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HBAC?
Hi
I recently found out Im pregnant again, it's still pretty early but I've been thinking a lot in the last year while we've been TTC and I'm fairly certain i want a home birth. It's not that I had a particularly traumatic time in hospital last time, had c-section for breech which was undetected till 42 weeks, but I know a few people who've tried for VBAC in the local hospital and it seems the staff only really pay lip service to what you want and kind of have you marked down for a c section from when you go in, and at the first opportunity whisk you off for one, absolutely not what I want this time around in less absolutely necessary!
I know you can refuse any treatment, but I don't want to have to be fighting doctors etc while I'm in labour. Ive read a lot about it, it seems that while the risk of uterine rupture is increased it only goes from 0.05% to 0.5% (so 1 in 2000 to 1 in 200) and you are far more likely (about 40 or 50 times more) to need an emergency c section for other reasons, but medical staff get so twitchy about the risk of rupture. It also seems that a lot of hospital procedures contribute to problems, like inducing and augmenting labour actually increasing the risk of rupture, and continuous EFM hindering labour by restricting your movement. I read another study that showed that planned VBAC at home has a much higher success rate than planned VBAC at hospital, and also the high level of care (midwife with you all the time) means that any problems will be picked up very quickly and acted upon. It's all very well having continuous monitoring, but unless someone is continually reviewing the trace then intermittent monitoring is just as useful!
All these things add up to me thinking the way to give myself the best chance of a natural birth is to do it at home, but I don't know what sort of reaction I'm going to get from the mw. I'll bring it up at the booking appointment and see!
Has anyone here had a HBAC / planned one but had to transfer etc? I'd be really interested in hearing about your experiences. Also would love to hear thoughts from everyone on this subject.
xxx
I recently found out Im pregnant again, it's still pretty early but I've been thinking a lot in the last year while we've been TTC and I'm fairly certain i want a home birth. It's not that I had a particularly traumatic time in hospital last time, had c-section for breech which was undetected till 42 weeks, but I know a few people who've tried for VBAC in the local hospital and it seems the staff only really pay lip service to what you want and kind of have you marked down for a c section from when you go in, and at the first opportunity whisk you off for one, absolutely not what I want this time around in less absolutely necessary!
I know you can refuse any treatment, but I don't want to have to be fighting doctors etc while I'm in labour. Ive read a lot about it, it seems that while the risk of uterine rupture is increased it only goes from 0.05% to 0.5% (so 1 in 2000 to 1 in 200) and you are far more likely (about 40 or 50 times more) to need an emergency c section for other reasons, but medical staff get so twitchy about the risk of rupture. It also seems that a lot of hospital procedures contribute to problems, like inducing and augmenting labour actually increasing the risk of rupture, and continuous EFM hindering labour by restricting your movement. I read another study that showed that planned VBAC at home has a much higher success rate than planned VBAC at hospital, and also the high level of care (midwife with you all the time) means that any problems will be picked up very quickly and acted upon. It's all very well having continuous monitoring, but unless someone is continually reviewing the trace then intermittent monitoring is just as useful!
All these things add up to me thinking the way to give myself the best chance of a natural birth is to do it at home, but I don't know what sort of reaction I'm going to get from the mw. I'll bring it up at the booking appointment and see!
Has anyone here had a HBAC / planned one but had to transfer etc? I'd be really interested in hearing about your experiences. Also would love to hear thoughts from everyone on this subject.
xxx
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Replies
Sadly no longer pregnant, miscarried twins at the end of January, but still hoping for a home birth if / when i become pregnant again.
I haven't had any experience in what you are thinking about but I'm happy to share my thoughts!
