Am I crazy for planning/wanting a home VBAC?!?

[summerblessing]

I'm starting to feel like I'm crazy for planning a VBAC at home. It seems like every midwife appt, the risks are brought up, and today I had to go to an OB consult that was less than fun. (He compared ALL homebirths to driving drunk!).

Am I really putting undo risk on myself and my baby? Am I stupid for insisting on this?

Feeling a little discouraged at the lack of support and starting to 2nd guess myself.

[Arete]

No, you're not crazy!  How could anyone be considered crazy for desiring a non-traumatic event over a traumatic, compassionate care over industrialized, callous nothingness, control over victimization?!  I'm sorry, but that jerk of a doctor's comment makes me so MAD!!!  I wish we could really say what we think in such situations, instead of keeping options open, etc.  Is he your midwife's "supervisor" or something?  Is there any way you could work with another dr.? 

[Ms. B. Sprout]

I am currently planning my HBA2C. After the terrible care I have gotten by (twice!) going with the socially-accepted "safe" option of in-hospital birthing, I now have come to think that I am far, far safer at home.

It helps to assess the risks for yourself, rather than hearing inflated versions of risk from OBs. If you haven't already read it, I suggest the NIH Consensus Statement on VBAC from March 2010. It's a good meta-analysis of the studies, with the evidence of risk ranked in terms of quality.

I consulted with two different OBs early in this pregnancy, and they both hyper-inflated the risks (one said VBA2C had a 7% rupture rate! They both told me ACOG does not support VBA2C! WTF!!). Even knowing it was a pack of lies, it was hard for me to listen to that without questioning my judgment, so I totally understand how you feel.

I am limiting my contact with the OB world from now on. I have been lied to and treated like an idiot one too many times, and I am done. Done done done.

I'm so sorry your MW is not fully supportive. If there are other homebirth options in your community, I would explore them.

[cairomama]

Is it the midwife who is going to attend your homebirth the one who is bringing up the risks? Are the risks she is quoting accurate? How many HBACs has she done successfully? What is her transfer rate for VBAC?

If the stats she is quoting are accurate and she has a good reputation for successful HBACs in the community and her success rate for HBAC is good then she may just be making sure you are fully committed and have made the decision with all the facts. 

[kltroy]

I don't think your crazy, but I do think it's intelligent to think about what your transfer plan would be in an emergency.  Where would you go and how quickly could you get there if your MW suspected a problem?  If you could get to a hospital within 15 minutes that could quickly deliver your baby via cesarean, should there be a true emergency, I'd say it's completely reasonable to consider a home birth.  (I say 15 minutes because the typical guideline for "decision to incision" time for uterine rupture is 30 minutes or less, and I'm guessing it would take 15 minutes to get you into the OR if it came down to that).  I don't say this to alarm you or cause you to not trust your body -- after all, there's a 99.5% chance that this won't be an issue (although other obstetric emergencies are also possible), but I personally think it makes sense to plan for the possibility just in case.

Best of luck! 

[akind1]

I don't think you are crazy at all. I would love a homebirth if I could find a midwife that would attend one, but that really is next to impossible where I am. However, part of the process is assessing risk, and that is true whether you are a VBAC mama or not. I would maybe see if you could find another OB to consult that is at least open to, if not supportive of, homebirth. There is nothing wrong with being practical and pragmatic, and having a good emergency plan in place in the event you need to transfer. Even if I were not a vBAC, I would want to be within 15 minute of the hospital in that event, as uterine rupture is not the only complication that would neccessitate a move to the hospital.

You also need lots of positive support, and I think I would remind your midwife of this. If she is willing to attend you and thinks otherwise you are a good homebirth candidate, ask her to please, while being aware of all the risks, your best chance of having a successful VBAC comes with fully supportive people surrounding you. If she can't be that, than maybe you need a different midwife.

[howeberry]

I agree with everyone else: You're crazy for wanting control over how and where you birth. It'd be my plan for # 2 if my state allowed it.

Seems like overkill to bring up risks at EVERY appointment. I'd think that if you were high risk your MW wouldn't have taken you on as a HB candidate, unless there's something she isn't telling you.

[cinderella08]

You are not crazy.  You are birthing in a place that should be the MOST supportive place for a VBAC.  Don't doubt yourself mama.  You are strong, you can do this.

If your MW is not 100% supportive, I'd encourage you to maybe look for another midwife.....

Also - have you considered a doula?  Often times a doula will provide great support.

[jenninjapan]

This article was a great read.

http://midwifethinking.com/2011/02/23/vbac-making-a-mountain-out-of-a-molehill/

Your risk for cord prolapse is greater than uterine rupture.

VBAC vs first vaginal birth

Rozen, Ugoni and Sheehan (2011) compared women having a VBAC with women having their first baby. They found: “Uterine rupture rates were low in all groups, with no correlation identified… The maternal and neonatal morbidity associated with VBAC is comparable to primiparous women undergoing a vaginal birth.”

So, for women having a VBAC birth is just as risky (or not) as a woman having their first baby!

Why is your midwife bringing up the risks at every appointment? One discussion should cover it. Find another one if you can!

[labortrials]

So your homebirth midwife is taking about risks at every appt??  Can you tell us a bit more about this?

OB consult - of course an OB is going to tell you that HB is nuts and HBAC is more nuts-er.  You can always ask him/her to refrain from discussing risks with you further, that you are aware of the risks related to both home and hospital birth as well as the risks of VBAC and RCS.  Don't let it be open to discussion.  Just my advice there.

I am planning HBA2C; however, I am seeing an OB for shadow care.  He doesn't know that I'm not planning on doing this at the hospital.  The reason I've consented to shadow care is just in case I need to transfer, my records will be there and I'll be treated better by the staff.  (Oh, and he thinks I'm nuts and tried to scare me out of VBA2C at the 1st appointment; fun times.)

[newyorkmommy]

Hi, sorry, I originally posted here but decided to just PM you instead.