Home birth vbac? — The Bump
VBAC

Home birth vbac?

I was wondering if anyone has attempted a vbac at home, and I would love anyone's thoughts on the matter, whether you've tried it or not. My son was delivered via c-section about a year ago due to being breech. I am about 6 wks along with my second now and trying to decide on a provider. I live in rural Wyoming and our local hospital does not do vbacs. My only options are to have the baby at home with a midwife, or travel 100 miles to a hospital that does vbacs. I would love a midwife, but no hospitals in my part of the state have them, only ob gyns. I'm so scared of having another c-section and I'm worried that having the baby in the hospital will make that more likely! I also don't know how I feel about delivering at home. I would love any advice! TIA!

Re: Home birth vbac?

  • If it were me, I'd go to the VBAC friendly hospital 100 miles away. Personally I wouldn't feel comfortable attempting at home, probably because I had an unplanned c/s due to fetal distress. But can you even find a doctor near you that you can go to for your prenatal care, but that has privileges at the 100 mile hospital?

    If you did try at home, how close is the local hospital in case of emergency?
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    jmcgra06[Deleted User]MrsRucinski85katherines2ndminime
  • The local hospital is about 3 min away. The hospital 100 miles away has a practice of obs and I've heard that they do come to our town to see moms but I don't know how often. I imagine sometimes I'd have to go there for appts, but that's just kind of the reality of living here--we do stuff like that all the time.

    I think the thing I worry about is that they'll say they're vbac friendly, but then in reality will hardly give me a chance to labor.
    PregNancyClark
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  • I would be afraid to do it at home. I had my vbac baby after only 11mins at the hospital, and the doctor didn't even make it in time (oops!), so technically it would've been fine doing it at home... But there are just too many unknowns. My emergency c/s was because they realized my daughter was breech when I was at 10cm (after 16hrs at the hospital), and after that I swore I'd never do a home birth. Too much can go wrong too quick - esp with a vbac. IMO, I'd go to the far hospital, esp if driving that distance isn't uncommon for you.
  • Coming from someone who did rupture during a vbac, my situation would have been devastating had I not been right down the hall from the operating room. You always think that it won't happen to you but it has to happen to someone. My baby and I both made it through fine, but had we been even 10mins away from that operating room instead of 20 seconds, the outcome would not have been good for either of us. It is unlikely, but not worth the risk in my opinion.
    [Deleted User]RunnerMegkatherines2ndminime
  • I'd go to the hospital. 
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    af2004rn[Deleted User]katherines2ndminime
  • I had a amazing home birth vbac with my second. We are expecting again (8weeks) and I couldn't imagine doing it any other way. Let me know if you have any questions.
    PregNancyClark
  • Not to mention if I even went the regular obgyn/hospital way I wouldn't have even got to try to vbac. I delivered at 41 weeks and if I went the other way I would have had a scheduled csection right on the day of my 40 weeks
  • Meeting with a mw early January to go over home birth vbac. I'm driving 2.5 hours to do it out of hospital.
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  • We are planning a home vba2c with a midwife. There are multiple hospitals within 5-10 min away depending on which one you want to go to and each has NICUs if needed. There are multiple studies out from England about the recommendation of having a home birth with a midwife for low risk women. If I can find a link I will post it.
    laralisle
  • My sister had a successful HBAC, as has Iris247 (who is the mod of this board?). I wouldn't do it myself, but if you are close to a hospital and have a MW who has VBAC experience, it might be your best option. There are traveling MWs as well, and you would go to a Dr or OB for prenatal care.
    DS1 - Feb 2008

    DS2 - Oct 2010 (my VBAC baby!)