Basically as far as I was aware, MWs are really pro-VBAC. However, I have had a lady in my Due In group recently say that hers wasn't and they assumed she would go for another section. I woul think that had alot to do with her area, the NHS lottery as they say. Of course you would still be considered "at risk" due to the higher chance of uterine rupture, and so they would want you to be in the consultant-led labour ward, and probably strapped to the CTG machine
However, it is your choice. When these guidelines are put in place they are of course looking out for yours and your babies well-being, but it's a very general thing, they aren't looking at you as an individual with individual circumstances, which you need to get them to do
I think you would probably have a fight on your hands at first, but hopefully you would be able to find a sympathetic MW and consultant who would back you in your plans. They would I think want to keep a very close eye on you during your labour, to transfer you at first sign of any trouble
If you do ultimately go ahead with a homebirth the NHS are duty-bound to supply you with a MW to be there regardless, and I would imagine it will have already have been agreed who this will be, as obviously there will be some more comfortable with the situation than others, and this is the kind you want!
Best of luck to you! xx
I agree I think it will be important to find a midwife and consultant who are supportive and comfortable with what is happening.
Since writing that first post I have read another big study looking at uterine rupture during vbac, it basically analysed all the other little studies to try to get the bigger picture, and they came out the other end saying your risk of rupture is even lower than previously estimated, at 0.07%!
We're still in discussion at home about what way we will go, but obviously the pressure is off a little bit with no baby actually on the way, but I'm even more reassured re rupture rates now.
I thought my input could be of some help, I am 36+ weeks pregnant with my second child and only just changed my plan to a HBAC. My first was planned home but had to transfer after 48hours due to a back to back baby and an exhausted mummy.
For our second we decided to rule out the home birth as it seemed unpractical with a toddler and because I thought it was going to be a fight getting my way with the medical staff (and our local hospital was fantastic).
Anyway, I was still concerned with the rush to hospital and losing my frame of mind by going in too early and being strapped up and monitored so I talked about my concerned with my community midwife, she seemed to think I should prepare a back up plan if birth was to occur 'by accident' at home and send the supervisor midwife to meet with me. Next thing I know I was booked for a full on planned homebirth!
I met with the supervisor midwife yesterday, she was the one who booked me in and she was fantastic, appeased all my fears of the risks, mentioning everything you said in your first post. She didn't even try and convince me hospital was best but at the contrary how a lot of interventions could be avoided by labouring at home.
I would never have expected that and it really reinforced my trust in the NHS staff.
All of this to strongly advise you to see a supervisor midwife, my NCT teacher swore by them and I can now understand why, they are a totally different class of midwives.
I must add I am located near brighton where you could say they are very open minded so it may have helped but I hope you do get the same positive attitude to support you in your choice as I know I would not have gone with it if it would have meant having reticent midwives with me on the day.
Good luck in getting pregnant and in achieving your dream labour. If I remember I may try to tell you how it went my way!
I'm hoping for a wbac with my next baby (not till next year) and i've done a lot of research myself. I think it's absolutey absurd the extent to which you are treated as high risk after a c-section, when the increased risks are so ridiculously small! You're still more likely to experience the same complications as any other normal labouring woman (ie. Placental abruption) than something only relevant to previous c section mothers! Yet they don't have all women down for constant monitoring for placenta abruption???!
I think it definitely helps to go prepared with info! It shows that you mean business! I definitely think you'd be more likely to have a vaginal delivery without being tempted into an alternative by others!
It's your birth and your choice! Good luck xx
Elodiep I would be very interested in hearing how everything goes, wishing you all the best! Good advice re supervisor of midwives, I'll try and fix up a meeting.
Sharn - I agree, you can end up feeling like you're being treated like a walking time bomb, when there are so many other things that can go wrong that don't provoke the same levels of anxiety! Good luck with ttc next year
xx
I had a c section first time round and have recently decided to have a home birth. Have a look at AIMS website, it is fantastic and full of info. Basically EVERY mother is entitled to a homebirth regardless of risk factor according to the law. I would imagine that the government has recognised that most mothers are not complete morons and wouldn't risk a home birth if there were any serious risks. As far as I am concerned a less than 0.5% risk of a uterine rupture is negligible and I have as much chance of achieving a home birth as any one else.
