Is it possible to have a Home Birth VBAC?

[kaffers]

Hi everyone,
wondering if anyone has experience of this or advice to give? I am 34 wks with DD2 (DD! is 2.10). With DD1, despite all my plans for a natural birth at midwive led centre I was sent to hospital after waters broke with v. high blood pressure. From arrival at hospital, intervention after intervention followed. I was told I really had to have an epidural for BP and so I had one reluctantly...to cut a v. long story short I felt from there as though everything was taken out of my control and that fear replaced all my natural instincts..I ended up having emergency CS for 'failure to progress' although I had been fully dialated and I was told the head could be seen prior to being told a CS was necessary - TBH I was totally and utterly exhausted by this point after 28 hours labour and felt that there was no other option. But afterwards I was haunted by feelings of failure for months and felt that my whole mothering capabilities were suspect due to my 'inadequacy' at giving birth.

So anyway - this time I really want to try a VBAC, but I'm absolutely terrified - of the same thing happening, of being even more rubbish at it and of all the faffing from doctors, being strapped to machines etc etc I would actually love to try and do the whole thing at home...but part of me fears this would be irresponsible and that I might be causing unnecessary risk to my baby. I'm so worried about the intimidating atmospere of the hospital making everything go pear shaped again.....Apologies for this long post...I'm just trying to get my head round all the issues involved - any comments gratefully received.

Oh Riven - so sorry. How is your baby now? Thanks for posting. x

Do take a look at htttp://www.vbac.org for some very clear, evidence-based information.

Er... www.vbac.org

I had a successful VBAC in hospital - after a very fast labour with fetal distress.

If I'd have been at home, the problem with the heartrate wouldn't have been apparent, and there is no way I'd have got to hospital in time.

The emergency unfolded over ten minutes: literally the MW pressing the red emergency button, the room filling, the ventouse being done and the baby born while they were prepping for a c-section and unlocking the bed wheels to run to theatre and rolling me from side to side to raise the baby's heartbeat.

My baby was fine. And I actually saw the VBAC as a very positive experience. But I'm a fit, healthy, woman, under 30, no health problems past or present. That big red emergency button over the bed in the hospital is there for a reason, and if you are a high(er) risk - as a VBAC is - then think very carefully about what you are gaining (avoiding perhaps six-eight hours in hospital if all goes well) against what you are risking.

Sorry to be negative, but every day I am thankful that a fully trained medical team were seconds away. I'm one of the rare cases where a few minutes either way would have made a difference.

But on the positive side - my first labour sounds similar to yours, and I found it very difficult to come to terms with. My second labour was 40 mins start to finish and while it hurt (as it does!) it was much more manageable, even with the emergency ending, than the long labour with CS.

Good luck.

Thanks wondering wondering - I'm beginning to err more on the hospital side for just the reasons you describe. How on earth did you have a labour of 40 mins? That's the fastest I've ever heard of!!!! Also do you mind me asking what the fetal distress was to do with? I'd just always assumed that with quick labours there was little fetal distress and that it was caused by long labours.

Thanks as well carmensandiego - I will have a look at that.

I think I'm coming to the conclusion thatthe answer is to be very assertive with the hospital about not being made to be too immobile etc and stay at home longer than last time (I went in as soon as my waters broke before the contraction started last time). But I don't think I'll have the nerve to have a home birth, much as I'd love it, the memory of the panic in the room last time makes me wonder if I'd be tempting fate.

