Midwife attended VBAC

guineas12 · March 2011

I am just looking into options before we start trying for baby number 2.

Does anyone have any information about the safety of a VBAC with a CPM (certified professional midwife). I would really like to have a baby either at a birth center or at home. There is one birth center here with a CNM, but she does not do VBACs by state law.

We are in the Tampa Bay area. Any information would be helpful!

iris427 · March 2011

If you're looking for statistics here, there aren't many. Pretty much all VBAC studies are done in hospitals, with either physicians or nurse-midwives attending. There is one study on VBAC in freestanding birth centers that I have found. The authors conclude that VBAC is safest in a hospital setting; however looking at some of the data in the abstract, VBAC in a birth center looks acceptably safe for me.

https://journals.lww.com/greenjournal/Abstract/2004/11000/Results_of_the_National_Study_of_Vaginal_Birth.9.aspx

So there aren't a lot of medical studies to go on here but I think that VBAC out of hospital is a good option for a lot of moms if they are comfortable with it and will be fairly close to a hospital. I think you have to weigh the possibility that a serious rupture would be handled better in a hospital vs. the increased risks of unnecessary interventions and repeat cesarean in a hospital. It's all a matter of what is acceptable risk to you.

*LrCg* · March 2011

I would interview some midwives in your area. I had a homebirth with a CNM and she keeps all her records/stats, etc. and compares them to others (I beleive most midwives would do). They are immeidately on hand to patients/potential patients. My second birth was a c-section due to an almost complete placenta abruption. For my third, I will do a VBAC at home with my CNM. I think it would be fair to say that at least 1/2 of her births are VBAC and I'm very comfortable with her and our decision.

Harper'smom · March 2011

I am considering a birth center VBAC for my next pregnancy. I have concerns regarding their distance to the nearest hospital but they are the most renowned birth center in the region. They recently began accepting VBACs and I have been in contact with the owner/founder head midwife. They accept VBACs on a case by case basis and I have to take my hospital records to a consultation and tell "my story". I plan on doing the consultation and consulting with a new prospective O.B., that was recommended by ICAN, before we TTC. I think I have to fully explore both options in order to make the best decision. I have too many unanswered questions to commit to anything at this time.

MissyOlivePants · March 2011

I'm in Tampa Bay & planning to have an HBAC! There are several midwives in the area that will do them. By law, they cannot at the birthing center, but can at home.

Send me an email at missyolivepants at gmail dot com and I'll shoot you a list of potential midwives to interview! I still have yet to set up interviews for mine.

lorryfach · March 2011

guineas12:
Does anyone have any information about the safety of a VBAC with a CPM (certified professional midwife).

The Midwives Association of North America probably does, but they don't make that information publicly available. That makes me uncomfortable, personally, that they need to hide the numbers. Plus CPMs have less education and training than legal midwives anywhere else in the industrialized world. I would not birth with one.

iris427 · March 2011

lorryfach:
guineas12:
Does anyone have any information about the safety of a VBAC with a CPM (certified professional midwife).
The Midwives Association of North America probably does, but they don't make that information publicly available. That makes me uncomfortable, personally, that they need to hide the numbers. Plus CPMs have less education and training than legal midwives anywhere else in the industrialized world. I would not birth with one.

Do ACOG, ACNM or AAFP release their own VBAC or general mortality/morbidity statistics? I don't think they do either but if I'm wrong, someone point me in the right direction.

A37licia · March 2011

A birth center isn't an option for me either, so at 26 weeks, we switched to a homebirth midwife from a hospital CNM. We felt a homebirth was as safe, and was a more supportive and empowering environment in which to give birth, esp since I'm a VBAC and could have doubts creep up of whether I can do it.

As another poster said, there is very little data about HBAC because it's a very small number. We assessed the safety and risk by 1) realizing how LOW risk a VBAC really is. Yes, the risk of rupture is greater than in an unscarred uterus, but it was still a lower risk than other bad birth events (ie placental abruption) and 2) realizing our view on childbirth from our first baby - we chose a birth center then and had an unnecessary c/s, but we, in the first place, felt that birth is normal and yes there are things that can go wrong but we felt that a well trained and experienced midwife can resolve those issues or transfer care in time. Yes, some things happen where minutes count, but we don't view childbirth as a disaster waiting to happen and accepted the very small risk of various things going wrong outside the hospital.

So, remembering our view of birth in the first place and also realizing how low the risk is for rupture, it made sense to choose a homebirth. It hasn't happened yet but I'm really looking forward to it and am absolutely confident in my body's ability to give birth. And, I am very comfortable with the abilities of my midwife. That is really important.

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