I have written to my head of midwifery informing her of my decision as AIMS recommends so will see what happens. And by the way, a midwife has a duty to attend your birth so they cannot refuse you. Go for it if that's what you want!
thanks for replying. sadly had another miscarriage, but we're still trying and know we will get there eventually.
Thanks for the info re the AIMS website, writing to the head of midwifery sounds like a good idea. Have you heard anything back yet?
I agree, an HBAC woman has as much chance of achieving a home birth as anyone else.
Elodie - have you had your baby yet?
xx
No news back about my HBAC but have seen a midwife who is backing it and says she will chase up my letter to the Head of Midwifery.
Thinking of you x
Thanks for your reply. Hope the chasing up of your letter is going well. When are you due?
I found out the other day I'm pregnant again!!! Straight off the back of the 2nd miscarriage!! So I'm going to get down to some serious research before my booing appointment at the end of this month
Thinking positive 
Glad you've got the full support from the head of midwifery! That's brilliant. Will be very interested to hear how you get on if you want to post about it all.
I just had yet another miscarriage
That's us on 3 now, so have been referred to the recurrent miscarriage clinic. But, if/when things progress further I still plan on following the homebirth route. xx
Feebs that seems crazy to me that you are getting this kind of response from your consultant about having a waterbirth after successful VBAC. Has the consultant read the recent research review which puts risk of scar rupture much lower than was previously thought?
I agree that if you make a lot of noise and don't back down you are more likley to get what you want. Ultimately it is your choice anyway but if you have obstructive professionals it can feel like anything but. You know the risks, it's your body, your birth, your choice. They might not like it but they can cover their backs by documenting all conversations - maybe you should do the same and write a letter about lack of support for your informed choices! Informed choice is a buzzword in maternity care just now but it seems a lot of the time only lip service is paid to it, and in reality your choices are limited to what the individual healthcare practioner is comfortable with.
/rant
Good luck with your upcoming arrival, it would be lovely to hear about it afterwards if you feel like coming on here and sharing
Interesting about the NICE guidelines Tashua, will keep an eye out for that! Hope all well with you
xx
hi kittlelitten
so sorry to hear that you have lost 4 babies, what an awful time you've been having. you sound very positive despite the knocks you've taken, heres hoping you have some happy news soon and a sticky baby.
i agree the evidence with previous caesarean does not warrant the over reaction by health professionals. as someone who works in the field though, and not wanting to sound negative as i know a lot of the replies have been very supportive - health professionals are frightened of uterine rupture because they've seen it happen, and they've seen the terrible effects. Not trying to frighten you but when it happens (and i agree its very unlikely) your baby's heart rate takes a sudden dive, this might not be picked up by intermittent monitoring for another 15 minutes, and then there is a tranfer into hospital too.
Ive seen ladies have lovley vbacs in the pool with continual monitoring (there are machines that can do this in water now). I think there are ways to achieve a low risk birth without being far from help should it (rarely, admittedly) be needed. i know it depends on the support of your local hospital but im sure they'd rather try and go the extra mile for you.
I understand how horrid caesarean is and why you want to avoid this. Thankfully in my area caesarian for previous caesarian is now very rare, usually women are encouraged to try VBAC and most want to. But the continual monitoring is still important. Hope this point of view is not too unpopular! x
I do understand your point and quite rightly we need to look at every side. I understand that the professionals worry about uterine rupture, they are just doing their job. However, as a medical professional myself I agree with Mary Cronks thoughts on early detection of scar problems during VBAC. She states that monitoring the mothers vital signs are more effective than Continous CTG and I have to agree that it makes more sense. There are many potential risks in childbirth, I think we all accept that. But I also feel that pregnancy and labour are seen as a medical event these days instead of the natural process that it is. In my case, being in hospital with my first labour made me very stressed, everyone was too busy and believe that my labour stopped because of it. At home, I can be as relaxed as possible, be on my own time schedule and I am willing to accept the very low risk of an acute rupture. Even mums who are not VBAC have that risk.
Hope this doesn't offend you, just putting my side of it across from my own experience and research.