HBAC or VBAC?

[nanasmom]

Hello. I have been lurking here for a few days and finally decided to post. I am hoping all the wonderful woman on this board can offer some advice.

I am currently 23 weeks pregnant with my second and am really hoping for a VBAC. I currently am with a OB who is known to be VBAC supportive, but I still feel he is putting too many "conditions" on allowing me to attempt a VBAC. (ie. wants to have a u/s done at 38 weeks by a third party to determines baby’s size, can only labor for x amount of time, must have an epidural just in case an emergency C-section is needed due to uterine rupture, etc) Now, I have been contemplating switching to a midwife and debating between a hospital VBAC or a homebirth VBAC.

DD (3 yrs old) was born at 8 pds 13 oz. I went into labor and everything was progressing wonderfully, but when it came time to push, she wouldn’t budge and after close to two hours of pushing, I was rolled in for a c-section. I have a feeling this baby will be bigger but only time will tell. I am just torn between the hospital vbac with a midwife and a homebirth for the following reasons:

1) Although I want to try an unmedicated birth, I am afraid I cannot handle the contractions unmedicated. With DD I did receive an epidural because my contractions were absolutely unbearable.
2) I am obviously nervous that if something were to go wrong at home...I know there’s only a small chance of uterine rupture but I am still concerned about that and other things that can go wrong.
3) If I felt that a hospital vbac with a midwife had the same chances of success as a homebirth vbac, I would definitely plan to have the vbac in the hospital. However, from what I have read and people I have spoken to, most midwives with hospital privileges often have their hands tied by hospital policies. (ie. only labor for x amount of time, no water birthing, confined to a bed etc.)

Would love to get some feedback, advice....

Thank You!
Rachel

[Sk8ermaiden]

Major deja vu. You might want to check out this thread.

http://www.mothering.com/discussions....php?t=1159731

Also, this article really helped me be comfortable in my (future) decision to HBAC. http://www.midwiferytoday.com/articl...ercesarean.asp

The pain thing I really don't have a lot of advice on. Were you on Pit? Were you confined to bed?

[ShwarmaQueen]

Originally Posted by nanasmom

I currently am with a OB who is known to be VBAC supportive, but I still feel he is putting too many "conditions" on allowing me to attempt a VBAC.

Kinda an oxymoron huh? A VBAC supportive OB who puts too many conditions... If you really want a VBAC you need to run far far away from him and then thank him later for showing you the red flags early on!

1) Although I want to try an unmedicated birth, I am afraid I cannot handle the contractions unmedicated. With DD I did receive an epidural because my contractions were absolutely unbearable.

Were you confined to a hospital bed? Did you have any labor support (doula, husband, etc.) to help you cope? Did you try a tub/pool?

I won't go into the long story, but I just VBACd on Saturday and the times I had to lay down flat (for one reason or another) was EXCRUTIATING during contractions. I was clawing at the matress having to be horizontal!!! On the other hand, I found that while showering, leaning on the counter, swaying, etc. they were much more managable (though not painless by ANY means).

2) I am obviously nervous that if something were to go wrong at home...I know there’s only a small chance of uterine rupture but I am still concerned about that and other things that can go wrong.

There is a risk, there's no getting around it, but there's risk in birth period- no matter how you deliver. VBAC is safer than a rc/s most of the time.

3) If I felt that a hospital vbac with a midwife had the same chances of success as a homebirth vbac, I would definitely plan to have the vbac in the hospital.

It's just too easy to feel defeated and give in to a rc/s if you're birthing in a hospital IMO. The odds are stacked against you from the moment you walk in, regardless of your HCP. An experienced HB MW is probably your best best for a VBAC. You can totally do it mamma.

Would love to get some feedback, advice....

Start by checking out the VBAC resources at the top of the forum- then read, read, and read some more! There are great books and info sources out there that will build your confidence so you can acheive your VBAC, but you'll have to leave that OB so you can enjoy the rest of your pregnancy and plan your perfect delivery.

[nanasmom]

Originally Posted by Sk8ermaiden

Major deja vu. You might want to check out this thread.

http://www.mothering.com/discussions....php?t=1159731

Also, this article really helped me be comfortable in my (future) decision to HBAC. http://www.midwiferytoday.com/articl...ercesarean.asp

The pain thing I really don't have a lot of advice on. Were you on Pit? Were you confined to bed?

