How safe is a VBAC homebirth?

[zazas]

I am hoping to have a homebirth with my third baby in April. However as I had an emergency c-section with my second I am getting mixed messages from midwives about being able to do this.

Their main concern is womb rupture along the scar even though from my understanding it is rare?

My first was a natural labour / birth all under 4 hours, my second (over 5 years ago) was a emergency c-section through brow presentation - quite unusual and unlikely to happen again. This was also a straighforward labour though with only a few hours from waters breaking to being fully dilated and he was nearly 2 weeks early!

So I am hoping I will follow a similar pattern with this one and feel confident that my body is OK with a VBAC - so it is only the risk of rupture that is causing a problem.

Does the risk of this warrant not having a homebirth? The local maternity unit won't allow me to deliver there and I will have to travel to a larger hospital where they said that they will continuously monitor me (my fear!).

Anyone have an thoughts on this... thanks!

If you have a home birth and need to be transferred to the hospital, how far is it? How long will it take to get there in the worst case rush hour? If the answer is more than 5-10 minutes then I would think the risk is not worth taking. But, other will probably disagree.

The chances of rupture are in deed very slim, but the consequences if it does happen can be catastrophic.

Why can't you deliver at your local maternity unit?

I would imagine that you would have to use an independent midwife as I can't imagine your local NHS ones being happy with a home VBAC from what you say.

The homebirth website (whose address escapes me... homebirth.org? Not sure) would be a good place to look.

yahoo group for vbac and home vbac

here is a link to the homebirth website soupy mentioned, and it is some info about optimal foetal positioning.

brow presentation is rare. approximately 1 in 500 babies present like this, and having had one, there is no reason it would happen again. OFP gives good info about how to get baby in a good position for birth , as does this website spinning babies

i believe the risk of rupture is very very low....daisymoo has some good stats on this, as does toady, i am sure they will both find this thread and give their info .....

in the unlikely event you end up having to go to hospital, you do not have to consent to constant monitoring, you can ask for intermittent.

also, consider a water birth at home, as water is marvellous for taking the pressure of the abdomen and uterus, so it is a good way to have a home VBAC......continual foetal monitoring is one way to detect rupture..but a midwife should be looking at many other signs too,,,not relying on the CFM trace to see if there is a problem..have a read of this!

CFM does not reduce the risk of scar rupture..........

i would also read anything you can by ina may gaskin and sheila kitzinger about birth, to remind yourself, you can give birth vaginally and it is a physiological process you have done before !

the local maternity unit would have to class you as a high risk birth, so your care would be different to a regular vaginal birth.so home-birth, with an independent midwife might be the way to go.

AIMS should have some good advice, as will the home-birth site about this.

Thanks for your advice. Lulumama - you are right my maternity unit clasifies me as high risk due to c-section, which is a shame as it is a fantastic place to give birth at.

If anything did go wrong the trip the the large hospital is minimum 20-25 minutes from door to door but if any traffic up to 40 mins - gulp!

I am not good with odds as the odds of a brow presentation was even less and it happened to me - so I realise that things can happen...

Ultimately I will want to make a decision that minimises risk to the baby and I but the hospital I will have to go to is where I delivered my DS and I had a horrific experience there - just the thought of returning there throws me into a cold sweat!

I would love ensure I had the same midwife throughout delivery - your link to Mark Cronk really reinforces this - it is what I experienced in NZ with my first and it was fantastic.

I will check out the links you suggested and look at a Independent Midwifes too - thanks.

zazas..the point you raise about the thought of going back to the hospital making you anxious is a valid one...to labour well and effectively you need to feel safe, secure, supported and listened to....

i don;t think that having a brow presentation makes it any more likely for it to recur...if i am wrong..i;m sure someone will let me know!

every birth has its attendant risks..so you are really wise to weigh it all up in advance...

have you thought about having a doula

can put you in touch with a doula near you having a doula can reduce the risk of c,s and other intervention by a significant amount

this site also can out you in touch with a doula near you a doula can be with you at home, in hospital , wherever you are, for however long your labour is !

Zazas,

Please take a look at AIMs, there are some wonderful publications on VBAC which may arm you with many facts for when it comes to the time of telling your midwives what you want. Your health authority HAVE to provide you with a midwife, dont be fazed by (when the time comes) "oh, theres no one available, can you transfer in". You say NO, and someone will get there. (Obviously dont take any risks).

Take a look at:

www.homebirth.org.uk/youcant.htm

Theres a list of reasons/excuses they will give for not wanting you to have a homebirth!

Good luck. Also a Doula is a great idea (But i would say that!)

Cx

Thanks - yes I have looked into having a doula - it sounds terrible but the only one in my area just isn't what I am looking for. I might be being stupid here but my gut feeling that she was not the one - so I need to look a bit further afield and it really is something that I would like especially given my earlier experience regardless if I end up homebirthing or not.

I am not worried about another brow presentation - I know that I have no more risk than if I had never had one and my first was fine - we were laughing about it the other day as my DS even 5 years later can't walk / run / swim in a straight line - everything he doe is along his own path - fits in with his start to life! Anyway I digress!

