VBAC Home Birth Help!

[beccarocksbaby]

Hi all, really interested in advice and experiences as I'm going to my VBAC consultant appt in a few weeks to discuss my birth plans.

I'm pretty set on a homebirth but I anticipate friction on this due to my first birth. It didn't go well. My feeling is because it was a badly managed induction and is a lot of the reason I don't want to be in hospital at all. I'll explain his birth below.

I'm open to honest opinions, stories of VBAC and any knowledge anyone had. I didn't even consider it for my first!

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my son is now 13. I was 24 when I had him and looked about 16 and was treated like a naughty teen.

Was induced at 37 weeks due to no growth being noted on 36 week scan. I believe 32 week scan was inaccurate as put baby at 8lbs! Having lots of scans due to big babies being in family (my cousin was 13lb2 😳)

Induction went quickly waters broke after one pessary and I had contractions immediately. Was encouraged to be active so moved a lot walked around the hospital etc.

16 hours later I was 3 cm drip was prescribed but never given.

30 hours still 3cm and begging for rest and pain relief. Am shaking and boiling and told I'm in shock. Contractions every 2 mins for 7 hours at this stage.

Given epidural. Relief. Unable to rest as told that baby is in distress. Prepped for c section.

33 hours C section and baby born 7lb6oz. Baby healthy.

I crashed however. I had sepsis and was very unwell. 2 week hospital stay and external pacer for a time as was very weak.

Hi,I had an EMCS with my first. The hospital I had my second at were very supportive of Vbac,you could have a water birth/active birth etc which is much more relaxed than other hospitals.
I didn't want a homebirth the second time but I totally understand why you'd want to. I'd imagine they won't be happy to support your decision for a homebirth but I don't think they can force you to have a hospital birth.

Thanks @SarahBeeney - I think what's worrying me is I super want a water birth and there is only one at the birth centre so the likelihood of snagging it very low :( no one else can use it at home. Obviously there is all the other things like being calm and in my own surroundings etc

Every consultant and hospital are different. Some are strict with monitoring etc. At my hospital they had underwater monitoring hence the water birth.
As it happened I didn't even get in the pool!

Also,with Vbac they are very unlikely to induce you as there is a risk with scar rupture. So it will probably be spontaneous labour or straight to C section if you don't go into labour yourself.

What stands out to me (not an OB) is that you needed external cardiac pacing after your last birth- did you have cardiomyopathy? Labour puts a big strain on your heart and you need to be very sure you have no residual cardiac problems before giving birth without critical care back up- this would be outside the scope of practice for the vast majority of midwives. I’m sorry that this is probably not what you wanted to hear.

What stands out to me (not an OB) is that you needed external cardiac pacing after your last birth- did you have cardiomyopathy? Labour puts a big strain on your heart and you need to be very sure you have no residual cardiac problems before giving birth without critical care back up- this would be outside the scope of practice for the vast majority of midwives. I’m sorry that this is probably not what you wanted to hear.

Thanks for pointing this out I hadn't thought of it like that. My heart was very weak due to the sepsis. I have a mild murmur but have done since childhood and my cardiac consultant is happy for me to birth at home. I see him ever 2 years and have a 24 hr ecg and recent one whilst preggo was good.

I'm glad to be asked these questions as the consultant will!

While legally you can of course have a home birth (as in they can’t legally make you go to the hospital), a home vbac in any circumstances is very dangerous. Your scar is at risk of rupture and the type of emergency immediate medical response needed in this instance is simply not available at home.

And your history is complex and adds further challenges to a safe VBAC. You haven’t previously had a vagibal birth, you possibly are prone to large babies, you have experienced perinatal cardiac complications.

I’m fully sympathetic to the difficult and painful and frightening experience you have had. However, I really can’t see how a home birth is a wise and safe response to that. I’d expect your consultant to be very concerned about a home birth in the circumstance you describe. I’d also be dubious of any practicioner who suggests it’s a good idea.

I’d suggest asking lots of questions and thinking about how you can address specific concerns and feel properly supported but in a medical setting. A home birth with your history will not be the safest option for you or for your baby.

Best wishes for your appointment and whatever you decide.

Your scar is not at risk of rupture.

I had a home birth after a VBAC.

Although I did eventually end up in hospital because my cervix did not dilate I felt that at least I had given it a try. I had a second CS but did not feel that it had been forced on me.

Just remember that you have an absolute right to have a home birth. After your first labour I am not surprised you want to have control over the situation.

Best of luck.

And you can hire a pool for a water birth if you're worried it may not be provided.

BTW you do not have to go to a VBAC consultant appointment!

Just tell your midwife you're having a home birth and she will arrange it. I had the Supervisor of Midwives come to my home to try to dissuade me but I didn't pay any attention to her.

Stick up for yourself.

I don’t want to sound like a pantomime dame but yes, a scar from a previous section is absolutely at risk of rupture in a subsequent labour. Obviously not every single VBAC but there is a known, clear increase in risk of uterine rupture after a section compared with an unscarred womb. It’s a fact. It’s dangerous and incorrect to say it isn’t.

