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 you did try at home, how close is the local hospital in case of emergency?
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.
DS2 - Oct 2010 (my VBAC baby!)
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!
Sarah - 12/23/2008
Alex - 9/30/2011
"I say embrace the total geek in yourself and just enjoy it. Life is too short to be cool." - Shirley Manson, Garbage
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.
Sarah - 12/23/2008
Alex - 9/30/2011
"I say embrace the total geek in yourself and just enjoy it. Life is too short to be cool." - Shirley Manson, Garbage
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
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.
Sarah - 12/23/2008
Alex - 9/30/2011
"I say embrace the total geek in yourself and just enjoy it. Life is too short to be cool." - Shirley Manson, Garbage
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).
Sarah - 12/23/2008
Alex - 9/30/2011
"I say embrace the total geek in yourself and just enjoy it. Life is too short to be cool." - Shirley Manson, Garbage
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...
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.
Sarah - 12/23/2008
Alex - 9/30/2011
"I say embrace the total geek in yourself and just enjoy it. Life is too short to be cool." - Shirley Manson, Garbage
DS2 - Oct 2010 (my VBAC baby!)