VBAC or HBAC?

[John'sMama]

I'm just curious how many of you had a successful VBAC at the hospital & how many went with an HBAC. I'm very much leaning towards an HBAC & have a lay midwife chosen, but tomorrow I'm meeting with a CNM that works with a doctor (in IL CNMs cannot attend HBACs). My lay midwife said she believes my best chances for a successful VBAC are at home. I guess it's just nerves and the what-ifs that keep my from being ready to fully commit to HBAC (I have til May, luckily!) Any thoughts?

[3tammuz]

I had a VBAC. There are not mamny HB MW where I live and DH was not ready to do it anyways.

[kltroy]

I had a hospital VBAC without intervention. I did not want a home birth (partly for logistical reasons - I had a 2 yo at home and a small apartment! partly b/c my husband wasn't too into the idea, and partly because I had a good hospital and provider to go with). My take: if you want a home birth, have a home birth. If a hospital birth makes you more comfortable, do that. Either way, if you have a supportive midwife or other care provider (my VBAC was with a family practice doc), you are likely to be successful and well supported. Everything has risks, which you need to balance against the benefits. Off the top of my head:
Risks for VBAC at home:
farther from hospital if a problem should arise that is beyond the scope of your midwife's care
no option for pain meds, should you decide you want them
Benefits:
no unnecessary interventions
no need to travel or be away from family

Risks for VBAC at hospital:
possibility for interventions you may not need
possible requirement of EFM, heplock
Benefits:
immediate access to interventions when medically necessary for you or baby
peace of mind (possibly) for you or your family, if they are not comfortable with HBAC
birth is messy - let someone else clean it up!

Of course, there are many intangibles here too. Best of luck with your decision. Is a birth center an option? IMHO, that's the best of both worlds.

[John'sMama]

Unfortunately, IL doesn't have birth centers. Disappointing b/c yes, they do seem to be the best of both worlds!

[thepeach80]

I've had 3 hospital VBACs.

[Sk8ermaiden]

For me (have not had it yet!) it is a clear decision because I am very unlikely to have successful VBAC in a hospital here. You basically have to have a picture perfect pregnancy.

The dealbreaker for me, is that every "VBAC-friendly" OB here ceases to be VBAC friendly after 39 weeks. Then it's automatic section time. With DD1 being a 42 weeker, I think it is very unlikely I will fit that criteria with a future baby. Barring major medical complications, my babies will pick their birthdays.

[MamaMelis]

My first VBAC was a wonderful hospital experience. Honestly, after losing all my confidence after my very unplanned CS I needed to reaffirm my belief/faith in my bodies ability to birth a baby vaginally. Without that faith, I personally was not able to consider a HBAC last birth. Now that I have had a successful VBAC I am having a HBAC this go round

Birth canters are not an option for VBACS in my state (PA), so that was out of the question.

HTH and good luck with whatever you choose!!!

[kathan12904]

HBAC all the way. I work as a doula and cannot imagine myself having a successful labor in a hospital setting. Many women successfully homebirth and it is very safe for vbacs, especially since there's no pitocin, the number one most dangerous drug for a vbacing mama that is routinely used in vbac labor in hospitals all across the country. Almost every part of the medical process of childbirth is subtlely saying "you can't do this by yourself" and many women find that prohibitive to a natural birthing experience. If you feel strongly about homebirth, go with it.

[liberal_chick]

We went with a HBAC. I didn't feel I'd be able to have a successful VBAC at our hospital (they only see about 10 successful VBACs a year). Dh was on board, so we stayed home.

[jess152]

It's a good idea to find out the VBAC success rates of the CNM/DR as well as the hospital in general. That can be a telling indicator of how 'supportive' they truly are. I agree with the PP that mentioned all the interventions that can be pushed upon you once you set foot in the hospital. You are on their turf, and in a moment of weakness/pain, you may submit to whatever.

That's not going to happen at home. What's your midwife's VBAC success rate? That's a good one to know too.

I've got an HBAC planned. I know my local hospital views VBAC mamas as flawed already, what with the 'trial of labour', urging me to opt for a RCS and more. If they think I'm a lemon, I'm not going to set myself up for failure by trying to birth there. I found the more I read about it (including birth stories on MDC) the more I felt confident in the idea and my ability to do it. You've got lots of time to decide. Good luck!

[CookAMH]

I have the exact same question though I am not pg yet. Thinking about vbsc vs hbac a lot though.

[cairomama]

I had a great hospital VBAC. I did have a heplock and continuous EFM, but I was 8cm when I got to the hospital and my baby was born 2.5 hours later. I had freedom of position (I was on my hands and knees almost the whole time including pushing). The hospital did have a telemetry unit for monitoring, but I was well beyond walking the halls when I got there. My midwife had a good reputation for VBACs and I had a doula as well.

If you go with a hospital, be sure to understand your providers restrictions and rules for VBAC. You can negotiate or refuse, but that adds stress so if you know in advance you can either choose another provider or be prepared for the fight.

