Leaning toward HBAC

[CookAMH]

I've been on the fence for a long time about hospital vs. homebirth for a VBAC. We interviewed a hb midwife today that we liked. I've always wanted a homebirth, not a hospital birth. Went with CNM at a natural-childbirth-friendly hospital and are currently under care with her. With DS we used a birth center since I didn't want a hospital so I kinda wonder why we are with a hospital now anyway. Intially it was for worries with VBAC, but I'm not worried about uterine rupture at all.

We plan to interview at least two more and make a decision. DH has been coming around more but would like to read a couple more studies (anyone have any?).  He is more relieved having talked to the hb midwife today and from learning what emergency equipment and skills she has.

I'd be a HBAC and this mw thankfully transfers with her clients to the hospital if needed (OB would take over), and the transfer hospital is friendly for VBAC and seems to be respectful of HBAC transfers.

One question, this midwife has done about 100 births as a midwife and 300 as a doula. 90% of her clients are VBACs. How does that compare to the experience of other midwives? We love her approach on everything, has never had an emergency transfer. Any transfers were able to be made by car.  I felt she answered all my many questions.

One reason we might have stuck with our CNM is that we were told she would consider attending a HBAC after a VBAC wit her in the hospital, but they are changing their setup of the practice and she is no longer doing homebirths. I really want a relationship with MY midwife - I've seen this one once (and do really like her), will see her at my next appt (28 weeks) and then not until the last month.

But, really, it's coming down to having the freedom I feel I physically and mentally need to have all the time to push this baby out. DS probably would have been very long pushing had we not had the c/s.  Labor went GREAT until then, so I am not worried about actual labor. The hosp, requires CFM, 2 hour cervical checks and I just don't want to be restricted by that and want the comfort of my own home.

Any thoughts are welcome.

[MsBlack]

Personally, for many reasons I believe hbac is safest for healthy women who can get competent care.  See the reasons why on my website essay about vbac/hbac. 

http://womynwisespeaks.wordpress.com/informed-choice/hbac/

good luck~

[MarineWife]

My 2nd was an induced VBAC in a hospital. My hospital VBAC was ok, not hassle free but not traumatic for me, either. I had excessive bleeding afterward. My homebirth MW explained that it was probably from the pitocin given for induction. That can overwhelm the uterus so that it can't continue to contract adequately after birth to stop any bleeding. So, it had nothing to do with having a VBAC. I was at a military hospital where I didn't get a lot of pressure or coercion to have another c-section, I assume because military docs don't have to worry about being sued. I did get some hassling over not allowing them to do cervical checks or insert an internal fetal monitor. They wanted to do that because they thought my labor was taking too long (after only about 6 or 7 hours) and wanted to increase the pit dose.

My 3rd was a HBAC. It was nice to be able to labor in complete peace. No one bothered me or did anything to me unless I allowed it. The people attending me were there to take care of me and my baby, not to "deliver" a baby. There are many reasons why I chose homebirth. It would take a long time for me to go into all of them now. One big reason was that, even though I had a previously successful VBAC, the civilian OB practice I was going to still assumed that I would probably need another c-section.

Strangely, this time I'm feeling apprehensive about having another homebirth. I was very gung-ho about having my homebirth so I don't know what the problem is now.

[Mamatoabunch]

I think HB is best for VBACs, especially in this ridiculously hostile VBAC and birthing climate. I have had all 8 of my VBACs at home, the last 7 UC even. My baby expected next June will be another HBAC of course.

[phathui5]

From what I've seen, I think that having a homebirth gives you the best chance of having your baby vaginally. If you have a baby in a hospital, you have to deal with hospital staff who think that you're doing something dangerous (you're not) or that you're crazy (I'm guessing you aren't).

[pearl2]

I am also planning a HBAC for the very reason to avoid the hospital at all costs. I have no desire to be monitored the entire time (required at all area hospitals that do "allow" VBAC here, at least from what I've heard) and I don't want anyone freaking out that I am "taking too long" or put me on some you must deliver by 40 weeks or else C-section threat. I also firmly believe that being in my own environment surrounded by people there to take care of me will go really far for sphincter law!

I am 5 minutes from a major hospital with NICU if needed, so really, within the 30-min "decision to incision" if absolutely medically necessary. So why bother going to the hospital (at least in my situation) since I  was planning on laboring at home until the way absolute last minute anyway before I even considered options. 

Your situation and midwife sound fine! Go for it!

