Do not trust hospital or midwives - is HBAC a really bad idea?

[SoozleQ]

So, the short(ish) story is...

I'm currently 34+4 with DC2.
DD was breech all the way through and, in spite of being booked in for an ELCS, I was turned away from the hospital on the relevant morning because they'd cocked up on their admin.
I went home, waters broke, went into labour, went back to hospital, was stuck on a monitor in triage for 20 minutes, was left in the cubicle for a while, was eventually walked through to delivery, was left in a room there on my own for another while and then was eventually, 2 hours after getting there, given an internal which showed I was fully dilated and DD's leg and hand were presenting - cue emergency section for fear of cord prolapse.

I would like as natural a birth as possible this time and, given that from waters breaking to being fully dilated must have taken about 2 and a half hours last time, I am feeling pretty confident in my body's ability to labour.

However, I have still had a C-section and so there is still a risk of scar rupture.

I do not, after my last experience, trust my consultant led unit at all. I keep being told "you will get one to one care in labour" - er, that didn't happen at all last time so I don't trust that it will happen this time.

I am not allowed in the midwife led unit because I am high risk due to previous C-section. And, to be honest, as much as I am sure there are many great midwives working there, I have not been having good experiences with meeting midwives in the hospital this time round.

Am I being really stupid to be pushing for a homebirth?

I just feel really pushed around by the hospital and midwives there. I don't trust them. I just feel like I'm either going to get forced into something I don't want or ignored to the point of emergency like last time.

I like and trust my community midwives a lot more than the myriad of different midwives I've encountered at the hospital. Once I've got them to my home, they can't just bugger off down the corridor and ignore me for half an hour at a time and I do genuinely think they will be more vigilant for the signs of scar rupture because I'm at home. I think I will be more relaxed at home and more able to remain active. If there's any sign of problems, I'm happy to transfer in. But I also know that that transfer time could be the difference between life and death.

I fully understand the risks, I've done all the research, read all the papers but I am just having to jump through so many hoops with the supervisor of midwives and don't seem to be getting anywhere that I'm wondering whether I am just being stupid/stupidly beligerent. I have had the same conversation so many times with so many different midwives and consultants that I don't know whether just to give up or not.

I just want to run away. Having a baby really shouldn't be this difficult.

How far away is the hospital (in minutes)?
Is there an alternative hospital that you trust more?
Who have you discussed your concerns with? Have you talked to your midwife about labour last time?

The reality is that you have had major abdominal surgery and so a home birth is very very risky. I have had two VBAC, in hospital and they were fine. I also have a DH who was fully prepared to go and nag staff if I needed to be seen.

I also know a friend who nearly died about 2 weeks after her third CS when her scar ruptured whilst she stood doing the washing up. Luckily we live about 5/10 minutes from the hospital with the blue light flashing.

'I fully understand the risks, I've done all the research, read all the papers'

If you have done all this and your informed choice is still a homebirth, then I think you should go for it.

You shouldn't be jumping through anyone's hoops - you have a right to a homebirth whether your consultants or hospital midwives advise it or not.

Hospital is really close - 5/10 mins with lights flashing like you. Also the ambulance station is just round the corner so would hopefully not take long to arrive at all. Notwithstanding that, I am conscious every second counts (but then you could be in hospital but with the operating theatres and surgeons already busy on other women).

Other hospitals are a good 30 minutes away on a clear run but and hour and 30 minutes in rush hour and I'm not sure I do trust them more to be honest. I'm conscious I dilated very quickly last time and so am reticent to aim for a hospital further away given things may be as fast or faster this time.

I feel as though I have raised my concerns with everybody in the world and that's one of the things that's getting to me. Community midwives have been understanding, lovely and supportive. Hospital midwives are far more obstructive and difficult and I just feel like I'm being passed from pillar to post and getting nowhere. I have a meeting with a supervisor of midwives on Wednesday to discuss further. I have already spent over an hour talking with her face to face, another 45 minutes talking to her on the phone and yet I still have to go over it with her again. The consultant I have seen previously and with whom I am supposed to have an appointment next Friday I have just found out no longer runs clinics at the hospital so it will be someone different yet again that I will have to start from scratch with. I'm just worn out with it.