Hi Nellie1 - sorry for not replying earlier - I just missed yr message - Are you at UCH then? That's where I am? You're absolutely right about the informed consent - very important to keep that in mind. I didn't really have that mind set last time - I just felt totally overwhelmed. I will let you know what happens - and vice versa please!!!

wow wonderingwondering how did you get to hospital in time?? 40 minutes sounds full on. kaffers if you stay at home at all with a labour that short, you'll be having a hb whether you wanted one or not

I hope you don't mind me asking riven but did the medical staff think it was the delay in getting to hospital that caused the problems and were the problems themselves because it was a vbac attempt? I really hope you don't mind me asking - feel free to ignore

it is one of the harder parts of choosing a homebirth imo, that you are expected to live with guilt (not that you should) if anything should go wrong and yet if anything goes wrong in a hospital setting noone ever blames the mother and neither does the mother often blame herself (quite rightly of course). I know several women whose babies died due to medical incompetence in hospitals, a few more whose babies caught horrible infections in hospitals but I've never heard anyone say it was their fault for choosing a hospital birth when in fact a hb would probably have not had the same outcome

My 40 mins was from the start of established labour. So I had a few period-type pains, was told to go to hosp as I was a VBAC so they wanted me in early, was walking, talking, and 3-4cm. Then suddenly was in lots of pain, waters broke, and the baby was born less than 40 minutes later.

There was meconium in my waters when they broke, but apparently the fetal heartbeat can be disrupted by a very fast labour, too, as they descend very quickly and it can press on a nerve in the head.

But my baby was fine, she's just started school!

I was terribly nervous about the birth as first time round was a long labour with an emCS. I read up on the NICE VBAC guidelines: they say things like no induction, if labour stalls then EMCS, if labour goes on past 6 hours then EMCS.

It gave me a lot of confidence that DH was ready to insist on a CS if things slowed down or went 'wrong' - none of the 'just another hour' that I had with my first. So I knew it was unlikely that however much pain I was in, it was likely to end one way or another after six hours, and I could cope with the idea of that. As it was, it was rather speedier, but having been fully dilated first time round helped, I think.

Riven, I hope my 'my baby is fine' comment wasn't insensitive. I know your circumstances from past posts. But I want to reassure the OP that it is possible to have a 'good' VBAC - even in the high-risk unit of a hospital! - but equally, share my experience (like yours) of something going wrong unexpectedly.

I was very fortunate, and I hope my comments aren't seen as too flippant. I'm constantly aware things could have been very different.

Kaffers, yes I am at UCH. The Consultant Midwife there is Belinda Green, so it might be worth contacting her to arrange a meeting. I'll let you know how I get on ... not sure about posting etiquette, but I can let you know her email address if you need it.

Hi,there was a lady on 'home birth diaries' that had a vbac after two previous c-sections,it did look like a lovely birth and she was so pleased that she'd managed it,she had really good support which i think made all the difference,
I was considering having a home birth this time but having read riven's posts I'm opting for a hospital birth,good luck

Riven, I understand why you hold that opinion and I'm so sorry for what you've been through, but there is more chance of a cord prolapse, shoulder dystocia, haemmorhage or any number of other things going wrong than there is a chance of uterine rupture, yet where VBACs are concerned, it's always the UR that's wheeled out. By this logic, NO home births should happen, VBAC or otherwise.

Even with the risk of all these things, home birth still carries less morbidity and comparable mortality to hospital birth and I'd suggest that with new research (e.g. the new large-scale Canadian study) showing very significant differences in morbidity (much greater chance of birth injury for example in hospital), even a VBAC is safer at home.

Having had a suspected UR and seen the absolute panic amongst the staff in the hospital, I'm pretty well-placed to have a view. Theoretical risks and statistics are fine, but if people are asking for experiences and lessons learned, then I will share my experience for them to think about.

There is no way I would advocate anyone in my position trying for a HB after what I went through. Everyone has to make their own decision, and that means being aware that things do go wrong, without warning, and the consequences can be devastating.

Why do we attach such guilt and blame to home birth which is a perfectly rational choice, but we accept when bad things happen in hospital that we 'did everything we could.'

Home birth isn't just about enjoying the nice curtains and a cup of tea. A woman's own territory is the most logical place to encourage natural oxytocin production, reduce adrenaline and stress and allow labour to progress normally as well as to reduce chances of infection for mother and baby.

Stepping into hospital causes chemical changes in the body and brain and immediately raises the chance of intervention. Yes, it's a good place to be if something goes wrong, but by entering the hospital, your chances of something going wrong rise rapidly.

