To Home VBAC or elective seciton

[SunnyScot89]

I'm pregnant with my second DC. DS was a planned home birth but ended up a emergency section due to fetal distress (his head was in a bad position and I was not dilating despite having regular contractions for 48 hours).

Due to a genetic condition, I have been advised that this time around they wouldn't use forceps, ventouse or scalp monitoring, and due to my previous section they wouldn't induce me. So I feel I have 2 options - and elective section or a totally intervention free vaginal birth. Obviously vaginal birth is safer and has generally better outcomes for both mum and baby.

However, if I were to give birth in the labour ward I would be totally consultant led and heavily monitored. I know that in that circumstance I'm not going to get my best chance of labouring naturally and it feels like I'd be setting myself up to fail and I might as well just go for the elective...

So I feel that going for a home birth gives me the best chance of being intervention free. That obviously carries it's own risks, although the likelyhood of needing a hospital transfer due to scar rupture is less than needing to be transfered for other (non previous C section) reasons... obviously the consequences if something did go wrong are much worse if I am at home (FWIW - we are a 20 minute drive from the hospital, last time I was in hospital within 30mins of calling the ambulance)

Part of me says it isn't worth the risk and I should just go for the elective section.... but then I feel like I would very much like the oportunity to give birth naturally, and if it all goes to plan it would be the best option for both me and baby.

Obviously the consultant has strongly advised against homebirth, but my midwifery team are happy for me to have one, and I have a friend who is an ex midwife who will be my doula, so I feel well supported and in the best hands if I were to choose a homebirth.

But is it worth the risk????

I won’t if 20 mins away from hospital. That is my personal opinion but others will have had hvbac in similar situations. But you have the right to refuse monitoring and not allow a Dr in the room at all.

Read the AIMS book on VBAC and there are some good Facebook VBAC groups out there.

A supportive midwife team sounds good. Mine are not.

I would say that by far and away the best chance you have of an uncomplicated delivery is an elective section. And by "uncomplicated" I just mean everything goes exactly as expected with no twists and turns along the way.

For me personally having that degree of certainty was more important (just!) than the possibility of a straightforward vaginal delivery. That't not to say it needs to be more important for you

Good luck in your decision!

If it were me, I don't think I'd take the chance. I had a very similar delivery to you first time round in terms of close contractions for 44 hours with no dilation, but with me they opted for ventouse to get DS out after induction and 2 hours pushing.

Knowing how I laboured the first time, I feel the chances of that repeating would be quite high (especially as my sister had the same type of labour - genetic?). That, combined with knowing that intervention would be impossible, means I'd go elective CS in a heartbeat.

Would not even give it a second thought! Your situation sounds complicated and I understand your desire for a VBAC but given the circumstances you’ve described by far the safest outcome for both you and baby would be an ELCS.
Best of luck!

I had a home birth with DC2 after a difficult hospital birth woth DC1. I'd be cautious in your position - if you didn't dilate with your first what have they said about your chances of a successful VBAC with DC2?

Is there a consultant midwife you can talk through your options with at your hospital? Mine was able to negotiate changes to hospital protocol - so you could for example ask about being in the midwife led bit of the labour ward?

I would go ELCS without a second’s hesitation in those circumstances.

I totally understand you wanting a VBAC but it sounds like the safer option would be an elective c-section. You’re not close enough to the hospital and you don’t want or need the added worry.

While I understand your point about being consultant led - I had a natural, intervention free, birth for DS in the CLU at 36 weeks. I had made it very clear to the midwife who was with me that I wanted to be free to move around/get in the bath etc, and she was fine with that. I didn't have to be stuck on the bed hooked up for CFM at all - she used a doppler to check on his heart rate every so often to keep a check on it.

In your position, I'd say that attempting that sort of scenario is probably your best bet to avoid a potentially traumatic hospital transfer. I do agree with Ratrolypoly though, that if you want predictable an ELCS gives you the best chance of that.

An ELCS is the safest option for both you and baby.

But that's not to say a VBAC is a bad plan. However, a homebirth VBAC is IMO.

You could opt for a VBAC in hospital and decline extra monitoring.

Why will you need vontuse or forceps in hospital- but not if you home birth?

I'm in a similar position and have decided on hypnobirthing classes before, and a hospital vaginal birth. I'd also rather have a fetal scalp monitor, compared to being strapped up to a monitor (which can limit how you're able to move/get comfortable).

Do what is safest not what is 'intervention free' intervention is what gave you a healthy outcome last time if I read your post correctly? I'm sorry but I wouldn't even think about it I would be opting for an elcs.

I had a VBAC with forceps and monitoring and it was fine. I had a long labour like you so my body dilated very quickly second time of asking! Very glad to have avoided a section.

I’d echo what a pp said about talking this through with a consultant midwife. If the midwifery team are supportive that’s a useful point to begin with. I started with the premise of wanting to give birth in the standalone MLU when the technical advice was to have the baby in the hospital, I got my way but I looked at how to mitigate the risks too.

