Home VBAC - where can I get honest advice (sorry bit long)

[pinkmama]

Just been to hospital to see consultant as I am 18 weeks pg with 3rd child. 1st was an emergency section, horrid experience which went wrong from very early on in labour and was catalogue of disasters. 2nd was 4 hour VBAC in hospital, despite being threated with continuous monitoring, they left me to get on with it mainly and had 2 hour first stage, 2hour second, resulting in ventouse delivery. I really wanted a home birth this time, but registrar has just scared me, saying high risk of uterine rupture and I need continous monitoring so should go to hospital. Thing is I am terrifed of continous monitoring as I swear that was what went wrong in 1st labour when I couldnt move and could no longer cope with pain. My midwife 2nd time around was very supportive and didn't force me to be monitored.
I realise that the hospital has to be cautious and advise me of risks, but where can I get impartial advice, I would never want to put baby, or me, at risk, but I suspect that my risks at home aren't that much worse. I just want some facts. Can anyone help?

hello darling! no help, but wanted you to have a post on your thread. talk later. xxx

Hello HC, bloody doctors, just made me cry! What a waste of a trip! Speak to you later X

Not sure of 'facts' - but I'm pretty certain if you've already had a successful VBAC then the risk of rupturing with a 2nd one is very low indeed. And from what I understand (someone may correct me on this) the MW attending at home would be able to recognise if rupturing was occuring and you'd be rushed straight into theatre - in a similar amount of time it would take if you started to rupture at home.

www.homebirth.org.uk/

www.radmid.demon.co.uk/

The risk of uterine rupture is actually very small, especially as you have already had a VBAC I would imagine. Also bare in mind that you can have whatever antenatal care YOU want. It is not essential to see a consultant. Opt for midwife-led care if that is what you want.

You will I think have problems getting support for a home birth after a C-section - the RCM and the Royal College of Obstetricians and Gynaecologists both now recommend against because of the very low risk of rupture (I'm not saying I agree with this, just that I've asked and that's apparently what they say!). So quite a few community midwifery teams, including mine, won't support you. You do however have a right to a home birth if you insist.

This isn't very helpful, I know, but it's what I've been told.

Oh and for what it's worth 'if' I ever get a chance of baby no.3 I want to go for a home birth - 1st was (IMO) a completely unnessecary CS, 2nd was a heavily monitored and assited ventouse delivery and even if DH doesn't like it I want a HB if he ever lets me have anohter baby

Thanks. My midwife is supportive. I live in an area with quite high home birth rates, and my mw seems to be quite an old no nonsense woman. She had to refer me per guidelines. Registrat did say it was my choice, but she would recommend hospital, I just want to make an informed choice, rather than one prejudiced by fears of litigation. I will have have a look at those links RosiePosie

If you have a homebirth, you're getting one to one care from a midwife. There was me, my husband and the midwife in our living room for the whole time. In hospital, often one midwife is caring for 2 or 3 labouring women at a time. So, for a homebirth the "monitoring" is actually often more thorough. One more link. If you request a homebirth and the midwives tell you you can't have one, AIMS will offer you advice on what you're rights are and how to handle the situation. No one can tell you that you can't have a homebirth. It is perfectly within your rights to do so, and providing that you inform the midwifery team of your intentions - they are obliged to attend to you.

www.aims.org.uk/

pinkmama It sounds like you are lucky and have a reasonably supportive team. I know when I wanted to discuss VBAC it was out of the question to even contemplate a home birth. They also refused to allow me the option of a water birth in hospital! Finally I had a 2nd c-section but that is by the by. Good Luck, hope you get what you want

Two fantastic places to get advice are:

ukmidwiferygroup

and ukhomebirthgroup

These are forums where you will get the BEST advice from many experienced midwives who support homebirth and also women who have expereienced it too.

Also Angela Horns site homebirth.org is FANTASTIC. Lots on there about uterine rupture...

You will hear lots from unhelpful but perhaps well meaning souls about "risks" connected with homebirth - IMO you will get much better care at home and the risks of a hospital birth are more frightening to me!

If your m/w is supportive then that is fantastic, remember when considering advice from m/w's and registrars that registrars probably very rarely see normal birth, and it is their job to step in when things go wrong, their advice is not likely to be incorrect but they err on the side of caution to cover their backs and their views are likely to be coloured by the fact that they see the more difficult aspects of birth.

Can I recommend the AIMS booklet "Birth after Caesarean" written by a woman who gave birth vaginally after 3 sections, Jenny Lesley. Full of facts and info about your rights and choices.

And also "Choosing a home birth" by Pat Thomas.

You can get them both here

All the best!

Just want to say good luck PinkMama. I don't know any statistics for this, apart from the fact that you are 'allowed' the birth that you choose... but this doesn't really allow you to make an informed decision. I think (but it's a very vague recollection) that the risk of scar rupture is the same with a subsequent VBAC as with the first one (i.e. it neither increases nor decreases if you've had one successful VBAC). However, that risk is very low, as you know. How close to a hospital are you in case of an emergency? That might make a difference (i.e. if it'd take you an hour to get to the nearest hospital might not be a great idea, but if only a few minutes' drive away then would almost certainly be OK).

