HBAC - good idea or dangerous?

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My instincts tell me I'd like to stay at home for my VBAC and that I would be more likely to have a successful VBAC as would feel a lot more comfortable with a midwife I know (I'd be scared turning up at hospital and having a midwife I didn't know as last time a midwife didn't listen to me and put DC in a lot of danger as a consequence). But I have concerns for safety if anything went wrong at home. Previous EMCS was due to poor baby position which resulted in distress and heartbeat petered off and didn't come back but there was plenty of warning that something was wrong so had plenty of time to get to hospital from birth centre (had been at hospital several hours being monitored before the emergency) so I would transfer immediately if there are any concerns. Also Drs said there is no reason to think any of it would happen again and I would be a very good candidate for VBAC.

Would be very interested in thoughts of those with experience of VBAC or HBAC on the pros and cons. Particularly interested in any midwifes who attend home births and their thoughts on the safety of HBACs. Thanks for your thoughts!

I would never do it.

You've never delivered a baby vaginally, you have no idea how your body will respond in the latter stages of labour. Far too much to go wrong in my opinion.

I attempted a VBAC in hospital but ended up with second CS, so am probably biased!

No experience of hbac but I am a midwife who has seen more than a handful of uterine ruptures. Once seen never forgotten. Sorry.

Support here:

www.aims.org.uk

This website is really helpful too www.homebirth.org.uk/

Really, the most useful thing to know would be the likelihood of a rupture, and whether the risk seems remote or very significant to you.

Asking other people will only tell you about their comfort zones surrounding risk in birth, not your own.

The figures are just under 1 in 200 by the way, for a scar rupture after 1 c/s.

I'm not sure whether that figure includes VBAC's where there has been a medical induction, who may be more at risk of a rupture.

I tried for a vbac. First delivery was due to position, stressed baby, hospital transfer. I wanted to try a hbac. I was told I was a v good candidate. First delivery was bad luck.

I had another emcs due to position. It was a very good thing I was in hospital actually. There were some tough bits. Home might have been a different story.

wow.homebirth.org.uk is a good starting point.
Currently planning my own water VBAC (I planned home births with previous babies but first was meconium ventouse and 2nd was elcs for breech). My hospital has wireless monitoring so can go in pool. Although my consultant said she would support a hbac or vbac on midwifery led, for me as long as I can stay mobile (which I can with telemetry) I feel more reassured with the continuous monitoring.
I think that you need to do your own research as well as speaking with the professionals and decide what risks you are happy with. The risk of rupture is 0.5% but this increases with induction. The baby's heart rate is usually the first indicator of rupture although there are other signs e.g. pain in-between contractions, maternal tachycardia. At home you would have intermittent monitoring and the danger is that you could rupture in-between the monitoring and a change in baby's heartrate wouldn't be picked up instantly. On the other hand, you are more likely not to rupture and you will have one to one care at home.
Like I said, gather all the reliable information that you can and make an informed choice.

I suppose the key thing to consider is, although the probably of something going wrong may be small, the consequences of something going wrong could be catastrophic. And that scar rupture isn't the only thing that could go wrong.

I know someone who has had several HBACs. And another who had a uterine rupture during an attempted VBAC in hospital and nearly died. There was a MNer who had a child who was profoundly damaged at birth during an attempted HBAC. Everyone has anecdotes, good and bad. It really is about your personal risk threshold.

I had a uterine rupture during an attempted VBAC I had a crash (and I mean crash, not emergency CS). DH didn't even go into the theatre as there was no time to get him ready. It was very frightening - nearly lost me and my baby. If I'd been at home we wouldn't have stood a chance. I hadn't had any interventions by the way. Straightforward labour until baby's trace went crazy. So I am very pro monitoring too!!!

Another here who's vbac in hospital ended in an emcs (wheeled into theatre with a midwife straddling me with her hand up my vagina to stop ds2 attempting to descend as it was basically killing him)

I am all for vbacs, if I were to ever have more children I would try again, but always at hospital as the risks are completely different risks to a first birth or homebirth.

I had one to one midwifery in nhs hospital as well, she wasn't even allowed her break without cover. Was lovely environment, lovely labour, right up until the end.

I've had 3 VBACs following an ELCS due to ds being breech. I had though had a vaginal delivery with my first child who was head down like my last three.I would never have wanted a HBAC far too risky for me to contemplate especially when dsis's friend's scar ruptured during her VBAC and they had a matter of minutes to save them both. She has since had another child by ELCS though.

I had an unplanned HBAC. Interestingly, my midwife freely offered me a home birth and it was never suggested to me that it was an unsafe option. My first birth was a crash section due to severe foetal distress. I was advised that this was a 'baby-related reason' so not likely to recur (in the way that a 'mum-related reason' for c-section might).

During my labour, I was attended at home by my midwife at home because I used the NHS funded One to One Midwives service. I was monitored regularly but using a handheld doppler (I think!!) and wasn't hooked up to anything. I suspect I got much more personal attention at home with a midwife right there with me than I would have in hospital - my understanding is that 'continuous monitoring' just means you're attached to the monitor - it doesn't mean someone is actually watching the readout constantly.

I ended up delivering at home (entirely without incident) and was happy with that outcome, although I had planned to go to hospital. If we have any more DCs (under discussion at the moment!) I would choose a home birth again. We live very close to the hospital and I would feel confident that I would have a midwife in attendance the very moment I asked for one (no idea if this is how it works with a home birth where the midwife is sent from the labour ward rather than being dedicated to you individually). I would be very very reluctant to birth in hospital

....because I know that I need to be mobile in labour and my local hospital doesn't have facility to allow continuous monitoring whilst you're mobile. my midwife expressed the opinion to me after my HBAC that I would likely have had intervention in hospital because the baby only came out once I stood upright. I wouldn't have been able to get into this position in hospital. So for me, I think my outcome (straightforward delivery with no tears or stitches) was better at home than it would have been in hospital.