You don't have to go through this with anyone again.

I planned a homebirth against medical advice (not HBAC) and emailed the SOM, met her twice, and that was that. In my email I stated that I did not wish to repeatedly discuss my decision, although I was willing to review it should something occur in that pregnancy or labour.

I refused consultant care as there was nothing they could tell me that I wasn't already aware of, nor would they change my mind.

Have you joined the Yahoo HBAC/Homebirth groups? Lots of ladies in similar positions on there - very helpful.

Thanks Flisspaps

Yes, I have joined the Yahoo group. I've not been on there for a little while so should probably have another look tonight in a bid to strengthen my resolve for Wednesday.

Just wanted to extend supportive vibes to you. I'm no medic and can't comment on risk/safety in your circumstances but I can certainly clearly understand why you feel the way you do. It must feel so frustrating but I suppose the hospital have to cover their backs hence asking you to attend lots of appointments.

The risk is ultimately yours to assess, if you are confident you are well informed and would have a more positive experience at home then you can have your baby at home no matter what the consultant or supervisor of midwives would prefer you to do.

It would be interesting to see the research that shows a home birth would be 'very very risky' for you as mummytime suggests. It seems to me that a successful vbac in hospital would have been a successful vbac at home.

Very best wishes with everything.

Just hang on though - you aren't being given a proper choice.

You've had totally appalling care and now, quite reasonably, don't want to go back to the hospital for a repeat performance.

So now you are having to take a course of action that although it doesn't have a great risk - it also doesn't have no risk. It sounds like you would like a natural birth but somewhere safe with caring staff.

Would you have chosen homebirth if you had met lovely caring staff who had stuck to their promises and supported you?

Yes, you do have a RIGHT to a homebirth - I'm not sure that's the point. I think you have been let down. I know several people like you who have had horrific experiences in hospital and then 'chosen' homebirth.

I have an issue about calling that choice. If a homebirth is what you want go for it but don't take risks if it is just that the other alternative is too awful to contemplate. If that latter, get in their and kickass about how the last experience affected you.

Good luck whatever you do - you deserve better than you've had so far.

Hi Soozle,
I had an immensely frightening and traumatic emergency CS for my first birth, with at least some of the trauma due to uncaring and incompetent staff.

My attitude second time round was very much like yours now - I wanted to labour where I felt safe, comfortable and supported, by the wonderful caring community midwives who knew me, knew my history, and who would just let me get on with it. I also wanted a pool, which wasn't an option if I went in. I was also 5-10 minutes from the hospital. If I'd been more than about 20 minutes away, I doubt I would have taken the risk of a HB. My rationale in the end was that you are more closely and frequently observed at home, so any problem would be picked up earlier and the hospital alerted to get an operating team ready (which takes 5-10 minutes), so there would be no real difference in time between home & hospital.

If you feel you have gathered all the information that you need, and your gut feeling is that HB is the best option for you and your baby, then go for it. My second child started school today, and just thinking back to the wonderful, happy and relaxed home water birth still gives me a huge sense of peace and empowerment. It was a fantastically healing experience (well, apart from the stitches!)

I wish you a safe and happy birth.

I can completely understand why you want a home birth. Know nothing about the risks of VBAC after caesarian but wish you the very best in whatever you decide. FWIW I have had 2 babies in hospital and were there ever to be a third I would have a home birth. It seems so much more humane and better in many respects.

I was classed as high risk, refused a WB and booked in for consultant, aneasthatist, etc. I researched and wanted HB. I was told it may not happen due to many MW's off with swine flu. I booked an independant MW and had a truly amazing WB at home.

Trust your instincts, inform yourself and make you choice. You have had some excellent advice so far. Good luck.

Have you also considered hiring a doula to support you as they would provide care and advocate for you either at home or in hospital. Good luck with your choice.

You've already had some great advice on this thread. I just wanted to say that in your situation, I would also want a HBAC. You sound incredibly on the ball, and informed. I guess the only thing I might investigate is whether an independent midwife is an option?