[mdnaturalmama]

ITA with the PP on this. I've also had a hosp VBAC but am planning a HBAC this time around. My local hosp is actually very VBAC friendly, as are my OBs, but I am not allowed to labor in the tub being a VBAC b/c of the "need" for constant monitoring. Which I think is bologna. I can not wait to labor and/or deliver in the tub! 

I chose a MW who has TONS of experience with HBACs(30yrs of them!) and I love her. I'm not worried about rupture(or anything else for that matter) at all. Now I'm just (im)patiently awaiting the day that LO arrives.  =)

[tracymom1]

I had an HBAC and now know that I would not have been able to go through that in the oppressive, restricted and generally unpleasant environment of a hospital.  I could not be hooked to a monitor the whole time, constantly having people analyzing every little decel, sticking their hands inside of me checking my cervix whenever they thought it necessary, not being able to eat or drink at will, not being able to be in the water for pain relief, and - most importantly- I just couldn't have THEM control my labor and birth.  I needed to be in control and feel peace, love and security.

Laboring at home was simple, graceful and uncomplicated.  Birthing at home was empowering and beautiful.  I look forward to doing it again next summer!

Congrats and good luck with your decision!!

[LiLStar]

So, am I gonna see you at an ICAN meeting one of these days? :) 

[CookAMH]

Originally Posted by LiLStar 

So, am I gonna see you at an ICAN meeting one of these days? :) 

Hehe I keep meaning to come!  Maybe both DH and I should come to help our decision. The yahoo group has been helpful.

Even though the hospital here is VERY supportive of VBAC and has a low c/s rate, I still feel like I need the total freedom of laboring and pushing, especially pushing. Trying to line up a couple more midwife interviews.

[CookAMH]

I'm conflicted again because I read of a great birth at my hospital which isn't the first time, this hospital does seem to be an exception for natural birth and really being proponents of VBAC. I think their c/s rate is 15%.  What conflicts me is when that happens, maybe it'll be that way for me and I can avoid the stress of telling our families that we're doing a homebirth (we cannot in our conscience keep it from them, but we can delay telling them until later in pregnancy, 27 weeks now).  It's EASIER now to stay with the CNM and hospital, and harder to choose CPM/homebirth and face judgment about our decision. If people around us were gung-ho, I think it would be easy to switch to homebirth.

Any thoughts?

[onyxravnos]

I Loved my HABC. and it sounds like your midwife has fantastic amounts of experience with VBAC mamas. 

I say go for it. 

[MarineWife]

Originally Posted by CookAMH 

I'm conflicted again because I read of a great birth at my hospital which isn't the first time, this hospital does seem to be an exception for natural birth and really being proponents of VBAC. I think their c/s rate is 15%.  What conflicts me is when that happens, maybe it'll be that way for me and I can avoid the stress of telling our families that we're doing a homebirth (we cannot in our conscience keep it from them, but we can delay telling them until later in pregnancy, 27 weeks now).  It's EASIER now to stay with the CNM and hospital, and harder to choose CPM/homebirth and face judgment about our decision. If people around us were gung-ho, I think it would be easy to switch to homebirth.

Any thoughts?

IME, whenever I have let other people's opinions influence my decisions, I've regretted it. I don't have an issue with friends or family getting in my business a lot, though. If they do and it's negative, I just ignore them. Ultimately, their opinions don't mean that much to me. My life is mine, not theirs. I've come to realize that I have a very different family dynamic than most people. My family didn't say anything to me about my home birth. They probably know by now there's no point. I'm going to do what I want regardless.

I might be more likely to give birth in a hospital if I knew I weren't going to be hassled about doing this or that. If you feel more comfortable in a hospital and you can find a provider and hospital that are supportive of what you want to do, that might be the best for you.

I looked into having this baby in a hospital even though I've already had one HBAC. I wanted to know all of my options. I talked to a MW who told me that I would have to at least have a hep-lock, continuous fetal monitoring, would not be able to use the shower or tub and would probably face a time limit for induction because of my age. In addition, since I've always been GBS+ in the past (except the one time I refused to let the nurse swab my anus, something to think about if you are going to get that test), they would expect me to be at the hospital within 4 hours of starting labor so I could get the two doses of antibiotics. All of that leads to the likelihood of more interventions and, eventually, another c-section. For me, that was too many hassles before I even started.

