"No obstetrician in the country will agree to a homebirth after c-section" is this true?

[Orangesarenottheonlyfruit]

The title says it all really. I had a section with DD1 due to breech birth, I felt thoroughly railroaded into it and actually said "whatever is best for the hospital and the midwives" when we were discusing my options, fool!

This time, I would dearly love to have a homebirth, I live about 12 mins walk from the maternity hospital, my husband is all up for it etc but the OB gave me quite a rough ride and was very firm that it was against all medical advice and I could kill the baby.

Help, please all you wise mnetters! I had an horrendeous el c-s last time and nearly killed the baby, the thought of going back into the same hospital makes me tense up now, let alone when in labour. Am stressing massively!

I'd love to know the answer to this too. See my post "change of birth plan - gutted". Am facing an elective CS and have to make the decision about my next pregnancy now. watches thread with interest

I know women who have had home births after sections, so that can't be true.

Have you looked at the home births uk website? There are bound to be other women there who have done it.

My friend is planning a homebirth for her DC3 after two previous sections.

If you are 'high risk' and wish for a homebirth I think you have to accept that you may never get the support of your or any obstetrician.

I was 'high risk' because I was thought to be carrying a baby well over 10lbs and had gestational diabetes. I couldn't face the thought of giving birth in hospital and got very distressed by the lack of support from NHS midwifery staff as well as my obs. Actually 'lack of support' is putting it mildly. My obs used fairly strong language to try to terrify me into coming into hospital. My midwife said the community team 'wouldn't touch me with a bargepole'.

I booked with an independent midwife in the end and had my baby at home. She explained the risks and the benefits to me and we talked about what might happen in the case of an emergency at home. She talked to a consultant midwife from a large teaching hospital on my behalf, who confirmed that our plan to give birth at home was reasonable in the circumstances.

I found that once I accepted that the obs had a very particular (and reasonable) viewpoint, which was rooted in his experience of dealing with obstetric disasters, but that there were other perspectives which were also important, that I stopped feeling stressed about it.

I imagine there are plenty of midwives who would be happy to deliver you at home - the tough thing would be to find one through the NHS. IM do VBACS at home fairly regularly I suspect.

Good luck with your labour plans!

"I know women who have had home births after sections, so that can't be true"

It's quite likely that their obstetrician has not been encouraging though!

I have never heard of anyone receiving support from an obstetrician for anything except a super-low risk homebirth (though I'd be happy if someone came along and challenged that belief!)

I do know someone who had a home water birth after 3cs.

She did have an independent midwife though.....

The issue is the risk of scar rupture. I think most if not all consultants would advise hospital birth because of this risk.

I wanted a home birth after a c-section and the consultants fell over themselves to advise me of the rupture risk. We live a similar distance from the hospital, but I was told quite bluntly that if the scar ruptured then we only had minutes to get to a theatre.

I continued to insist on a home birth and was assigned a group of lovely community midwives - they also advised of the risks but said that in all likelihood there would be warning signs before the scar actually ruptured and then they would call an ambulance asap.

In the end, I developed liver cholestasis and had another section at 36 weeks.

The problem ime is that you are weighing up things that cannot really be balanced - i.e. the very very small risk of you and the baby dying but a good chance of a positive experience (home birth) against the high chance of safe delivery but high likelihood - or so it seemed to me - of a negative experience (hospital birth).

The consultants don't understand why anybody would take even the tiniest risk of death because, in my experience, they simply discount the issues of wellbeing/positive birth experience that most of us want.

I don't know what I would have done on the day tbh.

Thanks so much for speedy replies. I think you're right Stand, Obs are going by statistics and worst case scenarios, which is perfectly reasonable. Actually, I did say to her in the meeting that if the situations were reversed I would probably be saying the same.

Problem is, she really put the fear into me, and am really not sure what to do...

"against the high chance of safe delivery but high likelihood - or so it seemed to me - of a negative experience"

TBH I think they're also in denial about the high risk of iatrogenic injuries women experience under their care. It looks to me that women are not just likely to have a 'nicer' and 'happier' experience at home, they're also more likely to emerge from the birth without experiencing serious birth injuries.

I feel for you Oranges. I don't know what I would have done without the support of my midwife. My obstetrician also terrified me.

The thing is though, scars do not rupture with no warning. With a homebirth, you would have continuous support from a midwife who would be able to closely monitor you for them. And if you could transfer very quickly to the hospital, you would be in theatre just as quickly as if you were on the ward as it takes them a while to prepare the theatre anyway, and the mw would have them all prepping while you transferred.

Talk to the mw team about their experiences and what they do in emergencies, then make your decision

There isn't always other signs before a scar ruptures. My friend laboured for hours on her VBAC. It eventually became obv that she was getting nowhere, so they did a section.

Old scar had ruptured & babies head was poking thru. This was 4yrs after her first section.