OP, you should discuss with your consultant. And remember that just because something is legal, it doesn’t mean it’s a good idea. Any kind of ultra-high-risk pregnancy is legally able to have a home birth, simply because society does not want to permit the arrest pregnant women and forcing them to deliver in hospital. But that in no way means all home births are equal or all home births are safe, far from it.

Can you afford an independent midwife?

www.imuk.co.uk

Risk of scar rupture is very low

www.vbac.com/what-is-a-uterine-rupture-and-how-often-does-it-occur/#.XWAvTPZFzIUisk

Thank you very much for your input people it really is making me think very carefully about what's the plan.

I have a lot of anxieties about going into a hospital. Our birthing centre is attached to the main hospital but that seems to make me more anxious. I don't want my anxiety in interfere with the labour.

Talking this all through with the doctor is important to me. I'm used to dealing with consultants so I can stand up for myself 😉

I'm open to listening and understanding the real risks but also being heard. I want evidence based plan for the birth.

@RoxanneMonke I completely understand why it would be a concern.

How long between your births?

Mines been 13 years. I've looked at the papers on it and it does seem you were exceptionally unlucky :( that said it's a risk that has to be considered.

I guess though if I take it on prior experiences I ended up nearly dead BECAUSE I was in a hospital.

I won’t get into the pros and cons of a VBAC home birth, but one thing I’d say is that you’re last birth was 13 years ago- things have definitely changed in respect to trying to give women the birth they want in a hospital environment.

I had dc2 in a birthing centre attached to a hospital and the whole experience from start to finish was positive in regards to the staff, equipment available and how they made me feel in control.

Can you do a tour of the unit to see what it’s like? Most of the newly equipped ones go above and beyond to create a home from home atmosphere, so it may be the best of both worlds.

Of course there’s a risk of scar rupture- 1 in 200, unlikely in any single birth, but with the potential for catastrophic brain injury or death for the baby if it does happen, especially if surgical rescue is not immediately available. OP, if you have a scar rupture at home and are brought in for emergency treatment, there could be an extra delay because of your cardiac history whilst people make sure we don’t kill you with the wrong treatment (crashing blood pressure, tachycardia and fetal distress could also be caused by heart problems and without appropriate monitoring to refer to, it may take a while to figure it out), and that the most skilled people are available to anaesthetise you. This is an added delay that would be specific to your situation and something you need to consider when making your decision, as it would probably worsen the outcome for your baby.

I'm honestly so grateful for everyone's input. It's given me a lot to consider and talk about.

I'm genuinely very scared of being in hospital (and I'm a nurse 🤷🏻‍♀️) and the control element is very important. I never ever planned to have another baby so it's all brought a lot back.

I'll have a good chat with the consultant and try and see if I can see the birthing centre / staff there.

Prefacing this by saying this is anecdotal as that's what OP asked for - there is of course a risk of rupture with any labour and more so with a vbac, and it's always worth listening to what medical professionals have to say - but that you're within your rights to assess the risks/concerns and decide what risks you consider to be acceptable.

I had a hvbac one year after a disastrous elective section (anaesthesia issues resulting in GA) which left me with massive anxiety about the hospital environment. As it happens I ended up delivering before the MW arrived, so to all intents and purposes it was actually a freebirth.

I was absolutely fine. Nobody tried to dissuade me once my decision was made; at the time our local trust funded independent midwife provision and that's the route I took so mw was very supportive. Laboured well and very quickly and baby was born healthy with no issues, I recovered very well. However I'm aware that I was lucky that there weren't any problems during labour/delivery (although when we realised the Mw wasn't going to make it my husband panicked and called an ambulance so medical assistance was there within 5 mins of the baby arriving). Main issue was that it only transpired once the mw arrived after the birth that she didn't suture so I was left with an unstitched 2nd degree tear (it was that or having to get myself and baby into an ambulance and get taken to hospital for a couple of stitches - at the time it seemed a drama too far! But I did need them really, healed ok but could be better).

But - I don't have a history of big babies or obstructed/slow to progress labours (I realise in your case this was probably a result of unnecessary intervention and early induction), and there were underlying health issues and no problems with my section wound healing the first time. I also lived less than two minutes drive from the hospital. In retrospect, now that I'm out of the pregnancy brain-fuzz, I recognise that my decision probably wasn't the most sensible; but if I'd tried to get to the hospital once in labour I'd probably have ended up delivering in the car park so it may have been the right decision for the wrong reasons! If I were to have another, I'd struggle to decide the best option but I suspect I'd go for HB again unless there were any complicating issues, purely because I laboured so fast.

I'm happy to chat through if you want to pm me x

*NO underlying medical issues! Fat fingers..

Hi! I too want a home vba2c. 2 previous sections. One emerg (kind of) and 2nd elective due to being terrified from first birth. Forst c section was only due to my son being in the wrong position, his head got stuck as he was back to back. I was too traumatised from my first birth to try for a vbac 18months after. so I elected a c section. I am.not pregnant, I am longing for a natural birth and to breast feed so much, my other half however is completly against it because of what happened forst time round. I was told being wheeled out of my last c section 3.5 years ago that I would NEED a repeat c section if I where to ever have another baby! I think it's bollox.