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????

Hi all,
Thanks for all your advice. My head definitely says that elective section is safer, but my heart says I want a VBAC.
My reason for avoiding the Labour ward is they are well known for interfering and I would be much more comfortable and relaxed at home. The midwife led unit would have been a good compromise but they won't allow me there due to previous section.
Sitting down and doing calculations I think I have a 50/50 chance of birthing at home, and if I was transferred it would be an emergency section which is more risky.
Being able to plan the elective section is very appealing and at least I would be pretty sure of outcome. The consultant was such a horrible person though so I really don't want her touching me!!
I'm just struggling as I have a lot of people around me (DH, midwife and doula) who are all pro home birth.... it sounds stupid but I also don't want to let them all down.... I know it's not about them.... Oh it's just so hard.... I'm kind of hoping that the baby will be breech as that would take the decision away from me....

Elective section.

I had an emergency section with my eldest for similar reasons as yours. It was very distressing the circumstance of his birth and this was while I was in hospital. I couldn't imagine having to worry about getting to the hospital in the middle of it all as well!

With my youngest, I had an elective section. I didn't want to risk trying to have him naturally and then still need a section again at the end of it all. An elective section is much more relaxed and straightforward.

@SunnyScot89 the people around you should be pro healthy baby! If your going to VBAC at least do it in the hospital, they cant force you into anything other than monitoring and thats what you and baby need! Why not have VBAC at hospital and have DH and Doula there for support and to voice your wants if anyone try's to intervene when not necessary..

My local NHS were very pro VBAC but very anti home VBAC.

The Royal College of Obstetricians and Gynaecologists have some good guidance on VBAC, including factors making a successful one more and less likely. Worth a read!

It’s NOT any of DH or your doula’s business! Your body: your choice!

Right, so your post implies that you’re paying a private midwife and doula?

“I have a 50/50 chance of birthing at home”: where do you get that from? I doubt the “odds” are as good as that.

What made you think the consultantil is a “horrible person”? Shit “bedside manner” doesn’t necessarily mean anything beyond that.

I have 3 DCs, 1 HVBAC which ended up being foreceps in hospital after 40 hours of labour, 1 elective csection for breach and 1 emcs.

Elective csection was by far the best experience for me and very different to emcs.

I was planning a VBAC with DC 3 but my scar ruptured and I was rushed to theatre.

I now feel that for me, the recovery is far more important than how the baby is born.

But if you want VBAC and have to do it in hospital, be really clear with yourself about what you want. Make sure DP is briefed so he can advocate for you and prevent unwanted intervention.

My worry with HB in your circumstances is that the MW would be very quick to transfer you so unless the labour is textbook, you are likely to end up in hospital and will have to deal with that disappointment too.

You have a midwife and doula who agree that a home VBAC is a sensible option? I'm really surprised. I think they are putting their own idealised views ahead of what is best for you. Home births are great, and I'd have loved to have one but it just doesn't suit every birth situation.

It really annoys me that MLBUs are so against VBACers (who are otherwise low risk) using them when they are often right next door to the regular labour wards. I wonder how many women have taken the risk of a home VBAC because they were denied admission to the MLBU and were unwilling to use the LW.

I think the most important thing is to have a healthy safe delivery and a live baby at the end of your pregnancy - nothing to do with letting your Dh, midwife or doula down. You want a c-section, as is clear by your last post where you hope baby will turn in order for the decision to be taken from you. I'd definitely go for the elective section.

A decent midwife shouldn't be pro anything. They should be supporting you in making informed decisions. And a doula shouldn't be giving out any sort of medical advice or medical opinion.

A hospital no intervention labour vbac is possible. Nobody can make you have monitoring, etc not even in the hospital.

C-section. The home birth sounds very risky.

You can still have a positive birth experience labouring in hospital! My first was very calm, intervention free and smooth. The midwives respected my personal space and I had DS with just a bit of gas and air (and Apple juice!).
My 2nd was also in a hospital and while not quite so smooth sailing it was still overwhelmingly positive and I was damn glad I had an epidural to hand.
I’ve done a hypnobirthing course this time so I understand all the ‘chain of intervention/ disruption to hormones’ discussion. I agree with it all in theory but I genuinely believe you can work to achieve an intervention free labour while in hospital. You probably know all the advice about taking in personal items, dimming the lights, drawing curtains etc. Your birth partner can help question the need for any checks etc. Do the breathing/ visualisation... you can have a birthing pool as well in my hospital - is that an option?
Then you’re giving a VBAC a strong chance while being in a place where you’ll get quick support if any of the risks of VBAC materialise?
I’m one of those people who feel safer giving birth in hospital due to the ‘what if’s’ and in your circumstances I wouldn’t consider a home VBAC.
Good luck with your decision (and don’t do anything just because of your DH/ midwife etc! If it’s not coming from YOU then surely the niggles you have will set you up for problems labouring at home? - from a psychological POV I mean).

Are your homebirth midwives attached to the hospital? If so I would have thought a case could be made for the MLU, given that you've been tentatively approved for a homebirth? Could you ask to speak to a consultant midwife or the supervisor of midwives to discuss?
Also- it's your body and you get to decide who touches it! You can ask for a different consultant! It sounds like having a consultant you don't like is not helping you sort out what you actually want here!
Your doula (and possibly one of your midwives if it's a caseloading team) can attend an elcs to support you too.

It doesn't need to be vaginal birth at home or csection in hospital

Go for the vbac that you want but be in hospital incase of any emergencies. The ones I had in the consultant led suite certainly didn't interfere too much and listened to me and my requests/ concerns / queries. Nothing was forced on me.