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Childbirth

Share experiences and get support around labour, birth and recovery.

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Original poster

Anyone heard of a homebirth after an ECS?

66 replies

MeggLeVache · 08/04/2006 15:21

I am so scared of hospitals - had an awful time with ds - did not want to go to hospital and was coping fine at home then dh stupidly phoned the midwives on duty and they insisted we get to the hospital and it all went pear shaped from then on.

So, can I ask for a VBAC at home? Would a doula be a good idea. I have ages to worry about this as not due till the Autumn.
TIA

OP posts:

Are your children’s vaccines up to date?

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pinkmagic1 · 08/04/2006 22:43

Its up to you, but it might be safer just to stay at home a little longer, then go to the hospital last minute. This is what I plan to do this time. Although I didn't have a C section I had a complicated forceps birth. I will stay at home as long as possible but personally feel safer with the medical back up the hospital provides. All being well I plan to discharge myself as soon after the birth as possible.

ladyoracle · 08/04/2006 22:47

\link{http://www.homebirth.org.uk/\homebirth}
\link{http://www.caesarean.org.uk/\caesarean.org}

Sorry if you already know about all this, but most of my info, and support has come from these sites, some of the birth stories are really motivational and uplifting, and the statistics re rupture and other complications are put in perspective.

Happy reading!

pupuce · 09/04/2006 10:09

Meg you can always CAT me I am in Kent and know quite a few NHS midwives and consultants.
I don't think I want to even bother responding to Motherearth, her post shows a great deal of ignorance.... shortage of MWs is one of the reasons why women have bad hospital births and sadly we do know mumsnetters who have lost their baby in labour in hopsital due to negligent care... do I need to say more.
Hospitals are not safer than home !

Original poster

MeggLeVache · 09/04/2006 12:29

I can't CAT Pupuce would you mind e mailing me at meggmoo2 at yahoo(dot)co(dot)uk. That would be brill.

OP posts:

motherearth · 09/04/2006 13:05

I totally agree that hb IS safer than hospital birth.However can anyone on here provide sound research to back up the increaed safety following a previous cs ?

ladyoracle · 09/04/2006 13:41

There is unfortunately no research on home vbacs, we can only state that vbac is safe and home birth is safe, so why not in combination??

There is also no research to prove that home vbac is unsafe in case you were wondering

Laura032004 · 09/04/2006 14:33

My only thoughts on the safety of a hb/vbac combination is that you are more likely to experience problems during a c/s than during a natural unassisted birth, and this is more likely to happen at home. The risks associated with vbac are most common when the labour is augmented in some way - this doesn't happen at home. Unfortunately the exact stats aren't there yet. The incidence of scar rupture (with potential serious fetal or maternal consequences) is 0.1% (1 in 1000) which is really very low. Most of these will be in labours which have been augmented with oxytocin.

motherearth · 09/04/2006 19:22

Laura020304
You say she wont have any extra resources on top of a hospital birth.
What about the cost to the nhs of 2 midwives being on call every night from 37 to 42 weeks ! At 25. 00 a night each thats in excess of 1500 pounds. Not to mention the stress put on the poor already streched midwives.How are they to predict a ruptured uterus in time. 1 in 1000 is quite good odds-i wouldnt personally wouldnt risk any odds on my baby.1 in 1000 is awful if your baby is the 1 . How long do you have following the rupture to save both lives-i think its a few minutes.HB is safer only if there are no predisposing risk factors, of which a previous cs is one.Protocols are based on sound evidence to protect the lives of both mother and baby-they are not just plucked out of nowhere.They are formulated following lengthy discussions between hospital professionals and lay people experienced in midwifery research.

Laura032004 · 09/04/2006 19:48

I don't know about other areas, but in my area MW's are on call 24/7 anyway, but then we live in an area with quite a high hb rate, and the CMW's also do the deliveries at our local Community hospital. Therefore, at least if somebody is using them to give birth, them being on call is worthwhile!

Yes, you do need surgery within a few minutes of a rupture, but ruptures don't normally happen completely out of the blue. So you're down from the 0.1% to whatever the figure for labour without augmentation would be? Some say a quarter of this figure. Then if you are giving birth at home, with the full attention of a MW, you are more likely to pick up the symptoms of a rupture at an earlier stage. Having picked this up, you would transfer immediately, probably to a prepped theatre for a c/s. Not left for a while whilst the MW looks at other mothers or doesn't notice the symptoms because they are so 'overstretched' and relying on the CFM to pick up any problems, which don't always show up as expected.

Anyway, we'll have to agree to differ on this. I've made my mind up about what is safest for me and my baby. Personally I'd feel we are more at risk in a hospital, but then that's just my opinion :)

Olihan · 09/04/2006 19:52

Try and find a sympathetic MW or consultant. My friend had a CS with her 1st because he was breech. One MW she spoke to said the minute she was overdue she'd be booked in for another CS but when she spoke to the consultant he said that was rubbish, it was fine for her to go overdue and be induced if necessary. She had a very straightforward VBAC at 9 days overdue.
0.1% is such a tiny risk, there's more chance you'll be in a car accident that have a uterine rupture. I bet motherearth didn't stop travelling in a car for her entire pregnancy, just in case she was that day's statistic.

pupuce · 09/04/2006 19:57

"Protocols are based on sound evidence to protect the lives of both mother and baby-they are not just plucked out of nowhere." LOL.... if you only knew... I sit on 2 hospital committees.... and LOL LOL LOL!!!!

