VBAC at birth center

austenreader85

I had an awesome midwife that I loved until I was diagnosed with gestational diabetes with my first pregnancy.  I had to be transferred to OB care and then developed pregnancy induced hypertension, both contributed to my planned c-section.  I know she does VBACs and contacted her initially this time but decided since I was likely high risk to stay with the OB.  But I just passed my 3 hour GTT and my blood pressure is awesome so far.  My OB is anti-VBAC and said he will only do it in very rare situations.  He basically blamed the hospital for it and said that it's because they don't staff enough anesthesiologists and that if I should need the OR one might not be available right away.  At the time since I thought OB care was my only option I just went with it.  But now I'd really like to try a VBAC and the natural birth I wanted last time.

I haven't done any research on VBACs yet and while I know the midwife will say it's entirely fine I'd like to read and decide for myself too (though I'm already biased for them).  The birth center is 1/2 mile from the hospital but she is not on contract with the hospital and if I needed to be transferred could only stay on as a doula and not part of the decision making team.  Would your opinion on VBAC change if you're not actually IN the hospital?  And what are some good articles I can read about VBAC?

cchill01

I'd talk to your birth center.  Understand their procedures for VBACs and transfer in an emergency.  Since my VBAC was with a midwife, in an emergency, I would have been transitioned to the oncall OB.  Honestly, that didn't bother me at all. 

DH wouldn't have survived the stress of not being in a hospital, so it wasn't an option for me. 

Is there a third option for you to find a new OB/midwife who will support a VBAC in a hospital? 

austenreader85

I was with another OB practice with DS and hated them, they said absolutely no VBAC. That's not why I lwft. This is the only other one in town. I could see if one of the other hospitals are in network for me and a corresponding OB practice, but I live 30-60 minutes away from any of those options. So routine appointments would be a pain in the butt. I don't honestly know what to think of the anesthediologist situation. I mean presumably I could go into labor before the planned date and I'm sure they wouldn't give meds to stop labor just to make sure everything is available. They would have a protocol in place to make others wait to prep me. So by that account being pregnant again at all is a risk. I guess it might make a difference on when ruptures and complications can occur. Assuming I arrive and am at 3 cm and complications usually occur after 7 that would allow time to prep everything versus arriving as an emergency. But I don't know if that's the case at all, just throwing that sort of situation out there.

nosoup4u

You're right about the anesthesia thing, if a hospital doesn't have the resources for an unplanned c section for VBACs, what does it do with any woman who needs an unplanned c section?

What's the birth center's VBAC rate and experience? Does the MW have transfer rate stats to give you?

iris427

I had a VBAC out of hospital (a home birth in my case).  I think it's OK as long as you are otherwise low-risk, you are near a hospital, and you have a qualified labor attendant who has experience with VBAC.  There is not much research about VBAC outside of hospitals, but there are a few studies you can look at:

https://www.washingtonmidwives.org/documents/conferenceslides/acceptable-risk-VBAC-birth-centers-germany.pdf

https://www.ncbi.nlm.nih.gov/pubmed/15516382

https://annfammed.org/content/10/6/530.full 

If you are looking for good articles on VBAC in general, check out our blog, vbacbumpies.blogspot.com