We also live in a small town w/ no OB/hosp (150 miles to hosp/midwives) and first baby was footling breech. When our midwife (in city) discovered baby was breech, she couldn't ditch us fast enough, especially after a host of her other issues (refusal at 35 wks to attend homebirth after agreeing to it months earlier, etc.). Super stressor on top of everything else. Since it's illegal for midwives in AK to knowingly attend breech birth, our safest (and only) option was the hospital (vs trying it solo at home). I tried everything (ECV, moxa, pulsatilla, headstands in pool/on floor, chiropractor, etc.) to get baby to turn, feeling trapped, abandoned, cornered b/c of failing medical system. My backup OB (to midwife) was out of state when I drove into the big city about a week prior to due date for other business; guess I'd been in labor 24+ hours and water broke and baby's foot poked out on arriving at hotel. We went to nearest ER and on-call doc did stat C/S. Baby never stressed/showed HR decels, etc. and was born just fine, no complications. It really sucked to feel we only had one option b/c of other people's fears and submission to a top-heavy, doctor-centered healthcare system--at the hospital far from home, friends, family. Lucky for us it worked out as it did (great hosp staff and insurance covered most of it w/o headaches, fast/low-pain recovery--walking fine the next day): HEALTHY BABY and MOM to focus on for rest of life, in spite of missing the desired experience and some as-yet unnoticed slight side effects on baby from lack of going through actual birth experience, etc etc. Thinking on it now, I'd go with the several other "rebel" mamas who advocate laboring at home as long as you can IF everything is going alright at the end of pregnancy (baby in good position, mom in good health) and throughout labor (w/ good helpers on hand). [Get your own doppler/fetoscope to listen to baby, hire a worth-every-penny doula, know what staff/resources are available at your small hospital (you say they can't do "fast C/S"--think about it, if you go in to hosp. after labor is well established and you're fairly close to pushing, wouldn't they call OB in and you'd have time to continue laboring safely or have C/S should complications arise?).] Research and understand EXACTLY what risks you are most likely to encounter w/ VBAC, and find out what travel/lodging expenses your insurance may cover should you find a VBAC supportive provider in Vanc. (in US ins. co's required to cover some/reimburse you costs if you live far from required facilities). Here in rural AK, we're lucky to have a very affordable insurance policy (<$100/yr) that covers the cost of med-evac flights to Anchorage, should we ever need it. See if something like that exists where you are (search with state/province + "medevac insurance").
You mention other previous babies--all C/S? If not, your chance of VBAC success is greater than if no VB. You also have the advantage of previous labors--you know what to expect, hopefully, you're in tune w/ your body and can gauge approx. where you're at in labor if you try the "just show up at ER in 2nd stage labor" plan. You don't HAVE to do anything you're not comfortable with (like schedule C/S for OB's peace of mind), especially if you're well-informed, and the hospital/MD (in US at least) cannot abandon you if don't submit to their will (patient abandonment; it's called "battery" if they force treatment on you that you refuse). Start here and follow the rabbit: http://www.vbac.com/ and look under right-side column "Mothers to Be".
Do you have any friends/family who could help w/ other kids if you have to go to city?
My recent review of the uterine rupture study literature put my mind more at ease (http://emedicine.medscape.com/article/275854-overview --of the several thousand pregnancies in all the studies discussed, true uterine rupture occurred in a very small number of cases and usually in conjunction w/ other aggravating factors that arose earlier in labor (e.g., seriously stalled labor, traditional induction skyrockets your chances of rupture, http://www.nejm.org/doi/full/10.1056/NEJM200107053450101 ). Scar dehiscence seems to be more what OBs call U.R. and from my read of it, the consequences are much less catastrophic should this occur. Look at all your risk factors in success w/ VBAC and see what you can minimize, even at this late stage of game--we're malleable, tough creatures and positive attitude helps immensely. Your BMI, perhaps your age, plus the GD (have you gone militant healthy diet and water intake?) are strikes against you from an OB perspective, but your physical fitness, overall good health, possible previous VBs, and optimistic attitude may counter some of them. If the majority of evidence (that you thoroughly review and understand) suggests good chance of TOL and VBAC success for you, then TOL is plan A, with stat C/S as backup. If the evidence isn't in VBAC favor, then consider the benefits of a scheduled C/S: you can plan around it for other children's care, it's less worry about chaotic outcome, you can be awake when they do it and get to hold your baby sooner (the grumpy anesthesiologist in my case wouldn't even consider an epidural/spinal and I was out cold, missing delivery, holding baby sooner, telling them NOT to clamp the cord, etc.). W/ a planned C/S you could even bypass tearing, extraordinarily long/painful/back labor, and all those other wonderful effects of vaginal birth. It's all risks and benefits and you have to look realistically at the positives of both so you and your baby have the best outcome you can create. Your body isn't broken, you just live w/ a broken medical system which may have contributed to your current pickle. I know it's hard, but I'm focusing on all the positives I can after initial disappointment (not my fault almost no one practices breech deliveries these days and lacks a skill that was once more common).
Realize that although it's tough spot, you DO have options--esp. if you're creative and willing to push the envelope for what you believe is safest and healthiest option for you and baby. Here, care providers have to give you around 30 days notice that they are terminating your care and have to make sure you know your options for suitable alternative providers. Sounds like your OB isn't into VBAC at all, sees preg as pathological condition, and may do just fine for an emergency C/S--which is what you'd need should your labor go awry. If you trust your body to labor on its own, just do it and stay out of hosp as long as you can (w/ tools and helpers at home to clue you in to fetal distress). And READ, READ, READ all the data you can find (from reputable web sites and scholarly journals, typically addresses ending w/ dot edu, .org, and .gov). You need to be able to speak and understand the terms your OBs use to stand a fighting chance.
We're expecting #2 in March and doing co-care w/ midwives and OB who support VBAC (rare here) at hospital w/ very good VBAC success rate (70-80% for last 12 mos). Driving 300 miles/round trip for prenatal visits and for birth in winter in Alaska sucks, but it's in pursuit of the best long-term outcome we see possible. Still disappointed that it's illegal for us to have baby out of hospital (birth center is <7 min. from hospital), but if all goes well, #3 (hopefully) can be born out of hosp. The midwives can let us labor w/ them until labor is well established (6-8 cm, regular long contractions, etc.) then transfer to hospital, and they say they stay w/ us through birth--acting as a buffer between us and possibly pushy hospital staff for best chance of VBAC success. Any "buffer" support (patient advocate, midwife/doula to go w/ to hosp.) you can afford, GET IT! We have to arrange care provider for baby #1 so dad can come and we may go into debt a little bit more than w/ a typical hosp. birth, but we're going to give our VBAC the best efforts we're capable of. Eat as well as you can, exercise every day, practice deep belly breathing/relaxation, practice squatting as much as Kegeling (http://mamasweat.blogspot.com/2010/05/pelvic-floor-party-kegels-are-not.html and http://sweetsprouts.wordpress.com/2010/06/24/keeping-your-body-in-balance-squats-and-pelvic-floor-strength/ ), and try to keep the big picture in mind when the little detail monsters come creeping. Best wishes to you Elizabeth, be strong, I'll be thinking positive waves your way!
Edited by regomama - 11/15/10 at 3:28pm