Most uterine ruptures occur because of a poorly managed labour in hospital, usually involving instrumental delivery. Yes, occasionally they happen spontaneously during a normal unmedicated birth, but not nearly as often.

There's no guarantee that if you are in hospital, a catastrophic UR can be salvaged. But it is more likely to occur in the first place in a hospital.

Just wanted to say good luck to Kaffers and the others on here hoping for a VBAC. I really hope you get the birth you hope for this time, whether that is in hospital or at home.

Sounds like I had a very similar experience to you first time round, and even though it's now 7 months ago I still end up thinking about it every day and feel very sad about it. Would love a VBAC if there is a next time.

I agree with other comments here, be demanding and get a birth partner or doula who can demand for you if you're not in a fit state!

Do let us know how you get on

xxx

I think its really worth pushing for a VBAC in a MLU in a hospital - perhaps say you want homebirth and then try and compromise on MLU birth?? That way if anything happens you are near help, but on the other hand you have supportive midwifes.

Make sure its somewhere that encourages you to talk through birth plan in advance, and allows you specificially to book into the midwife led unit.

Actually I know women who have had a successful VBAC on the labour ward. Again I think part of it is staying at home for as long as possible (less time for intervention!) BUT not staying at home for too long so that you actually have the baby at home!

I was considering a home birth but still haunted by DD being resucitated by crash team after birth... born not breathing and totally blue, they hit emergency button and suddenly 6 people in room (she's fine now) - no real reason she was in that state - no intervention or drugs (other than G&A) totally upright or kneeling forward, I was moving around.

I have had 2 MLU births and both were great in different ways.

CarmenSanDiego - I know exactly what you're saying and I agree that in many scenarios hospital environments actually create the problems they purport to then 'solve'. But reading the experience of Riven and wonderingwondering, and remembering the panic amongst the doctors etc at my first emcs I suppose the bottom line is that a hospital does have factilites that can just never be available at home if needed in extreme circumstances.

Starting this thread has prompted lots of memories of my first emcs and actually the thing that makes me angry in retrospect was the psychological impact of the attitude of the midwives. I remember arriving at hospital (having been sent from MLU) and being delighted to be shown into a room with a birthing pool in it. I remember saying hopefully to the MW 'oohh could I get in that' and her just saying 'No way' like an angry school teacher without any explanation. I just felt crushed and stupid. Then a bit later I heard two MWs outside my room arguing about who was going to examine me - one going 'I don't want to do it - it's your turn' and the other 'shut up, I don't want to' etc etc and I remember sitting there wanting to cry between contractions, feeling really alone and like a burden to the staff...then I remember trying to tell the MW that I wanted to go to the loo because I was desperate to move around (being strapped to so many machines) and she was really pissed off and told me I couldn't keep getting up and down...honestly no wonder I lost confidence in the process - funnily enough I'd forgotten all that stuff before starting this thread - in retrospect there was a general feeling of a lack of respect I think from jaded and overwrought staff who probably had far too much on their plates. Funnily enough there was a panorama programme after shortly after I was discharged from the hosp showing lots of hideous malpractice there. Being at a different hospital this time might the key to acheiving a VBAC!!

Oh kaffers, I'm so sorry. No-one should have to go through that.

Sounds like you need to find some great caregivers who are on your side, whichever hospital you go to.

Hi again kaffers. Just to update you, I now have a meeting arranged with the Consultant Midwife next week, and she also said she could arrange for me to see an obstetrician too if I wanted. She sounded really nice, so would definitely be a good opportunity to make sure everyone is aware of your preferences.

Incidentally, UCH issued new guidelines on VBACs last year (she sent me a copy). Quite interesting reading, and although they do promote a more medicalised approach as standard (continuous monitoring and epidural) they are committed to promoting VBACs instead of routine CS. I don't intend to have that level of intervention myself, but do feel a little more reassured that they will do their best to help me achieve a VBAC.

I really hope you have a more positive experience this time round!