Hi this is just like my situation, 37 weeks dc2, dc1 8 years ago emcs was very traumatic for me. I have applied requested whatever the word is to do a hbac, .I feel I will be more calm and am 10 mins from hospital. I hope to see the sOM soon so I can get the process on the go, only a few days and this baby is going to want to come out!!

All the best with your plans, let. Us know how it turns out!

I booked an HBAC for similar reasons. I did transfer in for a section in the end but no emergency, just good old failure to progress.

No regrets at all, I knew I had my best chance of labouring at home and it didn't work but at least I wasn't being ignored and getting stressed out in hospital.

I discussed it with a SOM, yahoo group is fab, but the risks are to be considered against the risks of hospital birth. I felt the risks of hospital were too high, for me.

It's not a really bad idea but as you point out it's not without risks to you and your child. Personally, I'm not prepared to take that risk however miniscule though I would love a VBAC at home. I feel it is silly to think it could never happen to me and I would never forgive myself if the worst happened.
If your community midwives are v supportive and your DH/DP is also, then with clear agreed criteria as to when you would head for the hospital (poor presentation etc) you should be able to reassure your consultant, your DH and yourself. If you still have reservations at that point I would say to go with your gut and dismiss the home birth plan. If you can afford it, obtain the services of a doula/independent midwife/community midwife who fancies some private overtime to support you in labour and argue your corner.

I'm so sorry you've had such an awful experience and I totally get why you want a homebirth. I agree with a pp that it seems like its your bad experience causing you to make the "choice" of homebirth, which isn't how it should be, but it is so I guess you have to deal with it. You've had some great positive advice re home births here, but we all speak from our personal experiences. After my (100% natural!) delivery, I had a massive haemorrhage, losing 3L of blood and requiring emergency medical and surgical intervention. I have no doubt that had I been at home I would have died. They simply wouldn't have got to me quick enough, regardless of how close I lived. It still makes me go cold to think of my beautiful baby girl growing up without a mummy and me never getting to know her and love her like I do. I know you say you've researched and understand the risks, but without sounding patronising, I really don't think anyone can truly understand the risks and consequences unless you've been in that life threatening situation and had to think about what would happen if you were to die. This probably sounds overly dramatic, but please think about it before you make your decision.

i'm in a similar dilemma OP, i had a horrible first labour largely due to the continual monitoring which i know they will insist on if i try for a hospital vbac. last week i was all fired up for a hbac but when i saw my consultant she virtually begged me not to have one. i've got a midwife on one side saying there is no reason not to try for a homebirth and the consultant on the other side saying there is every reason not to :( i haven't got a clue what to do and i'm 34 weeks now. if it wasn'rt for the CFM or they could guaruntee that i could use the mobile monitor i would be more inclined to go into hospital but i think they will try to fob me off about the mobile monitor becasue it is more convenient for them to have me strapped to a machine. i know i can refuse the CFM but i don't want the whole labour to be a fight just to be able to move about. urgh i don't know what to do...

sorry, that was really no help

I would say consult with your SoM at the hospital, talk through your plans clearly and concerns from last time as well as this time.

Nobody can stop you having a homebirth, it really bugs me when women say they're not allowed. It makes me sad actually. You need to be fully informed of the risks benefits obviously, but nobody can stop you doing anything. Also the SoM may help you write a plan saying you CAN use the MLU as a compromise if you wanted, that's what I've seen happen in these situations.

I would 100% support you if you came to me with your concerns.

Thanks all for your great posts.

Unfortunately the MLU is out - they are totally inflexible on their policy there. That was initially the compromise position I wanted but I saw the most horrendous SOM about it at 18 weeks who was basically an aggressive bully, flat out refused and completely put me off going anywhere near the hospital or MLU at all. I had originally viewed my negative experience there as just one if those things - someone has to be the unlucky one and that time it was just me kind of thing. After that meeting, I was left with the impression that it wasn't just a one off and that it was actually a direct result of attitudes like hers, hence no ongoing trust in the hospital or system there. If it hadn't stressed me so much at the time and I had had the emotional energy to do so, I would have formally complained.