[DocsNemesis]

I'm hoping for a HBAC. I've had a homebirth before and I LOVED it. I really really want another and to me, the risks of being at home aren't as great as being at the hospital, sadly. And I'm a stubborn PITA. lol

The only thing for me is, I know its a possibility that I'll end up in the same situation as last time (HELLP, cesarean, preemie baby), but in that case, the hospital is fine. Its there for a reason. But at the same time, having another homebirth would be very healing for me-my last one was also supposed to be a homebirth and then all of this happened, he was in the NICU for 4 weeks, and it was sooo hard. It was the complete opposite of what was *supposed* to happen and it was very disappointing and painful, despite knowing it was necessary.

Anywho, I think it depends on your comfort level. I hate hospitals, I generally don't like doctors, and I REALLY hate delivering in the hospital. I wouldn't be at all comfortable there and having to fight interventions and hospital policies is just not what I want. (Nor will I just give in to them either!) But everyone has their own comfort zone and priorities.

[langdonslady]

I could smell which way the coffee was brewing when I looked into hospital VBAC 2 years ago. The "pro-VBAC" OB perkily assured me that she induces on VBAC all the time and it's perfectly safe (yeah if you consider a repeat cesarean as a "safe, successful" outcome!) and warned me that it was "too risky" to "let" me go a day past 40 weeks because I was a VBAC candidate. Good thing I knew that up to 42 weeks is still NORMAL, not overdue, as is often wrongly told to women in this country. And if I had stuck with her against my better judgement, I would have been a repeat cesarean because I happened to go into labor at 40 weeks, 2 days. And it could easily have been 42 weeks.

I felt much better when I walked out and hired a homebirth midwife of long experience including many home VBACs over the years.

And I will be grateful the rest of my life that I chose, along with the homebirth midwife, the ability to labor peacefully, to birth my way, to be respected and supported during labor and birth with no fear-mongering, no hospital germs or hospital procedures that put their best interests ahead of mine.

I pushed out my 10 lb son, with nuchal arm, without a prior vaginal birth, with no problems. He was born en caul, too, which probably made it easier. No OB there to break my waters just to "speed things up" for his or her convenience. Now that I have had my HBAC, I am free from the fear of whether attempting an HBA2C is too risky... I pushed out a 10 lb baby after prior cesarean, and all was well. I am no longer afraid of birth. In fact, it was less painful, start to finish, than a few hours of torture getting to a mere 4 cm on Pitocin had been before. Natural birth is MUCH easier than either surgery or inductions.

I knew, deep in my bones, that any VBAC "attempt" in a hospital was doomed to failure, and the deep sense of dread I had when talking to the "pro-VBAC" female OB disappeared when I finally hired the midwife at nearly 6 months along.

But if you check out ICAN (international cesarean awareness network) you can find out which hospitals and docs are less likely than the rest to get you a repeat cesarean, if you choose that route.

So go with your gut, and know that there are not guarantees, but your chances are far better at home. My midwife had plenty of HBAC experience under her belt, and couldn't have stayed in business if she had as lousy a success rate as hospitals, for VBAC. Word would get around and she'd be finished.

CNMs have to be "team players" with OBs in hospitals. They are nurses, and nurses by definition have to be team players to docs. Even the nicest CNM will still see a VBAC as a disaster waiting to happen, and the old bait and switch (super cheery and supportive of VBAC until the time comes, then talk of big babies, scary statistics, and "doing what's best for your baby" as you get closer, urging you toward interventions that will make it most unlikely that a VBAC will happen) is very, very common. Perhaps not by malevolent intent, but just because they really do think of things the same way OBs do, however hard they deny it. They have to, or they couldn't work with OBs and still sleep at night.

As for me, every birthday (he just turned 2) of my HBAC baby is a gift that keeps giving, and if I have another child, I don't have to live under the specter of whether I "can" VBAC, and it will definitely be another homebirth.

Oh, and birth wasn't messy at my house. The lay midwives really know their business, and there were chux pads where needful. There was no mess for me to clean up, and I got out of the birth pool and went dripping across the house, went upstairs pausing to push with them trailing under me with cloths in case, and pushed him out on my hands and knees at the foot of my bed! No mess for me to clean up. They took care of everything, and most of all, me.

[John'sMama]

Thank you for all of your wonderful words of encouragement! I appreciate hearing of successful hospital VBACs as well as positive HBAC stories. I know what I want to do (HBAC) but I am scared; I think I'd be more scared, however, to enter the hospital while in labor and expect to be treated how I want to be treated and not pushed to do things their way. I don't know the stats for successful VBACs at my hospital, but just the way things went the first time around I know they're not supportive of natural birth. In fact, my main nurse, the one who kept making get out of the shower where labor was manageable and lay on the bed for 30 min where labor was awful, kept asking me if I wanted something to make labor easier and more comfortable. When I finally gave in (I wasn't strong enough to resist while out of the shower & on the monitor) she said, and I quote, "This is the kind of labor I like, because now I can actually help you." Um, really? She didn't do anything before or after I had the epi! Very frustrating. Anywho, just needed to vent I guess! I do think successful hospital VBAC is possible with the right hospital and staff, I just don't think that's what I have. HBAC here I come

[DocsNemesis]

Well duh, she helped you by giving you drugs so you wouldn't be making noise anymore! Just like so many doctors *help* by performing a cesarean...for either no reason or for reasons caused BY them.

