, cue emergency C-Section - I was supposed to have had an elective section that morning but had been turned away because they had cocked up their admin, crossed me off the list (as apparently I'd already given birth) and given my slot to someone else.

Sooo, when I raised my concerns with the Supervisor of Midwives during this pregnancy, I was hoping for a bit of reassurance that things would be dealt with more appropriately this time. Instead, I got responses such as "well they obviously just didn't think you were in labour" (what great justification - that of course gives me comfort that the same thing won't happen again), "well DID you have a cord prolapse?", "my main consideration is my midwives" (glad to hear that your labouring women don't come in the way of your concern for your midwives) and, my personal favourite, "if you suffer a scar dehisience, your baby WILL die" (never seen a 100% baby mortality rate in any of the papers I've read - but if you are just talking about your hospital then I'll give it a miss, thanks). Notwithstanding that she may the Supervisor of Midwives, I don't want that woman anywhere near me or my baby at any further point in this pregnancy.

As a result, I have no intention of going anywhere near my hospital when number 2 decides it's time to put in an appearance unless there's a clinical need to. I do not trust or believe that you receive anywhere near appropriate care in the hospital in what they consider to be early labour because there's only enough of them to focus on the next lady they think is going to give birth - accordingly, you just get stuck in a room, possibly on a monitor, and ignored until they get round to you. Far more danger of something being missed in those circumstances than if you have a midwive with you at home - she's not going to be popping next door to check on Mrs Smith and she's going to be more vigilant and aware of the need for a speedy transfer if there's any indication of things going wrong.

I'm more than happy to trust my hospital in an emergency - they were very good last time once they realised they actually had to act. My issue is that things should never have got to that stage in the first place and it was purely due to their incompetence that they did. My DP isn't very happy (although will go along with it) about my wish for a home VBAC but all he is hearing from the consultants and evil SoM is risk of scar rupture = certain death of both mother and baby.

Having a baby really shouldn't be this battlefilled.

Oops, sorry, second reference to cord prolapse in first paragraph should, of course, be reference to scar rupture.