Thank you. I am going to go back and read that thread. I read it previously when I was half-studying and half-sleeping so...

I was confined to a bed from the moment I walked into the hospital which was way too early. I would not have gone when I did, but my OB was concerned because I said I did not feel the baby in a couple of hours (I was not worried at all because DD was not very active at all).

[nanasmom]

ShwarmaQueen, thanks so much for your words of support and congrats on successful vbac!! I know I just need to take the plunge and decide on a HBAC. Unfortunately, I am so super busy (nursing school and working full time) and barely have time to do any concrete research. Thankfully, my sister-in-law is very into doing research on birth procedures and a homebirth herself (not a vbac) and has offered her assistance - I think I need to take her up on her offer.

With my previous birth, I was in the hospital bed the whole time. At the time, I was told I did not have petocin and it does not indicate on my chart that I did have but based on the intensity of my contractions, I want to believe that I did have it.

I did not have a doula - huge mistake! Don't know why I listened to my husband who insisted I can do it on my own. Clearly, I am having a doula this time around.

My husband is a volunteer EMT as are many of our friends and I also work for a major ambulance company in my area. I know that if G-d forbid I do need an emergent transfer to a hospital, I can be there in no time but of course I am still a bit anxious to make this decision.

[Sk8ermaiden]

I believe you have up to 40 minutes to have a positive outcome in most cases of UR.

And every birth story I've ever read, when mom had been managing her labor just fine, as SOON as she hits the hospital bed, all of a sudden her labor becomes unbearable and she just can't stand it any more. Most of them don't even make the connection, but it's obvious as an outsider reading it. I know there is NO WAY on earth I could have handled labor on my back. Hand and knees, Belly in the tub and DH pressing on my back was the ONLY way for me, and with those things happening, it honestly wasn't all that bad.

[cairomama]

I had an unmedicated hospital VBAC. I didn't go into until I was really in labor and used Hypnobabies. I labored and pushed on my hands and knees. I think freedom of position is really important. In fact, my body wanted to be in that position so instinctively that right after my daughter was born I thought that if I had had to be on my back it would not have gone as well.

I would not agree to epidural in place or a time limit or a baby size limit. Those are not justified. Most cesareans have time for epidural placement and if there isn't time and it is a true emergency they can just put you under general anesthesia, but the chances are so rare that it is not worth agreeing to. The longer you can go without the epidural, the longer you will be able to use position changes and other methods to control pain. It is harder to change positions when you have an epidural, but possible if you provider is supportive, however, not to the extent if you don't have one.

I had a hep lock and monitoring for my hospital VBAC, but the freedom of positioning was key.

You definitely need to prepare for natural labor and practice your techniques whether you use Hypnobabies or any other labor coping techniques, you need to practice. If you practice and prepare for birth without an epidural and have a doula and supportive provider, you will be able to do it or at least get much further before you get one.

http://www.hypnobabies.com (I listened to my tracks on my piod in a sports arm band during labor)

http://www.thepinkkit.com is an at home natural childbirth preparation course that helps you understand your own anatomy and how to work with it as well as other pain coping techniques. I didn't use this, but my friend did and speaks really highly of it.

So home or hospital, you can do it either way if you have a truly supportive provider.

[John'sMama]

Nanasmom--IMO, above all, you have to be confident with your decision, whether it's to HBAC or VBAC. If you're not 100% then don't force yourself to go that way. But definitely, like others have said, leave that OB. Those restrictions would make staying active and naturally controlling your pain extremely difficult. And those may be that OBs restrictions, not necessarily the hospitals, so you many likely be able to find a midwife who's "rules" are much different.

I'll admit, I'm afraid of the pain this time around, too. I had back labor in addition to "normal" labor, so once one side was done contracting the other started. BUT, when I was able to be in the shower, focusing on my job, I could handle the pain. When I was confined to the bed, I couldn't. Like someone else said, if you choose to VBAC at a hospital, I would wait as long as possible to go in. If I went to the hospital that would be my plan, in addition to hiring a doula, as you'd mentioned.

I hope you can find answers to your questions so you can make a decision that you're confident of!