VBAC at home or VBAC in Air Force Hospital with Doula?

[Snowmama2011]

I am not sure what to do. Should I VBAC at home with a CNM that I am unsure about and who I only met once or VBAC with a Doula in a military hospital? For obvious reasons I am nervous about both. In the hospital there might be a chance of c-section, interventions etc even though the MW's there have assured me there wont be. But I am still wary. And at home, I am wondering if the CNM will be what she claims she is. This is out of pocket and not cheap for DH and myself and thats why I am second guessing the homebirth. I am so confused and questioning everything.

Please. Any advice from those who did VBAC in a hospital or at home. What would you change, if anything? 

[cblevins84]

I have done both. My hospital birth ended up with more interventions, and just being a longer labor.(54hours) the difference mainly though was my mindset. I was nervous and uncertain on how my hospital birth was going to go, it showed in my slow labor and emotional state. There were other factors too, but I think that had a lot to do with it. With my home birth I was just able to visualize how it was going to go, and was just very calm about it. You practice your pain management techniques at home, therefore when labor kicks in and you are at home it is very easy to get into that minset. That said, how much do you trust our doula to help keep the interventions at bay? If you are at home with the CNM that you don't necessarily click with she will have a much harder time talking you into something that is against your birhtplan. If you have a good support person/ team with you at home that is what you remember not necessarily the last couple of hours with a midwife you don't have the warm fuzzes for. As a VBAC mom you will have a harder time getting a non-intervention labor in a hospital, period. Even with the best midwife and the best doula, in the end the Ob/Gyn has the final say in the hospital. In your home you are in charge. In the end the best decision is the place you feel the most comfortable and safe. My hospital VBAC was not bad, I let feeling like I accomplished my goal, having my son vaginally. My home birth though was awesome, fast, stress free, and with no interventions. I am glad I've had both experiences, but if I could I would go back and have had my son at home. Sorry this is so long, I hope it helps! Good luck!

[CookAMH]

I appreciated the above poster's comment (thank you) as I am in a similar situation. To the OP, I can only offer what we're considering as we make the same decision.  DH and I are seriously considering switching to a home birth, and we hired a doula for a hospital birth earlier this fall. I'm 26 weeks. The hospital has a great reputation for VBACs and low c/s, very natural childbirth friendly, etc but I still want the freedom of restrictions that are there for VBACs (hep lock, continuous monitoring, 2-hr cervical checks, 2-hr pushing limit), plus I want the environment of home. As the pp pointed out, the CNM might be great (mine is) but it still depends on 1) the OB on call and 2) the current birth climate at that hospital. What I mean by #2 is that there may be more or less restrictions and flexibility if recent births went great or what not, but if something negative happened in the weeks before your birth, they might be really rigid on something that you hoped to push back on.

Something that influenced my initial choice of a hospital birth was that I had heard exceptions are made on their policies if you push back enough, but I realize now that a lot depends on the OB and what happened recently. So, it's a gamble for what I'd get when my time comes to give birth.

If we choose homebirth, I am SURE I will be nervous and doubt our decision. I am thankful that DH and I are deciding together and hopefully we'll both know the wise choice for us. 

I think I would be nervous during labor if I was at the hospital, and also worry about when to go in order to not go too soon. Compare that to periodic nervousness leading up to the birth but a relaxed atmosphere during birth...I'd rather have that since it can greatly impact labor.

HTH.

[jenniro]

I attempted a VBAC in a hospital this summer that ended in a c-section.  My labor stalled and I was told either pitocin or section.  I was in labor and didn't think about refusing both, so I had the section.  If I had been at home, I could have slept when my labor stopped.  I don't think it matters how VBAC supportive a hospital is, they still do not understand nor know how to manage natural birth.  The continuos monitor is an example.  It seems so harmless and non-invasive, right?  Yes, but the staff is watching and trusting the monitor, not you.  When something blips on the monitor, or your labor takes longer than 24 hours, that is outside the norm for the hospital and interventions begin.  If you are home, you are allowed to labor exactly they way you are supposed to. 