Anyway, since then home birth has seemed like the only real option. I've seen a different SOM who has tried to talk me out of it but ultimately has confirmed they have to support me and has written it as my birth plan in my notes. I'm not someone who wants a home birth at all costs but I do genuinely believe I am more likely to get more vigilant midwives attending me more closely at home than in hospital. In fact they have said they will send two out straight away rather than the usual one midwife initially with a second to follow closer to the birth. I did ask the head community midwife if she'd attended other HBACs and she said no, never. At least now that is an option I have available to me and I can still go in at any time if I have concerns.

All I've got to do now is finish the building work we are halfway through. Get running water, electricity and a kitchen installed downstairs and decide whether to get a birth pool on order . Four(ish) weeks is plenty of time to that, right?

ooh plenty i moved in on my due date my mw suggested a lazy spa for my water birth. At least you can use it afterwards either way.

Good luck with whatever you decide op!

I chose hb for my dc2 because I was really concerned about the care I would receive in hospital. Dc1 was born vaginally but there was intervention that I really didn't want and in hindsight I think was totally unnecessary. I was repeatedly "discouraged" from going into hospital during labour and arrived fully dilated and really distressed, the whole thing really upset me so much I couldn't contemplate giving birth there a second time. When dc2 was born the mw stayed with me from when I was 5cm until we were both tucked up in bed happily, any problems would have been picked up much quicker during my second labour because the mw never left me and so I feel that it was definitely the safest choice.

One thing to bear in mind is that you may have to wait a while if the mws are all busy, I had a fast labour with dc1 which they were made aware of but I still had to wait an hour and only had one mw for the birth as they were so busy that night. I still think I had much better care at home though!

OP - I chose a 'high risk' home birth rather than chance my luck at a hospital I'd had a bad experience in before.

It's a tough decision to have to make.

I think you should set your concerns out in a letter to the HOM and explain that you are choosing a home birth because of fear of a repeat experience of the substandard care that you had last time. Ask for a response.

My local MLU has taken VBAC mothers who are threatening to have their baby out of hospital if they are faced with the CLU. They obviously don't advertise this fact!

Ask them what would be the purpose of more discussions?

From their point of view they want you to change your mind - you're not.

From your point of view, I expect you want them to somehow 'approve' your decision - they're not.

If you have made it clear you know and accept the risks I can't see what purpose any more meetings would have.

Good luck and hope all goes well

Ok, just adding my own experience - hospital birth with dc1 was horrible, I too was abandoned, treated like an object, and with some scorn by certain staff. They seemed to leave me as much as they could get away with, until there was an actual emergency and they they just tried to do interventions.

I had an epidural and when my son's heartbeat dropped well below acceptable, no one was in the room except my mother who luckily woke and ran to get someone - cue trolley being pushed into another room, they wanted to do a CS, then they wanted to use ventouse, my mother said NO and I managed to push him out. It was fine but no thanks to being in hospital.

No one cared at all. Then I was left being really ill for hours while my baby cried and I couldn't reach him. then they threatened to give him a bottle - after he had already breastfed at birth!!! Just because I couldn't get to him in the cot and no one could be arsed to get him for me.

It was lousy...it seemed designed to put me on the conveyor belt of maximum intervention, I was given no choices, no control, very little respect.

Could not wait to get out.
Second was born at home, with two midwives, constant care, loads of respect and banter and just a nice atmosphere despite the incredible pain - and I did have a PPH, which wasn't expected, and they did cope with it, and I was FINE and so was my child.

Having a Hbac is not unusual. Plenty of people try, even if they end up transferring. Many succeed.

Especially living so near the hospital, I would back you ENTIRELY in your wishing to do this. Mine wasn't post caesarean, but still, we are a good half hour from the nearest place so it is a risk - and I've been encouraged to have this one at home, too. Thank goodness I don't have to fight - the only thing I get into arguments over is my (always, sadly) low iron levels but a bit of spatone and stubbornness sorted that last time

Good luck
It'll be Ok