I had a successful hospital VBAC with dd2, and if (still a big IF) I have a 3rd would definitely go for a home birth. I mentioned a home birth with dd2 and my consultant was very negative about it. I didn't push it because (a) he was very positive about everything else I asked for: no continuous monitoring, allowed to use the pool, etc. and (b) dh was not too keen on a home birth (mainly due to him having been scared half to death first time round, when I had quite serious placenta praevia/bleeding) as he was convinced it was 'dangerous' (think he had visions of delivering baby himself). I don't know if this is any use, but I got brilliant advice and stacks of information from a lady called Gina Lowden. I no longer have her email address, but if you can find out how to get hold of her I'm sure she'll help.

Good luck.

Just want to say good luck PinkMama. I don't know any statistics for this, apart from the fact that you are 'allowed' the birth that you choose... but this doesn't really allow you to make an informed decision. I think (but it's a very vague recollection) that the risk of scar rupture is the same with a subsequent VBAC as with the first one (i.e. it neither increases nor decreases if you've had one successful VBAC). However, that risk is very low, as you know. How close to a hospital are you in case of an emergency? That might make a difference (i.e. if it'd take you an hour to get to the nearest hospital might not be a great idea, but if only a few minutes' drive away then would almost certainly be OK).

I had a successful hospital VBAC with dd2, and if (still a big IF) I have a 3rd would definitely go for a home birth. I mentioned a home birth with dd2 and my consultant was very negative about it. I didn't push it because (a) he was very positive about everything else I asked for: no continuous monitoring, allowed to use the pool, etc. and (b) dh was not too keen on a home birth (mainly due to him having been scared half to death first time round, when I had quite serious placenta praevia/bleeding) as he was convinced it was 'dangerous' (think he had visions of delivering baby himself). I don't know if this is any use, but I got brilliant advice and stacks of information from a lady called Gina Lowden. I no longer have her email address, but if you can find out how to get hold of her I'm sure she'll help.

Good luck.

Sorry for double posting... sneezed and finger twitched!!!

Not sure that I agree with the "you're allowed the birth you want" statement.

I've known 2 women who have had HBACs (or I should say have attempted HBACs - they both had emergency sections) and they did have to fight for their right to do so (one fought her consultant and had to sign a disclaimer, one had a private mw). Both are very happy with the decisions that they made.

I've known one woman who had a uterine rupture during a VBAC - whilst this also ended up in an emergency section it didn't seem as "life or death" as her first section - in fact they didn't realise that she had ruptured until they performed the section. She left hospital after 2 days.

I appreciate that this doesn't help your decision. Do you have a "dedicated" home birth team in your area - perhaps you can talk to them and see how they would feel (as in practice they would be with you). If they felt uncomfortable then I would be inclined to go with them.

Go for it if you want pinkmama. I can't add anything useful as the other posts have been so good. I can also recommend Angela Horn's homebirth site which is here

I thought that the risk of rupture had more to do with how long it has been since the c-section rather than if you have delivered vaginally since then?

Wonder if Mears is around to address this. She would probably know.

I thought that the risk of rupture had more to do with how long it has been since the c-section rather than if you have delivered vaginally since then?

Wonder if Mears is around to address this. She would probably know.

Hi Uwila

pinkmama - the official guidance will be that you should be continuosly monitored in view of having a previous C/S. However, my view as a midwife is that if the only problem with the pregnancy is that of previous C/S, then it is not totally necessary. Baby's heartrate can be monitored well enough intermittently in labour with sonicaid/pinard every 15 mins and more frequently in second stage. In my own unit, women with previous C/S can request to use the pool for pai relief and have a waterbirth if all is well otherwise. They do not have contiuous monitoring. The risk of uterine rupture is extremely low for spontaneous labour which a homebirth would be. Induction of labour in previous C/S poses more of a risk but some consultants still opt to go down that route.
The links already posted on here should give you loads of information. I personally think that women who are trying for a VBAC should be as mobile as possible and only have continuous monitoring if there are other concerns.

Yep, v nice top obstetrician (who was v pro VBAC, actually) told me it was the NICE recommendations for continuous monitoring that meant lots of authorities recommended against a home birth - I still think it may well be difficult to get your community team to back you (is an independent midwife a possibility for you?). Good luck.

Thank you thank you thank you everyone. I spent afternoon with a friend who has had 3 homebirths and feel a bit better. Will read through all the links posted, thanks for those. I know if I opt for home birth I won't be given a hard time, which is good, think I have to sign something to say I will go in if needs be, which I am more than happy to do. I live 10 minutes away from hospital, so could be got there quickly if needs be. I think I will continue down the line of I would like to try homebirth, but prepared to go in. If this labour shorter than last then I may not get much choice anyway! I just needed some facts, so thanks for those. Have to go back at 34 weeks, and registrar said I could choose right up until I go into labour so I have some time yet. Just felt very chewed up after the appointment (think partly to do with fact that that sudden realisation of what I have to go through again hit me), as always support on here has calmed me. ThanksX