I am an RN and I am gratefel that I live in a time that c-sections are available to save moms and babes.  But I think that unnecessary interventions are being used on healthy moms and birth management in a hospital has more to do with legal and insurance reasons than what is safe and healthy for mom and babe.  Ultimately, you have to be where you are comfortable and I hope everything works out for you.  Are  you able to speak with previous clients of the CNM?  They could help answer quesitons you have about her.

[justKate]

Hi Snowmama2011, and welcome to MDC!

I haven't had a chance to VBAC yet, but I think this is going to be a really personal decision for you.  How much can you learn about the hospital?  You mentioned MWs in an Air Force Hospital--what's the situation there?  For me, that sounds great, but it's such a personal choice.  IMO military hospitals are not gung-ho on sectioning people, because there's no money in it for them.  They don't increase revenue by doing more surgery the way "regular" hospitals do.  If you're a military spouse/dependent/loved one, come over to the Military Moms thread here --there may be someone who has given birth at that very hospital.  :)  Good luck with your decision.

[Snowmama2011]

Thank you for all the reply's. It is such a tough decision.

[cairomama]

I work as a doula in an American military hospital quite a bit. A few things to know about military hospitals:

1. The staff rotates frequently, so policies change frequently. You should try to talk with other VBAC moms who have VBAC'd recently, as in the past few months. Ask them what their VBAC attempt rate is and their VBAC success rate.

2. The c-section rate is generally not low. The docs at the hospital near me said the rate is 24%. That is lower than the national average, but far from low, still 1 out 4 will be sectioned. Again, this rate is going to vary from hospital to hospital. Don't assume. Also, the military population has a lot of young moms so the lower c-section rate may be because of that. That doesn't indicate how they treat "high-risk" moms and they will consider VBAC to be high-risk.

3. You get whoever is on-call so you need to see and talk to all of the doctors/midwives. At this hospital, we don't have midwives. We had one last year and she would labor with a woman during the day, but overnight, the on-call doc took over. Make sure that you will have midwifery care 24-hours and ask what the criteria is for when the doc takes over.

As far as homebirth goes, are you uncomfortable because you have to pay out-of-pocket or because you don't trust the midwife? A lot of military people have a hard time paying for medical care because they aren't used to doing it.  It is possible to be reimbursed by Tricare if the midwife is a CNM and you get prior approval or switch to Tricare standard. In general, you are more likely to be successful as a VBAC if you are at home than if you are in the hospital. However, if you don't trust the midwife, you shouldn't hire her. Maybe talking to some of her former clients will make you feel better. If it doesn't, go with your gut and go to the hospital.

There are some things you can do to increase your chances of VBAC success in the hospital (in my experience).

1. Stay home as long as possible. VBAC labors often have long warm up phases. If you are in the hospital, they are going to want to do something. They can't give you as much Pit as they can a non-VBAC mom so then you are looking at section. Of course, if you feel something is wrong or feel you need to be in the hospital early, then you should go, but if you are comfortable laboring at home and can stay until you really need to be there, that will increase your chances.

2. When you do go to the hospital, minimize vaginal exams. They will want to do them hourly. Do them every 4-8 hours or less. Frequent vaginal exams break your rhythm, increase chance of infection and can be discouraging.

3. Don't let them break your water. They will tell you,"if we break this water, we will have a baby soon". If you've had multiple children vaginally and have some dilation that may be true, but for a VBAC, it generally isn't true. Your water is in tact for a reason, keep it that way until it breaks on its own or you are really far dilated. 

4. Don't get the epidural. Many hospitals have 2 hour pushing limits. Of course you can insist on more time, but if you have the epidural and aren't very effective, it can be a problem. 

5. Don't push until you feel the urge to push.

6. If you do get the epidural, ask to "labor down" so that you are at least +2 before you push. 

Good luck with your decision!