Thise on-call MWs are on-call for more tahn 1 woman and believe me if they don't waat to come... they'll make it plain clear and unless the mother knows her rights she'll agree to go to hospitals.

I know a woman who had a scar rupture with her 1st baby... too much synto... and she wasn't even a VBAC! There was a scar rupture highly publicised last year.... it was a HVBAC and the ind. MW involved transfered the mother when she knew there was a problem as she didn't have any medical rights once in hospital she had to leave the NHS (St George I think)... and the docs gave her synto, her scar ruptured after hours and her baby died.....

pupuce · 09/04/2006 19:58

Laura that is spot on!

motherearth · 09/04/2006 20:31

I can assure you these midwives are not on call most of the time for more than one woman . If you are on the protocol committee ,and you disagree with the protocol, then yes there is a major problem. Perhaps you do not have the research based evidence (which fortunately professionals in the nhs insist upon as it is more reliable and safer than heresay ) to back up your views . In that case they will not change their protocol.If you go in with the research in your hands and give it to them then maybe they would change-maybe for the better if rhe evidence says so.I can assure you i would be most distressed to be expected to have the skill to predict a ruptured uterus and then live with the consequences all my life.Primips will stop contracting whereas second time mums will just contract until they rupture.Finally i believe that if 1 in 1000 babies was to be saved by encouraging post c section women to deliver in hospital it would be worth while.I am still of the belief than hb is safer than hosp birh- if ther are NO risk factors.As soon as a risk is identifies transfer to hosp is better.In this case the risk has already been identified.The lady has a scar and a previous cs with numerous potential complications-rupture being just 1.

CarolinaMooncup · 09/04/2006 20:51

are you a MW, motherearth?

cori · 09/04/2006 21:15

Sorry to interrupt. Pupuce but how do you have a scar rupture if your not a VBAC?

ladyoracle · 09/04/2006 21:19

ME, the current medical evidence would suggest, given the average 25% c-section rate, that nearly 1 in 3 babies being born in hospitals would die or be severely disadvantaged in some way, were labour be allowed to progress normally. The risk of uterine rupture during vbac is less than the risk of many other complications of birth, whether previous c/s cases or not, the risk of cord prolapse during any labour is double that of uterine rupture during vbac, yet no one suggests that all mothers should birth in hospital just in case.

No one can 'predict' a ruptured uterus, however, the one to one care of a midwife at home is far more reliable than your average unattended EFM in a hospital ,where your midwife is more than likely relying on the printout to tell her everything, while she flits in and out of the room.

No birth is without 'risk factors' one of the biggest being the setting of foot in a hospital during labour, you have a 15-25% risk of ending up with a c\s. Some people think this is ok, some of us have never experienced such pain, loss of dignity and helplessness before, and don't wish to do so again.

ladyoracle · 09/04/2006 21:25

Cori, a uterus can rupture under certain circumstances whether it is scarred or not. Other causes include induction of labour, multiple pregnancy, or any case where the uterus is over-stretched ie if the baby is lying in a strange position. It is an extremely rare occurence though.

bubble99 · 09/04/2006 21:27

Could be a scar from a previous laparotomy for treatment of severe fibroids, for example.

motherearth · 09/04/2006 21:43

Cord prolapse can be identified as a high risk of occurring in most cases, ie, high head at term, polyhydramnios, malpresentaion or malposition, birth defects ect, therefore these women at increased risk of cord prolopse would be advised to del. in hospital anyway.
The cs rate is 25 % in America but not in uk.
I agree in many cases defensive hospital practice is a huge influence on the high cs section rate. The cascade of intervention following admission has a huge influence on outcome.If only more women would opt to have their babies at home so it was the norm not the rarity.
However i still sincerely believe that until there is evidence to suggest otherwise, previous cs is a good enough reason to encourage hosp del.Maybe a compromise on low risk care so mum can stay upright and mobile and take diet ?
Its a shame so may mums have such a bad experience of hosp birth and their midwives flitting in and out of the labour room.Most midwives certainly dont rely on the monitor to do their jobs.They use it as an extra tool when risk factors indicate continuous monitoring.Therefore unless the midwife does nothing else but listen in to babies heartbeat a)she wont be freed up at all to care for the women and b ) she will get sued if the protocol indicates continuos monitoring and this is shown not to have been done after the babe is born in poor condition.

bubble99 · 09/04/2006 21:50

I for one will be having a hospital birth after my last emergency CS and peri-natal death a year ago. I'm due in November but will ask for a CS as early as possible (38 -39 weeks?)which will bring EDD forward to October. I'll do this to avoid another failed spinal and failed intubation. In another life I would definitely have considered trying for a VBAC at home but with my obstetric history I wouldn't even try for a VBAC in hospital now.

ladyoracle · 09/04/2006 22:14

The cs rate is 25 % in America but not in uk.

Sorry, confusing local and national statistics, thu uk c\s rate is approx 23%. Big difference there then.

bubble99 · 09/04/2006 22:25

'I for one'......?? Sorry, I came over all 1950's then.

motherearth · 09/04/2006 22:32

We have the lowest cs rate in the uk here in Shropshire, and the highest normal del rate-just over 10 %

bubble99 · 09/04/2006 22:35

Is VBAC more risky after an emergency CS as opposed to an elective?

ladyoracle · 09/04/2006 22:43

I can't see any reason why anyone would differentiate Bubble, the procedure is the same.

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