  • Actually depending on the incision and the train for the first c vbac is not high risk. I had a hbac will be having my 2nd hbac in march. Have a midwife, hospital less than 10 minutes away. If you want to chat pm me I am more than willing to help if I can.
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    PregNancyClarklaurasuzanne2006
  • I'm really doing some homework! We are making the same tough decision. We've toured birth centers, met midwives, read books, watched documentaries, met real life successful HBAC couples and gotten hooked up with the local ICAN chapter. Learn as much as you can and go with your gut. There's no such thing as a risk free birth... Everything in life has risks associated. Just find out what is the best option for you for the best possible outcomes.
    We are leaning toward home birth with a solid transfer plan. We feel that the interventions led to our complications last time, so for us- lower risks include no unnecessary interventions and the ability to move and labor naturally.
    You'll find your way!
    laralisle
  • Personally, I'm a risk mitigator. My VBAC will be in August (God-willing) and knowing that I have a risk for a rupture, I won't do a home birth (though I've heard they're amazing). I am choosing to have my new baby in a hospital with a top NICU, just in case. Understanding that a VBAC is not a guarantee (in any situation) and likely to encounter resistance in a hospital, I am going in armed. I'm going to write a concise but forceful birth plan to keep on file. I'm going to educate myself and my husband on reasons FOR a section and reasons a section is NOT necessary. Remember that you have the right to refuse ANY medical care, including a CSection (just make sure you understand why they're recommending one!). 
    RunnerMeg
  • Rupture happens in ftm to. Saying it is a risk just for vbac is not true. The risk increases worn interventions like pitocin that I won't be getting during my hbac. Call me a risk reducer.
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    laurasuzanne2006MarettiePregNancyClark
  • It great to read about others who have had successful hbacs. I also believe that some of the hospital interventions were what led to my c in the first place. There are hospitals nearby and I will not attempt being home if there seem to be any obvious positioning issues when we get close. But I totally believe in myself and I won't be steamrolled this time around. I feel much more educated and prepared. The biggest issue is actually insurance.
  • laralisle said:

    It great to read about others who have had successful hbacs. I also believe that some of the hospital interventions were what led to my c in the first place. There are hospitals nearby and I will not attempt being home if there seem to be any obvious positioning issues when we get close. But I totally believe in myself and I won't be steamrolled this time around. I feel much more educated and prepared. The biggest issue is actually insurance.

    Yeah insurance sucks. We are having to pay completely out of pocket
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  • I am in a similar situation. I live 2 whole hours from the closest hospital that allows vbacs. We do have a closer hospital that is a half hour away, but being a rural hospital will not allow vbac. To me, its worth the 2 hour drive (and learning how to do an emergency backseat delivery, if we do not make it to the hospital in time) to be in a facility just in case something were to go wrong. I would love to have the confidence, and a closer hospital, to be able to freely have a vbac home birth. Good luck on your desicion! My suggestion is to go with your gut.
  • nosoup4u said:
    My sister had a successful HBAC, as has Iris247 (who is the mod of this board?). I wouldn't do it myself, but if you are close to a hospital and have a MW who has VBAC experience, it might be your best option. There are traveling MWs as well, and you would go to a Dr or OB for prenatal care.
    Iris has since had another hospital VBAC and would not recommend HBAC any more.  I'm not sure of the last time she's been on here but I talk to her almost every day.  She actually HBACed with a doctor but he's since had his license suspended and is being investigaged for babies that died at births he attended out of the hospital.  


    Wife, mom, Ob/Gyn resident
    Sarah - 12/23/2008
    Alex - 9/30/2011

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    "I say embrace the total geek in yourself and just enjoy it. Life is too short to be cool." - Shirley Manson, Garbage
  • mkjbw&+1 said:
    We are planning a home vba2c with a midwife. There are multiple hospitals within 5-10 min away depending on which one you want to go to and each has NICUs if needed. There are multiple studies out from England about the recommendation of having a home birth with a midwife for low risk women. If I can find a link I will post it.
    Yeah, but we're not low risk, at least not for labor and delivery, even if the rest of our pregnancies have been completely uncomplicated.

    You also can't extrapolate homebirth data from Europe to homebirth in the US,  Firstly, previous C-section is also part of the risk-out criteria in places where homebirth is more common and integrated into the healthcare system. Secondly, midwives in Europe that attend homebirths are more similar to CNMs (who rarely attend homebirths and are more often in hospitals and birth centers in the US) and most homebirths in the US are attended by CPMs and other lay midwives.  There is a huge disparity in education and training between CNMs/CMs and CPMs and other direct entry midwives.  It's actually downright frightening to me that they're allowed to practice without any real oversight. 

    By MANA's own statistics, 1 in 200 babies die from HBAC attempts.  Uterine rupture outside of the hospital is almost certainly fatal to the baby, even if you live across the street from the hospital.  I'm going to assume you probably wouldn't do anything else that had in 1 in 200 chance of your kid dying, right?

    So, to answer your question, I'd go to the hospital 100 miles away.
    Wife, mom, Ob/Gyn resident
    Sarah - 12/23/2008
    Alex - 9/30/2011

    image

    "I say embrace the total geek in yourself and just enjoy it. Life is too short to be cool." - Shirley Manson, Garbage
    jesselayne8RunnerMeg

  • mkjbw&+1 said:

    We are planning a home vba2c with a midwife. There are multiple hospitals within 5-10 min away depending on which one you want to go to and each has NICUs if needed. There are multiple studies out from England about the recommendation of having a home birth with a midwife for low risk women. If I can find a link I will post it.