I do need to arm myself before I see the midwife as the last one was completely dismissive of me which threw me somewhat. As I said I am not unreasonable and will weigh up risk but I hate when they refuse to listen to you and look at you like you are mad!!!

no , that is not terrible.. i am a trainee doula, not had the pleasure of a RL experience yet!! i;m sure herts will back me up though..if you don;t click with your doula, that defeats the whole object...if you have negativity in the labour room and your mind is occupied with thinking ' i really don't like this woman!'. you are not going to have the best birth !

there are doulas who are willing to travel so don;t give up!

zazas & lulumama,

Sometimes you just dont click, but most doulas recognise this, and will say something along those lines and offer to find you another doula.

If you want to give me your details, I can always post of the doula uk forum for you asking for a doula in your area to contact you. I may also know of someone personally who I can recommend. There may be a trainee who is willing to travel.......(I am doing a 120 mile round trip just to attend my first homebirth next month!) so hang on in there, im sure the right doula will appear!

my mail is [email protected] if you want me to help you find someone.

Cx

Hi - if you think you might possibly like a doula and you are anywhere near Gloucestershire let me know. I'm a doula and have been to several homebirths and had one myself too.

Hi Zazas

I had a homebirth last year after 2 cesareans. It isn't for everyone, but if you are aware of the differing risks of being at home or in hospital and feel more comfortable with a homebirth then I would say it is definitely an option.

The risk of uterine rupture after 1 previous cesarean is between 0.35 and 0.5% If the worst does happen and your uterus ruptures then 90% of babies will be fine if delivered with 20 minutes. Obviously the longer the delay before the baby is delivered the higher the risk. The maternal mortality rate associated with uterine rupture is very very low (can't remember what offhand). Being in hospital does not guarantee that a uterine rupture will be immediately picked up and some people believe that early detection is more likely if you are being attended and monitored by a midwife throughout labour, which doesn't always happen in hospital but should at a homebirth. It is reasonable to expect there to be the same benefits from booking a homebirth as you would see in a 'low-risk' labout - namely that the rate of emergency cesarean is halved and you are less likely to need forceps, ventouse, develop an infection etc as well as the psychological benefits (being able to get into your own bed and not be separated from family afterwards is just great!)

Alternatively you could labour in hospital but decline continous monitoring. This is your right and they can't force you, although can put pressure on you to accept!

I posted today on another thread on the pregnancy forum about my experience, so I don't want to repeat myself, but I would recommend the websites other people have mentioned. Let me know if you'd like to chat more about anything.

Hi Zazas

My best advice would be to research as much as you can, all the links you have been
given are excellent.

If you decide that you do want a homebirth, which I hope you do , then write a very firm letter addressed to the HOM detailing everything you want at YOUR birth. Tell them that you want midwifes who are experienced or more impotantly confident in your ability to have a home birth.

I am not sure what sort of person you are and you may find it hard to get your point across (as I do). A letter telling them exactly what you do and dont want will set it straight from the beginning.

Of course you are liberty to change your mind at any point.

Hope this helps.

Sorry this might be jumping the gun a bit as you still have to decide what you want to do'

A letter though would hopefully mean that you had pro home birth VBAC midwifes that you could be comfortable with.

Sorry I really am rambling on

Better go and have another glass of red

OK just had my next midwife appointment at 28 weeks today. This time expected to discuss my homebirth option so thanks to you all went well prepared with information etc but AGAIN I got - 'well no midwife would feel comfortable with this', 'we have to do what you want but I know the midwives won't be in agreement' etc etc etc!

And my favourite 'at the end of the day it is your choice and you have to deal with what happens'!!!!

I have to admit it just zaps my energy. I know other mumsnetter have said that you have to be forceful but I just want a wee bit of support is that too much to expect???

well, if they will do waht you ask and it is your choice , then fine !! goodness me....try speaking or writing to the head of midwifery

midwives are supposed to suppoort and facilitate normal vaginal birth, not encourage medicalisation..
blanket statements of 'no midwife would support you ' do not help...

did you look at the AIMS site of Homebirth site?

In February 2005, I tried to deliver my twins vaginally in the 'safe' environment of a hospital.

One of my healthy. full-term twin boys died during a botched labour which should have proceeded to a CS at a much earlier stage.

I've been left with the feeling that the aim of labour is to deliver a healthy baby/babies. Full stop.

In your situation I would choose to be in a birthing pool or natural delivery suite in a hospital with a manned theatre nearby. Why take any risks, no matter how small?

I understand what you are saying bubble and that is my no 1 aim as well. I just would like to be able to discuss my options with them so we could weigh them up together. I am willing to listen and take advice, it is just hard when they won't even do that!

By the way they won't let me use a pool due to previous c section or use the birthing unit nearby so it has to be the big hospital.

Thanks lumamama I was wondering what the aims thing I was suppose to look at - now I think I understand.

aims

the irony is that waterbirth is good for VBAC as support the uterus !

zazas. I'm jaded and still grieving and definitely bitter.

If I'd had the expected elective CS for the delivery of my twins I know that they would both be alive today. I didn't. I chose to try for a VD and it all went horribly, fatally wrong.

I'd give almost anything to be able to go back in time and do the 'normal' thing.

bubble99- i am so very sorry that you lost one of your darling boys.. i cannot imagine the grief you feel...and am truly sorry for your loss x

Really, really sorry for your loss Bubble99... and of course I take into consideration what you are saying...

awwww Bubble99. I was just thinking of Bo earlier today.