There are a number of reasons why I prefer the hospital, but naturally these are specific to me and may not apply to others. Basically, it boils down to where I feel safe, since that is where I will be able to relax and be able to labor "better" (if there is such a thing). That's the key thing I'd like you to know. So you need not read this whole long thing since none of it might apply to you. Here are a few of my reasons:
- I like the fetal heartrate monitoring (for the purpose of detecting rupture). I labor laying on my side anyway; I really cannot move once I get to a certain point in labor (well before transition) so wanting to be mobile is not an issue for me. I've had continuous monitoring in all three of my vbacs. In my last one, once active labor started suddenly at home, I was having some sharp pains in the area of the incision - it seemed like some pointy body part of the baby was poking and pressing on it during contractions - and the nature of the sharp pains was really quite scary re: rupture. Fortunately those pains were gone by the time we left for the hospital, but it was scary enough that I was much better able to concentrate on relaxing the appropriate areas of my body once I was hooked up to the monitoring and knew my baby was ok.
- I'm not particularly concerned about the labor process itself, based on my prior labors. My section was for breech, and my three labors have been relatively fast and uncomplicated, and always prior to my due date. I also tend to have a very "favorable" cervix to start with. It's hard to keep in mind that things could go awry for random reasons that I haven't experienced before and haven't prepared for, or simply take longer (the baby in the wrong position, etc.), but I'm confident that if he or she is in the right place, chances are very good that labor and delivery will go smoothly and quickly.
- I have tons of confidence in my OBs. I have had three successful vbacs in two different states, with two different OB groups (three separate docs). I love my OBs - pretty open-minded but also very current on the latest research, etc. (I've had so much experience with strange medical issues in my life and that of my kids that I really count on them to know their stuff and that is really important to how well-cared-for I feel. It's part and parcel of what makes vbac feel safe for me.) One of them is even the child of a midwife and has read Birthing from Within personally, and is simultaneously top-notch medically.
- My hospital experiences have been positive, so there's no real downside to the hospital for me. Baby rooms in. My ped does rounds on her new patients at my hospital. Plus having had so many other kids, the nurses leave me alone. It's not a teaching hospital (unlike my first hospital) so no med students or residents waking me up for rounds before the crack of dawn (however I did have a vbac of twins at a teaching hospital and no one batted an eye - something to consider if you're having trouble finding a vbac-friendly hospital). Carpeted (quiet) postpartum rooms. Room service food from a menu - sounds and looks better than it tastes but I can get it anytime.
- I really need those two days alone with the baby before heading back to the mayhem of what will have become six children, ages 8, 6, 6, 3, 13-months and 0.
- I'm on anticoagulants so planning to deliver anywhere else really is not an option anyway.
My last vbac was unmedicated, a short, very intense labor, and ultimately I ended up with the fetal ejection reflex (which I had only the barest awareness of from reading these boards beforehand). It was the middle of the night, in a quiet, dark room. More recently at least one article I saw on the fetal ejection reflex stressed the importance of the mom feeling safe in order for hormones to bring about that reflex. (that is, if you want to experience it LOL - it was not exactly calm and peaceful from my perspective, even if it appeared so from the outside. I was in such physical shock that I couldn't even hold my baby when the doc offered to put him on my chest immediately after he was born. At least the reflex was mechanically efficient!!)
Having had success three times now, and really really not wanting a section this time because I have five kids at home already besides the new baby (i.e. my primary purpose in vbacing is about the recovery), there's always the fear that some unknown complication will pop up and spoil my plan. I've been surprised with so many things in other medical contexts that it's hard to surprise me but still the weirdest things happen. So, I'm trying to consider as many possibilities as is reasonable for how I think it will go. That has often been an approach I take to the unknown in life - knowledge is power, prepare the best you can. That way if some problem should crop up, I'll know pretty readily what to expect or at least to roll with it, so to speak.
My advice would be to try to figure out what happened with that first labor that was so long. For example, was it just position - then I'd go all out to work on position to the extent possible (spinning babies website, etc.). If it was a lack of dilation, then I'd consider things to softent the cervix (EPO?). If you have a good idea what the issue was, do what you can to address it. The hard part is that sometimes there's only so much you can do, and it's important to know that too. You prepare the best you can and then you have to play the cards you're dealt. Hope they're good cards, and I hope you have a wonderful birth!