    Yeah, but we're not low risk, at least not for labor and delivery, even if the rest of our pregnancies have been completely uncomplicated.

    You also can't extrapolate homebirth data from Europe to homebirth in the US,  Firstly, previous C-section is also part of the risk-out criteria in places where homebirth is more common and integrated into the healthcare system. Secondly, midwives in Europe that attend homebirths are more similar to CNMs (who rarely attend homebirths and are more often in hospitals and birth centers in the US) and most homebirths in the US are attended by CPMs and other lay midwives.  There is a huge disparity in education and training between CNMs/CMs and CPMs and other direct entry midwives.  It's actually downright frightening to me that they're allowed to practice without any real oversight. 

    By MANA's own statistics, 1 in 200 babies die from HBAC attempts.  Uterine rupture outside of the hospital is almost certainly fatal to the baby, even if you live across the street from the hospital.  I'm going to assume you probably wouldn't do anything else that had in 1 in 200 chance of your kid dying, right?

    So, to answer your question, I'd go to the hospital 100 miles away.

    1/200 rupture rate is not the risk of a catastrophic uterine rupture. It's actually about 6% of the rupture rate

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  • Geekchick921Geekchick921 member
    edited June 2015
    1/200 rupture rate is not the risk of a catastrophic uterine rupture. It's actually about 6% of the rupture rate

    I know what the rupture rate is, what the risk of catastrophic rupture is, and what the rate of perinatal mortality in HBAC is.  I didn't confuse them.

    MANA's OWN statistics showed 5 babies died during/after 1000 HBAC attempts. That's 1 in 200.  They happened either intrapartum or within the first month after birth.  Keep in mind these are also voluntary, self-reported statistics so I wouldn't be at all surprised to find out that many people with bad outcomes just avoided using the data registry, which would mean the incidence may even be higher.  Table 5. https://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full  

    The risk of rupture in women with 1 prior low-transverse C-section is 0.5-0.7 (sometimes 0.9) in most studies.  I certainly don't think it's coincidence that the rate of UR and the rate of HBAC death are almost identical.  The statistics that show 6% of babies die because of uterine ruptures (another 6-7% have brain damage) come from HOSPITAL data.  Perinatal mortality for uterine ruptures in developing countries is anywhere from 70-95%.  These ruptures typically happen to women with unscarred uteruses as a result of obstructed labor (something we rarely see in the industrialized world because those women would be taken for C-section before that point), but they have the same problem has HBAC.  They don't have access to prompt cesarean section when these ruptures happen.  Studies show C-section should be done in less than 10-37 minutes after recognition of rupture to prevent significant long-term damage or death to baby. 16-18 minutes is a narrower time frame that experts reference for the same goal.  

    You aren't going to get that with HBAC.  First of all, actually picking up on the uterine rupture probably won't happen as promptly, because you're not on continuous monitoring getting constant, real-time updates on baby's status and the most reliable sign of uterine rupture is prolonged decels or bradycardia.  Even if the rupture was picked up right away, there's no way you're getting out of your house, into a vehicle, to the hospital, assessed and into the OR in 16-18 minutes.  

    I don't know of any HBAC attempt rupture stories where the baby lived firsthand but I do know one woman who lost her son during an HBAC that ended with a shoulder dystocia that lasted a full 20 minutes, followed by 20 minutes of resuscitation from the ambulance team that showed up and worked on him before transferring to the hospital.  He had massive, global brain damage from 40 minutes of oxygen deprivation.  He was very nearly 11 pounds.  SD also happens in the hospital, but the hospital is more prepared.  This even assumes the hospital wouldn't have recommended a repeat C-section if they'd suspected her baby was THAT big.  The L&D staff drills a specific set of steps to reduce an SD and the NICU team is waiting in the wings the soon as the baby is out.  There will never be an adequate for a NICU, OR or bloodbank at home, even if you subscribe to the (false) notion that homebirth midwives are better at delivering babies than hospital CNMs and physicians.  