[mdnaturalmama]

Originally Posted by CookAMH 

I'm conflicted again because I read of a great birth at my hospital which isn't the first time, this hospital does seem to be an exception for natural birth and really being proponents of VBAC. I think their c/s rate is 15%.  What conflicts me is when that happens, maybe it'll be that way for me and I can avoid the stress of telling our families that we're doing a homebirth (we cannot in our conscience keep it from them, but we can delay telling them until later in pregnancy, 27 weeks now).  It's EASIER now to stay with the CNM and hospital, and harder to choose CPM/homebirth and face judgment about our decision. If people around us were gung-ho, I think it would be easy to switch to homebirth.

Any thoughts?

I'm in a very similar situation. My local hosp was pretty good about my VBAC there a little over 2yrs ago and my drs are great. BUT, I still had to have all of the monitoring, IVs, no shower, no tub, etc. Which lead me to an epi, which lead me to being on my back and all that crap. Baby came out well enough, but in my own home I'll be able to do whatever I want. Eat, drink, walk around, no needles for IVs(yes!!), shower, tub, whatever. My CPM has yrs and yrs of experience with HBACs and I'm fully confident in her. I'm also much happier with the prenatal care I receive from her! Instead of a packet from some formula company I got a handbook about all kinds of different things. Exercising, eating right, testing that she does(fully explaining everything), etc. Rather than my dr just saying "ok, you have to go have X test done". I'm sure they would explain it to me if I asked but the fact that my MW wants me to know without me even asking is huge. IMO. Oh yea, my family is NOT supportive. AT ALL. It's been hard, but I found that telling them earlier was better. It let them get out all of their misinformed crud and now no one says anything to me much. If I'd waited until much later I may never have heard the end of it, lol. And who knows if I would have been more emotional at that point as well. BUT, you have to make your own decision. And whatever it is will be right for you. Trust in yourself, mama. Good luck.  =)

[MarineWife]

Originally Posted by mdnaturalmama 

I'm also much happier with the prenatal care I receive from her! Instead of a packet from some formula company I got a handbook about all kinds of different things. Exercising, eating right, testing that she does(fully explaining everything), etc. Rather than my dr just saying "ok, you have to go have X test done". I'm sure they would explain it to me if I asked but the fact that my MW wants me to know without me even asking is huge. IMO.

This is such an important part. I've had two babies that at least started out with CNM care with a hospital birth planned. I didn't get anywhere near the amount of time and info as I did with my home birth MW. One big thing for me was that they really focus on nutrition and preventive measures whereas docs and even most CNMs who work in hospitals don't. I never got any nutrition info from the hospital HCPs until they decided I had GD at about 30w and sent me to a nutritionist.

I get an hour with my home birth MW every time whereas I was lucky to get 15 minutes with the hospital HCPs. My home birth MW will be with me throughout my labor once I call her. My hospital HCPs maybe popped a head in my room when I first got to the hospital and didn't show up again until right before I was to give birth. There was no help or support during labor. You can hire a doula for that, which I highly recommend if you are going to have a hospital birth, especially a VBAC. I wouldn't have a hospital birth without a doula.

It's a totally different relationship. My first home birth MW was close to my age so she was like a sister. My current MW is older so she's more like a mother figure. I feel cared for as a person rather than just another patient.

[mdnaturalmama]

Originally Posted by MarineWife 

Originally Posted by mdnaturalmama 

I'm also much happier with the prenatal care I receive from her! Instead of a packet from some formula company I got a handbook about all kinds of different things. Exercising, eating right, testing that she does(fully explaining everything), etc. Rather than my dr just saying "ok, you have to go have X test done". I'm sure they would explain it to me if I asked but the fact that my MW wants me to know without me even asking is huge. IMO.

This is such an important part. I've had two babies that at least started out with CNM care with a hospital birth planned. I didn't get anywhere near the amount of time and info as I did with my home birth MW. One big thing for me was that they really focus on nutrition and preventive measures whereas docs and even most CNMs who work in hospitals don't. I never got any nutrition info from the hospital HCPs until they decided I had GD at about 30w and sent me to a nutritionist.

I get an hour with my home birth MW every time whereas I was lucky to get 15 minutes with the hospital HCPs. My home birth MW will be with me throughout my labor once I call her. My hospital HCPs maybe popped a head in my room when I first got to the hospital and didn't show up again until right before I was to give birth. There was no help or support during labor. You can hire a doula for that, which I highly recommend if you are going to have a hospital birth, especially a VBAC. I wouldn't have a hospital birth without a doula.

It's a totally different relationship. My first home birth MW was close to my age so she was like a sister. My current MW is older so she's more like a mother figure. I feel cared for as a person rather than just another patient.

