I am 12 weeks pregnant and just had my first visit with my HB midwife. I worked with her during my last pregnancy and birth, and we love her to pieces. So much about my pregnancy and labor was in my hands, down to to call of transferring to the hospital after 70 hrs of labor and 15 hours of involuntary pushing, and even down to the c-section itself, because we had a great back-up OB who even left that call in our hands. Overall my entire birth experience, while 100% not what I expected and a pretty traumatic amount of pain, was still MINE and I appreciate that so much.
This pregnancy I want to plan a HBAC. I worked as a doula for 10 years and counseled women through this process, but it's so different when it's your own body and your own risks. With my last birth, I have some things that make HBAC more likely to be safe/successful, and some things working against me. I know I have a low, double stitched horizontal incision and I am young and healthy. The reason for my c-section, however, was something that could repeat-- the labor was not stalled or ineffective, he was truly stuck and not descending. It was CPD-- his head circumference was actually off the charts and he was 9 lbs 4 oz and I am 5'1 and petite. Nonetheless, I had absolutely no fears of birthing that big baby and thought there wasn't a chance in hell my body couldn't push out a baby it grew. I also went to 42 weeks with him and he seemed to grow quite a bit at the very end.
This time, I may try to think about the baby's growth more in terms of how much protein ( a LOT last time) and white carbs I'm eating and how much I'm doing at the end to naturally push things along a little sooner. I'm also doing more chiro and PT this time to loosen my ligaments, which seemed very tight at the end of my pregnancy (I went to a Webster chiro last time).
That being said, I think things could go in either direction. I could have a nice easy labor, a long drawn out labor, and I could need a c-section. I'm mentally prepared for any possibility.
What I'm having the hardest time thinking about are the risks to HBAC. I do have 2 great options other than HBAC, one (which I don't want to do) is transfer care to the OB who did my c0section, who has a 90% VBAC rate. It would be in a hospital close to me, which would help with child care (but not as much as a HB would!). One complicating factor here is that he does not take insurance, which probably means I'd owe somewhere around $20,000. Of course, I don't have that money.
Another option to to continue working with my CNM and if we decide at the end of my pregnancy or during my labor that the risks are too high (but it's not an emergency) we can transfer to a very VBAC friendly hospital where she would remain in change of my care. It is an hour away, however, so we could not do it in am emergency. I like this as a back-up plan because then my pregnancy/labor is still under the care of someone who is just so respectful and responsive. A downside to this hospital is that while it does have an actual waterBIRTHing tub (not just laboring) and it does have private recovery rooms, they are 100% insistent that they take the baby away for exams, including one close to birth. I cannot do that! Even after my c-section my son never left my side. That hospital has since closed or it would be the obvious backup choice. An emergency backup would mean going to the nearest hospital and being treated like crap for being a HBAC transfer. On the financial side, I will still owe a good deal of money after my out of network insurance kicks in, but not tens of thousands of dollars.
How can I be comfortable with the risks of birthing at home? A rupture that injured or killed my baby would not be something I could ever forgive myself for, clearly. Another case of CPD that instead resulted in stuck shoulders and nerve damage and CP would be unforgivable. I want the experience of delivering at home so badly, and I want a birth that gives me the best chances of success.
How does one live with these risks?