    Wife, mom, Ob/Gyn resident
    Sarah - 12/23/2008
    Alex - 9/30/2011

    image

    "I say embrace the total geek in yourself and just enjoy it. Life is too short to be cool." - Shirley Manson, Garbage
    RunnerMeg
  • My hospital is two hours away also. As lovely as a home birth sounds, to me, it's not worth the risk. I've read a uterine rupture story in which the baby did not survive the uterine rupture because the birth was a home birth, the hospital was 15 minutes away and it was too late to save him by time they go to the hospital. When a uterine rupture takes place There is only about 37 minutes to get the baby out alive( that's 37 minutes from the 1st indication of rupture.) I would ask myself if I thought I would be out the door to the hospital in the hospital and in an OR in 37 minutes or less if I were to rupture at home.
  • Have you looked for a birth center w/ a midwife near by or closer than the hospital?
  • I am in the same situation. Our local hospital has a VBAC ban, the only hospital that would let me try is 90 miles away and the doctors wouldnt let me even meet with them until 36 weeks. They said that you cannot tell if someone is a good candidate for a VBAC until then. This shows me that they are NOT VBAC supportive but mearly VBAC tolerant. So we will be having a HBAC. I know the numbers and the risks of an HBAC but I also know the number a risk of a RCS. 

    I am not sure this is the best forum if you are looking for support with your desion. I would contact your local ICAN chapter and check ou the FB page as well as birthwithoutfearblog.com

    The maternity care system in our country is confusing and hard to nagivate. Most of the data on home birth is skewed because it just isnt collected. I have found speaking with mothers that have had HBAC's has been a life saver. 
    laurasuzanne2006april&aaronnosoup4u
  • Geekchick921Geekchick921 member
    edited June 2015


    The maternity care system in our country is confusing and hard to nagivate. Most of the data on home birth is skewed because it just isnt collected. I have found speaking with mothers that have had HBAC's has been a life saver. 
    This is true.  MANA's own "reassuring" data (it's anything but) is derived from a voluntary database of self-reported statistics.  The real numbers are probably worse.  Who do you think is more likely to avoid using the registry, providers with worse outcomes or providers with better outcomes?  

    You can't be truly informed of anything without knowing about the good and the bad, so I hope you've read some stories from HBAC (attempt) moms that regret their decision as well, and why.

    I hope everything works out for you.  I find it odd that other practice won't even see you at all before 36 weeks, though it is true that complications that develop late in pregnancy certainly affect your likelihood of VBAC (they'd affect your likelihood of vaginal delivery if you hadn't had a previous C-section either).  
    Wife, mom, Ob/Gyn resident
    Sarah - 12/23/2008
    Alex - 9/30/2011

    image

    "I say embrace the total geek in yourself and just enjoy it. Life is too short to be cool." - Shirley Manson, Garbage
  • Yep. I know I've said it before, but I ruptured. I live about 10-15 mins from 2 major hospitals and I am still 100% sure my son would have died if I was at home. He was unresponsive when they cut me open as it was and we were literally about 15 feet from the OR...I also lost about 50% of my blood volume and need a pretty major transfusion so I would have likely died and left my 1st kid motherless.

    There was nothing about my situation that made me high risk for rupture. I had a planned section for a breech baby with my 1st... Both pregnancies healthy etc...I was just randomly in the unlucky minority. It is just not the risk to lose your baby or you life...
    RunnerMeg
  • Edan, I'm so sorry!  Thank goodness you were in the hospital.  How is your son doing now?

    There is a uterine rupture support group on Facebook an online friend of mine runs.  She attempted an HBAC, ruptured, and lost her son.  Are you a member there?  If you search FB for uterine rupture you should be able to find it.  It has just shy of 250 members.


    Wife, mom, Ob/Gyn resident
    Sarah - 12/23/2008
    Alex - 9/30/2011

    image

    "I say embrace the total geek in yourself and just enjoy it. Life is too short to be cool." - Shirley Manson, Garbage
  • nosoup4u said:
    My sister had a successful HBAC, as has Iris247 (who is the mod of this board?). I wouldn't do it myself, but if you are close to a hospital and have a MW who has VBAC experience, it might be your best option. There are traveling MWs as well, and you would go to a Dr or OB for prenatal care.
    Iris has since had another hospital VBAC and would not recommend HBAC any more.  I'm not sure of the last time she's been on here but I talk to her almost every day.  She actually HBACed with a doctor but he's since had his license suspended and is being investigaged for babies that died at births he attended out of the hospital.  

    Oh, I didn't know (haven't been on much and haven't seen her on here in a long time). Good to know!
    DS1 - Feb 2008

    DS2 - Oct 2010 (my VBAC baby!)

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