HBAC

[Altair]

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?  

[sunflwrmoonbeam]

Are you certain it was true CPD and not a bad position? I had planned a homebirth but after 40 hours of natural labor wound up with a c-section at 42+3. I'm enough of a birth junkie that DH knew the vocabulary, so while the doctor told him "that baby was too big to fit through that pelvis" she told the nurse "occiput posterior face presentation." DD's head was in the 98th percentile (9lbs12oz, 14ish inch head, I'm 5'3" and very average build) but I dilated, she descended, and it was never an emergency. She simply couldn't get through my pelvis without tucking her chin, and she wouldn't tuck her chin. I'm planning an HBAC this time and feel fairly confident that not only is it very safe but that we'll be successful.

[liberal_chick]

I dealt with the risks by weighing them.  But this was an easy decision for me b/c, where I am, the climate is not VBAC friendly at all.  They'll technically do them, but they put so many obstacles in the way that it is amazing to me that ANY woman can successfully have a VBAC in this hospital.  I mean, not letting you out of the bed after your water breaks, at all, for any reason?  Come on!  I knew that my chance of a repeat c-section was high at my hospital, even if nothing was wrong.  Either that or they'd have created a problem b/c of all the interventions they required.  I even had a doctor that delievers here tell me, after the fact, that my birth with ds2 would've been a c-section b/c it took 30 hours.  Ridiculous.

So anyway, look at the risks of HBAC vs the risks of a repeat c-section.  Or vs. the risks of lots of intervention.  It does sound like you have some good options.  Honestly, I wouldn't trade my HBACs for the world.  There are risks to every decision you make in life.  This is no different.

Best of luck!

[Altair]

We've fairly certain it wasn't malposition because my midwife requested an ultrasound when we got to the hospital.  We knew we were possibly headed for a c-section, so we wanted to see if maybe it was OP or something that we could continue working on.  The midwife and OB agreed from the ultrasound that he was perfectly positioned (yay spinning babies all 3rd trimester!).  They said I could have an epidural and pitocin and sleep the night away to see if anything changed (after 70+ hours of limited food, I kept throwing it up, and no sleep, we were weighing that as an option) but we decided together not to do that since he was so perfectly positioned and for the past 3 days I had been trying every move and position known to man to get him descended-- an acupuncturist even came over to work on my pelvis.  

So my midwife did say she thinks it was one of the first true cases of CPD she has seen.  

I guess what's hard to decide, and I'll need to think about this a lot as I get closer and see how big baby is and how far over I am... but is the risk of HBAC too much when I have the option of delivering in a VBAC friendly hospital with my HB midwife as my attendant?  Logistically, I don't want to go to the hospital for a million and 1 reasons, including very limited child care options for my son, not to mention the very emotional reason for wanting to stay home. 

[TrumpetMom]

Two weeks ago I had an HBA2C with a velamentous cord insertion with a low-lying placenta. The OB I was paralleling my care with gave me a 5% risk of thecord rupturing with membranes which could lead to the baby dying. They pushed for an early c/s until they saw that the placenta had moved out of the lower segmaent and was further from the cervix (they still wanted me to do a c/s because of the first two). I weighed the risks of everything by writting them all down. In the end, I was more comfortable with the HBAC than a RCS. For me, being able to look at all the risks and decide what my threshold of risk was helped me makemy decision. 

I think one thing you should consider is what is the likelihood of CPD happening again, and what if it doesn't? If it doesn't but you go for the RCS, how will you feel? (this was an important question for me; just something to think about). I suggest looking at all the possible outcomes, good and bad, best and worst case scenarios, and how you think you might handle and react to each, in addition to weighing the risks and benefits of each choice (VBAC vs. RCS).

In the end, make the decision that is best for you and your family. Good luck!!