If I do have another baby, I will obviously have concerns and fears about the birth - with only a 50% positive experience rate, I wouldn't want to second guess how it would go next time. Overall though, for me the level of personal attention and care I got at home and our proximity to hospital, plus the fact that I know and trust the midwife that I would

Sorry, posting on phone so having difficulty-

I know and trust the midwife that I would have taking care of me, so overall I think I would choose the home birth option. I couldn't switch off the little bit of 'what if' feeling, but I know I would not cope with labouring in hospital and so that makes the decision for me. Things can go wrong in both settings for lots of different reasons. All you can do is get as much information as possible and decide what you're comfortable with. You can always book a home birth and then transfer voluntarily to hospital if it doesn't feel right at the time.

Thanks everyone your comments have been really useful. I think the dilemma is that I'm sure my labour will stall in the hospital with unknown midwives as I will be very anxious because of the last experience. I'm also concerned that they might intervene if things are moving slowly. Personally I'm happy for it to take a long time so long as mother and baby are doing fine.

Did people find the hospital supportive of VBAC even if it was slow progress? Did they only intervene when genuinely concerned for the baby?

I wonder if there is some sort of middle option? Maybe I could stay at home with a midwife for early labour and once labour is well established (maybe 6cm or so) I could go to hospital. Then hopefully it's less likely to stall. Does the risk of uterine rupture increase later in labour? Or would I be expected to go to hospital at 1cm? If it's the latter, I really don't think this is going to work for me and therefore maybe I should just book elcs. I liked my CS tbh it was a wonderful experience (apart from the fact that DC was in danger - obviously wouldn't want a repeat of that) but i was very well cared for. I want a large family so want to try VBAC mainly as its safer and just general curiousity.

I stayed at home til advanced labour with ds2, (vbac) so just 30 mins in hospital before he was born. Dd was a hbac. She had intermittent monitoring for about 5 hours so i guess her birth was really the safer from the pov of monitoring. It does depend on your attitude to risk and the kind of risk/responsibility you are willing to take

My hospital has been very pro vbac (section was 14 months ago and due next month).
Have you considered meeting with a supervisor of midwives to discuss your concerns and go through a birth plan? I have been meeting with one and she has been brilliant. Part of my plan is to stay home as long as possible, they don't expect me to go in as soon as labour starts as you are more likely to birth vaginally if you arrive in hospital at least 5cm. She has asked whether I'm happy to have vaginal examinations and said these can be done in the water. She agrees that being mobile will be better and also being in pool- I have chosen the wireless telemetry but again this has all been my choice. I explained that I had a fear of being labelled the 'vbac' and that people would be quick to intervene because of this. Because of this any decisions (obviously that are not life and death) will be discussed with the consultant (who I have met 6 of and they are all woman focused/empowering and forward thinking). My birth plan will be in my notes and also on their supervisor system (there is always a supervisor on call as well). These are just a few things that have been planned for so that I feel more confident.
I also have a doula who will be with me at home and in labour - have you considered one?
Before meeting with the consultant and midwives, I had a lot of preconceptions about how they would treat me and what they would want me to do. I was completely wrong and wished I wouldn't have second guessed them before speaking to them.
Is there a midwifery led unit attached to your hospital? This may be another option.
Hope that you get the birth you want!

My consultant wanted me to have another ELCS with what turned out to be a successful VBAC. Reasoning being I was 9 days overdue and dd was back to back as well as me having a small pelvis and dd being bigger than my first baby.
He agreed to a half dose of prostaglandin to see if it would kick start labour and I agreed to an epidural from the beginning and constant monitoring and a Csection if labour didn't start.
As it was labour got going and MW broke my waters as soon as she was able and dd was delivered quickly and easily and totally pain free for me.
For my next VBAC I got to hospital at 4 to 5cm,again had epidural at consultant's request (for csection if needed) and constant monitoring ds again arrived easily.
For my last birth it was a different consultant as mine had retired. My waters went but no contractions so I was given a syntocin drip. I had constant monitoring but only gas and air and dd arrived safely.
My consultant wasn't pushy about an ELCS although perhaps didn't fully understand why I didn't want another. I hated my C section,I hated feeling like an invalid when I got home. It just suits me better to be up and running once I've delivered. The actual birth to me didn't matter so much if I'm honest so long as babies were fine. If C section recovery was like a vaginal delivery recovery then the C section wouldn't bother me I don't think.

Have you spoken about this to a consultant? I am not sure they would allow because you are risky due to previous c-section.

I wanted a Vbac with my second. Never happened but if it did I would of rather been in hospital.

I've had 2 vbacs following emcs for failure to progress as a result of induction and baby's position. I found they listened a lot more to me with both vbacs than my 1st birth. I think it's on the grounds you've done labour once so you know your body. I had the same doula for all 3 and would trust her to deliver over the midwives if need be so don't really care hugely which midwife i get and whether i've met them before . In the 1st vbac they did start suggesting they might need to do a cs on time but when i in lots of pain agreed enthusiastically the obs ran away in the hope this meant things were progressing which they were as i think that was transition. In the last one they just asked regularly where the pain was and on me assuring them it was pushing pain they left me alone. I wanted to labour at home until quite late but got scared and got to hospital too early. Remember that a place of safety can be anywhere you feel safe and at home in pain did not feel safe enough to me.