Exactly!! Sometimes I feel like others will think I'm silly for feeling like this. But I really feel like your care person should want to tell you how to eat right, etc. Even if you may already know. Instead of just reading off a list of the "don't eat" items.  =)
 

[labortrials]

If I had a good hospital with both a low c/s rate and a high VBAC rate, I'd entertain the idea of birthing there.  But, it's not just the hospital that you have to consider - what happens when you go into labor NOT during business hours, or over the weekend, or during your CP's vacation?  And how "on your guard" do you mind being - keeping your space and doing things the way YOU need to do them?

In my case:

1. hospital has average c/s rate and a very low VBAC rate (last time I checked)

2. hospital would require CFM, heplock, and other interventions - I'd have to refuse them and possibly "fight" (you do have the right to refuse routine interventions!)

3. local OBs don't attend VBAmC by choice even though ACOG has revised it's VBAC recommendations

4. local OBs formed a large call group - when you go into labor at an inconvenient time, who know WHO you'll get

5. doing anything "different" in a hospital setting pushes the staff out of their zone of comfort; I'm not going to waste my energy on fighting for a constantly justifying evidence-based care

6. last time around (had to have OB because I was prego with twins), my OB was going to make me push in the OR!!!!

7. I went into labor with the twins in the middle of the night during my OBs monthly vacation.  I know he was in town.  He still didn't come in for me.  I had my cesarean early early in the morning on a Friday, and my OB didn't visit me until Monday.

8. The OB who did the surgery nicked my bladder.  It's a very common surgical error . . . ERROR.

I felt like I'd been left at the altar.

My midwife thinks I could actually have a VBA2C at this hospital.  I don't know WHY she thinks that based on what I already know about my birth community.  Honestly, even if VBAC were a viable option for me, I'd probably still choose HBAC.

I guess the long of the short of it is, know thyself and know thy community! ;)

[CookAMH]

Thanks for those comments.  One reason I have been torn is because my hospital IS a great hospital in which to have a VBAC and natural childbirth, and I have an independent CNM and a doula (but CNM of course it still bound to OB). However, I go back to the position I had with my son that I never wanted a hospital birth in the first place and we chose a birth center. This time, it's really no different for me but we chose this hospital because home birth wasn't an option at the time (DH has since come to support switching to HB). So yes, it's a great hospital, but I think I'm realizing that to be consistent with my beliefs, home birth is the natural choice since a birth center isn't an option here for VBACs.  It's just a more daunting choice when dealing with family members or friends, just not as accepted. But I completely agree that can't be a basis for a decision and it won't be.

I wish I could get in touch with one of the midwives I keep leaving messages for. She's called me back once but didn't get me....I just want to get one appt with her as she's a good option! More experienced than the one I mentioned above, but we'd be happy to go with the one I mentioned in my original post. I feel we can't make a decision until we have interviewed a few midwives.

[ShwarmaQueen]

Originally Posted by CookAMH 

I'm conflicted again because I read of a great birth at my hospital which isn't the first time, this hospital does seem to be an exception for natural birth and really being proponents of VBAC. I think their c/s rate is 15%.  What conflicts me is when that happens, maybe it'll be that way for me and I can avoid the stress of telling our families that we're doing a homebirth (we cannot in our conscience keep it from them, but we can delay telling them until later in pregnancy, 27 weeks now).  It's EASIER now to stay with the CNM and hospital, and harder to choose CPM/homebirth and face judgment about our decision. If people around us were gung-ho, I think it would be easy to switch to homebirth.

Any thoughts?

Honestly, the hospital sounds like an ok place to birth. I had a great HBAC, minus the PPH for retained placenta, but it would be great to have that option next time.

I would make a list (because they help me) and write it all out- advantages and disadvantages of each. Consider that you can switch to a hospital birth at any time, but you cannot usually switch to a HB MW at the very end, because MWs usually like to really get to know their mommas. 

Oh, and don't bother caring what other people (except your DH) think about your plans to birth, it's your birth, your body, and your baby, so their opinions don't really matter anyway. 

[Mamatoabunch]

I just can't imagine planning to birth in the hospital. Getting in the car in labor, traveling, others expecting me to do tasks, put on gown, get monitored, checking my progression, possible i.v. all are such a huge deterrent to VBAC in hospital. Regardless, you only get a few chances to birth, you don't want to regret a decision you made b/c of others opinions. Only yours counts!