I remember reading statements made by OB's before somewhere. So many of them said that to them, a cesarean is the only birth they like. When mom has the baby vaginally they don't get to do anything-with surgical birth, they are doing it all. Very selfish and wrong. Yes, they aren't birthing the baby for the mom in a vaginal birth, but its not about THEM! I mean, even from a doctor perspective, a good doctor would see that cesareans are major surgery, they are painful, have risks, carry a much longer recovery time, and...have risks! Lots of risks! I mean, even my old OB, who was intervention happy, didn't do cesareans without an indication to do one. I mean, I went overdue 2 weeks and we induced, but had that not worked, he said no, we wouldn't section over it. He said we'd wait a few days and see where I was. Even he knew a baby couldn't stay in there forever But he told me that cesarean is much riskier than a vaginal birth so unless he had a good reason to do one, he wouldn't. (Btw, I checked back later and this OB has a 15-20% cesarean rate-much better than the national average!)

Anyway, it seems like many nurses get this same attitude of wanting to control everything and make it about them, not the mama. Of course, that isn't anywhere near the norm-and some are probably truly trying to help, as I'm sure its hard for a caring nurse to watch a mom in pain when they have pain meds right there. And I also think a lot of nurses don't see pain meds as being dangerous at all (dangerous meaning cascade of interventions leading to problems-I don't really know what the direct dangers are of epidurals since my reason for not getting pain meds lies purely for selfish reasons-a non working epidural + being stuck flat on your back = misery) so to them, its better to try and get the mom to take the drugs, be comfortable, and not see them in pain anymore.

I also agree that many CNM's are just as quick to jump to interventions, but not all. Mine was great and while we still induced (I had pre-e), we tried everything but pit first and as I said, she had no problem with me doing everything I wanted. She even told the nurses to shut up when they kept asking me if I wanted pain meds (at 8cms....arg). And there is a great CNM in my area that while I haven't used, my lay midwives refer their risked out clients to because she's great. I've heard so many good things about her So not all CNM's are quick to intervene and freak out. Its just finding a really good, natural minded one that can pose a challenge.

[John'sMama]

I had my appointment with the CNM on Tuesday, and had I not already been "prepared" as to what I'd hear through reading others' experiences, I would have left feeling very unsupported and felt I was already beginning my uphill battle. Instead, I left feeling happy, knowing and being confident with my decision to HBAC!

After introducing herself, the very first words out of her mouth were, "So you want to attempt a VBAC?" There were many other words used like "trial" and "aim for it" used throughout the appointment. Whereas when I talked to my lay midwife about VBAC the first time, she made it sound like yes, I can and will do that! Then the CNM told me my pelvis was relatively small in the front but I had "plenty of room in the back", but she wouldn't want a 10 lb baby. And she told me if I go to 41 weeks (I did with DS) I should "go ahead and schedule a section". Like I said, I'd heard all this before from others who went through a similar experience, but it was still frustrating.

So, bottom line, I'm going to HBAC. I think if I had a supportive CNM and if the hospital was very VBAC friendly, I may go that route. But as it is the above is not true. I think I just needed to try out a CNM to put my mind at ease that I'm making the right choice for a VBAC. And now I do!

[GOPLawyer]

Congrats on choosing a HBAC!!!! I just know that you'll do great!

After having gone through all the crud that is thrown at Mamas from the hospital side of birth...working w/ a DEM is just that much better. I truly treasure the experiences I had w/ my CPM.

You won't regret your decision! You CAN do this!!

[ACsMom]

Originally Posted by Sk8ermaiden

For me (have not had it yet!) it is a clear decision because I am very unlikely to have successful VBAC in a hospital here. You basically have to have a picture perfect pregnancy.

The dealbreaker for me, is that every "VBAC-friendly" OB here ceases to be VBAC friendly after 39 weeks. Then it's automatic section time. With DD1 being a 42 weeker, I think it is very unlikely I will fit that criteria with a future baby. Barring major medical complications, my babies will pick their birthdays.

This is me, exactly. VBAC in my area is actually "Trial of Labor," not VBAC. They'll "let" you do it if you agree to continuous EFM, hep lock, and section if you haven't gone into labor by 40 weeks. I'm staying home.

[John'sMama]

Originally Posted by ACsMom

This is me, exactly. VBAC in my area is actually "Trial of Labor," not VBAC. They'll "let" you do it if you agree to continuous EFM, hep lock, and section if you haven't gone into labor by 40 weeks. I'm staying home.

Yes--that's how it is with me, too. The CNM (nor the doctor I originally talked to) said, Yes, you can VBAC, they said I can try to VBAC and have a "trial of labor". How frustrating! And the monitoring was another huge turn-off; I "had" to be monitored with my first labor every 30 min for 15 min, and that was torturous enough. With a VBAC it would be every 15 min for 15 min. I have little doubt that I wouldn't last long at that rate without pain medication, thus furthering the cascade of interventions! I'm so happy to hear others who are choosing to take matters into their own hands (and homes)