My sister had a uterine rupture and her MW (one to one care not an overstretched MW) failed to notice it. The fist indication was when pints of blood started pouring out of her. Both she and my nephew nearly died. They are fine now but that is due to good surgeons and a brilliant paedeatric consultant.

It is important to remember that uterine ruptures are very rare but the effects can be devastating.

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As ProvincialLady said, have at look at the homebirth website. It gives specific info about at home VBAC. The AIMS website will be helpful as well. Remember that the medical profession are advising you, they can't order you. You can balance their advice with your own thoughts and make a decision.

There is a Yahoo chat group providing homebirth support - I've read a lot of VBAC homebirths on there. You can link to it from the Homebirth website. Some of the posters there are pretty hardcore and strident, but they seem to get what they want, with good outcomes all round.

Its great that you have your husbands support. I'm the polar opposite of a high risk homebirth and mine is decidedly lukewarm about it. Good luck

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There is a mainstay on the Yahoo list who has had 3CSs, and 6 VBACs, three of those at home.

"Seems to confirm that having achieved a vaginal delivery there have been complications which led them to limit their family size"

Half of all women who have a c-section don't go on to have more children.

I think you've also got to take into account that many women who try for a vbac are given the type of suboptimal 'care' in labour which results in very high rates of 'failure to progress' repeat c-sections, birth injuries and instrumental deliveries.

Personally I'm amazed that anyone manages to achieve a VBAC in our local hospital, given how little support they get to have a normal birth (ie, rigid time limits placed on second stage and restricted mobility).

We crossposted there, lucybarnes. I didn't mean to sound so tart!

lucybarnes - I know someone expecting her 6th baby after 2cs. One of those babies was a HBAC.

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"The thing is though, scars do not rupture with no warning. With a homebirth, you would have continuous support from a midwife who would be able to closely monitor you for them. And if you could transfer very quickly to the hospital, you would be in theatre just as quickly as if you were on the ward as it takes them a while to prepare the theatre anyway, and the mw would have them all prepping while you transferred.
"

Sorry I would totally disagree with that. Sometimes the first sign that a scar has ruptured is either intense pain or baby's heartrate plummets. I have seen a scar rupture with no pain and first sign was a FH of about 50bpm. At that point you have minutes to get that baby out.

There is no way you would be in theatre from a homebirth as quick as if you were on the ward. You have to call an ambulance, wait for the ambulance to get there (could be 10 mintes) and then transfer in. You could easily be looking at 20-30 mins before you're in theatre and thats if you live close to the hospital.

The theatre in hospital is kept ready for emergencies. All the packs are on the trollies, etc. In an true crash situation you crash bleep the doc and theatre team and the woman can be on the table in theatre in 2-3 mins with the team there and ready.

You went get an Ob to support homebirth. You need to be aware of the risks and make an informed decision about if you are prepared to accept those risks. The chances of having a scar rupture are small but the possible consequences if you are that person are big.

Sorry Lucy but I know IRL several women who have had VBAC and gone onto have further vaginal deliveries.

I also know one woman who after her first was born by CS went on to have 4 further babies, VBAC's at home.

I think the op's OB was right she will be unlikely to find support from any othe ob's to have a VBAC at home this time but it doesn't mean it isn't possible and that it can't happen.

The best thing is to discuss it with the MW team who would be doing the HB and find out how and what they feel on it as well.

I just check "threads I'm on" occasionally. OK, more than occasionally. Hijack over! Back to you oranges!

Lucybarnes - I don't really understand your post. Are you saying that you have never heard of anyone who has achieved a vbac going on to have more children? Speaking as someone who had a emcs first time round followed by 2 very uneventful vbacs I find that a little puzzling.

In reply to lucybarnes-
As a doula I have supported quite a few VBAC's and I must disagree with your poinyt about women not going on to have more babies after a VBAC, I know quite a few personally that have. I have supported a GP to have two VBAC's (her second and third children) the second VBAC was on a midwife led unit, she delivered standing up, without constant monitoring and had a natural third stage (See testimonials on mt website for the story www.magicalbirth.co.uk).
Obstetricians are there to talk through the risks with you as an intelligent person to allow you to make a choice and to provide expert care to high risk pregnancies, that cannot forbid a homebirth and should not be scaremongering or bullying women into hospital.
Some obstetricians are more open to discussion than others (I recently supported a woman to negotiate a twin birth on a midwife led unit, without constant monitoring, to labour in water and birth without the obstetrician or paediatricians being in the room-it was a lovely birth and the obstetrician was supportive f this choice)
We all make choices every day that other people may think are risky or foolhardy but the way we live our lives is individual and what feels safe o one person is different to someone else, many people play the lottery, even though their chance of winning is incredibly low.Other people like to go rock climbing. Every time we cross the road its a risk.
You need to make a choice that feels right to you.
Some useful info here
www.homebirth.org.uk/vbachome.htm

Selina