Is there no middle option? A midwife led unit? (Appreciate you may not be eligible) Or giving the hospital delivery a go but staying at home as long as you can and going in with the doula?

Hi op, we’re in a bit of a similar position so it’s ibteretinng to hear someone else talk about it. My daughter was born by ELCS as she was breach, and my plan for a home birth was scuppered by midwives and doctors who told me they ‘could do it in theory, but don’t in practice’! I was disappointed but the birth was trauma free, though the recovery was pretty hellish.

I’m now pregnant again and I really want a VBAC, but like you I’m really aware of how unlikely that will be if I end up on a maternity ward. My MIL is training to be a doula and she and I have had some interesting convos about this...she is btw insanely rational and evidence based, just doesn’t believe in hospitals being the right place to labour as the staff and surroundings interrupt production of birth hormones.

I’m thinking of really pushing to be placed in the midwife led unit that’s attached to the hospital, that way I’m there if anything goes wrong, but I’m not on the ward.

Do DM me if you’d like to chat - it’s a tricky thing to work out isn’t it? Congratulations on your pregnancy

I had a similar experience with my son, 3 days of labour and only ever got to 3cm. It was awful and ended up having a c section.
This time round I've gone for elective c section because i just can't bare the thought of going through that again!

If you want a predictable (less stress) delivery I'd opt for the c section, but of course it is your choice and you can try at home if you wish.

I'd just be wanting to know how likely a repeat is of last time in relation to not dilating?

My mum had the same issue with me and my sister so i am curious if it is genetic as a previous poster had said!

Also....i don't necessarily feel that vaginal is always better. I was 100% back to normal after my c section by about 3/4 weeks, minus some numbness around the wound. But my friends who i met at the NCT classes who had vaginal births are still dealing with some issues down below a year later. Sometimes i question how 'natural' it is when there are so many problems with tears, incontinence etc! BUT everyone is different of course.

Sounds like you'll have a lot of support , i would have tried for vaginal birth had i got further than 3cm last time.
Go with your gut!!

Obviously vaginal birth is safer and has generally better outcomes for both mum and baby
I think the evidence doesn't necessarily back this up, especially in relation to VBACs and your specific set of circumstances which increase the risk associated with a vaginal birth. You may well want the experience of a natural birth but it's definitely worth doing thorough investigation into the pros and cons of VBAC Vs ELCS to make sure you're making a totally informed decision. In my experience there is often a big push from consultants and other NHS staff to sell the benefits of VBACs and it's pretty rare that they offer completely balanced, unbiased information so it's definitely worthwhile doing your own independent research.

I don't think a home birth VBAC attempt is a good idea at all. I think labouring in the hospital where they can intervene quickly if necessary is your safest option, would that be a third/compromise option for you? FWIW my first birth ended up EMCS after failure to progress, it turned out that she was face presentation and well and truly stuck fast. I'd been in labour for about 48 hours by then. There was a lot of tugging to get her free, and she was born exhausted with a big black eye. Second time round, 13 months later, I went into labour naturally, took myself off to hospital and it was in some ways a re run of the first time. They didn't hang about the second time though, the EMCS was offered much earlier. I think after about 8 hours labouring. It was much better all round.

Don't do it, my sister wanted a VBAC she didn't dilate the first time either and they ended up have to put her to sleep to get the baby out fast. She needed a section with her 3rd also.... just isn't worth the risk towards you & baby for the sake of 'Natural birth'

Given all the risks you've outlined- why are the midwife team supporting a home birth when you have a genetic condition, and an emergency section- this makes no sense. The doula would obviously, but I find the midwife saying that it's fine odd.

No way would I risk the home VBAC in your situation. ELCS sounds miles safer.

How will you feel if your VBAC fails/doesn't go to plan? It sounds ideal, but the stakes are higher.

Also, I believe a section is safer for babies. More dangerous for mothers in terms of mortality during procedure, but long term outcomes are better than a vaginal delivery.

I can understand your two options, but I think I would work off my first question. A section has a much more predictable outcome.

I wouldn't even question having the section in those circumstances tbh

You would be absolutely nuts to attempt a home VBAC IMO.
I would say to try for a VBAC under consultant care if you really want to try for one. You can ask for wireless monitoring, and you don't have to consent to regular pokings from the doctors/midwives. My local hospital will allow you to use the birthing pool (with the wireless monitoring). If it isn't going to plan you can have the CS.

I suffered a uterine rupture attempting a VBAC and the outcome for both me and DD2 would not have been rosy if we'd been at home. They had 7 minutes to get her out. My experience hasn't turned me against VBACs at all, but I would urge everyone to plan for what is most VBACer's greatest risk.

I ended up being consultant led for my third child after being in the midwife led unit for my first two. I was concerned too but apart from extra heart beat monitoring and checks I laboured and gave birth the same as my first two! So don't be put off just because it is consultant led. I wouldn't even consider a home birth tbh given your circumstances