Torn between a home vbac or repeat c-section.... anyone had a home vbac?

[activealli]

Long story short, I had a very high risk pregnancy with my first son and it was very necessary to have a c-section for my first son. Until I found out I was high risk, I was planning a home birth. Since then I moved from vbac friendly portland, OR to santa barbara, CA, where vbacs are banned everywhere within 200 miles... I really dont want to have another c-section, especially if its not medically necessary. Not only because I cant stand another impersonal cold c-section, but I will have 1 year old son and an infant to care for, leaving NO time for recovery from a major surgery.

I did find a home birth midwife who is willing to try a home vbac. I am a little nervous, as I may lose the support of my back up MD and have no idea how Ill be treated IF I have to transfer or what exactly the risks may be of having a vaginal birth at home, and only 1 year after I had my first c-section.

Anyone have any experience here?

[obdoc]

What made you high risk, and are those factors still present?   That would affect opinion.

[BMDoula]

As long as you are healthy I don't see why a HBAC wouldn't be a wonderful option. 

[womenswisdom]

Assuming you are no longer high risk, I'd look into it. My hbac was wonderful!

[uwritegirl]

I would absolutely do the home birth.  You always have the option of transferring to the hospital if your health becomes a concern.  Also, midwives KNOW how to screen and monitor for uterine rupture, which is the big fear for VBAC.  Also, you are less likely to have uterine rupture without hospital interventions such as pitocin and forced pushing counts.

Some women do not speak openly to their OB's regarding their desire for homebirth (I myself was dismissed from an OB practice for mentioning my homebirth plans!) in order to keep a back-up physician.  Other women, like myself, do not feel the need for a back-up physician at all, given that the homebirth midwife can demonstrate to me her professional quality.

Contact Nancy Wainer, CPM - quite the authority on VBAC's as she coined the term and also had one of the first VBAC's in this country years ago.  She has attended two of my births (my first child was a c-sec also) - she will help you to believe in yourself and to believe in birth like you have not ever before.  She will also authoritatively answer any of your medical questions with as much information as you could possibly need.

Nancy's site, which also has a helpful blog, is www.birthdaymidwifery.com

[activealli]

Well, called 3 midwives and birthing centers in town. So far no one will take me. The one person who said she will do vbac, is not returning my phone call. Why does this have to be sooooo difficult!

[activealli]

Just finished anotehr round of calls. I got an appointment with an MD who does home vbac http://supportdrfischbein.com/bio.htm but it could cost upwards of 10k out of pocket. We just bought a home.. I dont think we could swing it financially. I called every midwife, birth center within 50 miles and everyone said they dont do it, and this is the only guy they know who does.... called the one midwife who said she would again, she still doesnt answer her phone or return my calls. Even if she does vbacs.. I dont like the fact that she isnt returning my calls. Not a good sign....

[activealli]

FYI- no longer high risk. My first son had a problem with his instestines, causing extremely high levels of amnio fluid and he was diagnosed with down syndrome and NICU care immediately after he was born. According to the ultrasounds and the nature of the problem with my last pregnancy, we do not expect any problems this time around.

[obdoc]

I get less than 2K from insurance for VBAC---most of which goes to pay for the malpractice coverage and office operating costs----10K?????  whaaaaattt???

[Gray's Mommy]

What about a neighboring state? Could you travel to your mw or pay travel expenses for your midwife to come to you? I'm sorry this is so challenging!

[kim.mpls]

I had a fabulous HBAC in January.  $4000 for all care with CNM/CPM midwife team (and their apprentice).  Met backup MD at 30 weeks, though I never saw MD again ;-)

IF I was going to have another baby-  I would TOTALLY do this again with midwives at home.  It was such a fabulous experience, so empowering and sacred.  Quite the contrast to the hospital c/s with strangers, OR, and hospital protocols and staff.  (And I had a really good c/s as they go!)  

[liberal_chick]

I had 2 HBACs and they were great. I highly recommend them! I had to find an unlicensed midwife ro give me care (she came highly recommended, was highly skilled, and did a great job) because licensed midwives are barred from attending HBACs in my state. That may be a route that you want to look in to if you're comfortable.

[Ivy53]

Would you be willing to travel? I don't know how it is in Santa Barbara, but there are places down here that are VBAC-friendly. I'm in Orange County and I'm having a homebirth. I know things are easier for me because I've already had a successful VBAC, but there are midwives who will do primary VBAC in Orange County and Los Angeles County, including mine I believe (I have spoken to some midwives who work in both areas, and my midwife has a partner that serves Riverside and San Bernardino Counties). There are also hospitals that will do VBAC in both counties - my first VBAC was at a hospital. HBAC not being allowed is definitely not state wide, though I know it doesn't help much since I'm sure you most want to have a VBAC in your own home. :) Maybe look at Ventura County? The midwives down here all seem to know each other. Maybe I can get you a list of names and they can see if they know of anyone further north.

[activealli]

I did finally find SOMEONE willing to do it. Could not find a midwife in all of Santa Barbara or Ventura county... except one who was flaky and had issues with getting in touch with me. I JUST got back from meeting with Dr. Fishbein in Camarillo (about 40 miles from our house) who does home vbacs. Most of my primary care would be done by him and then he and a midwife would meet at our house for the vbac. He actually went to school with my ob/gyn that I started seeing (who can only do c-sections, because of insurance and hospital regulations in this one-hospital town) so hopefully if anything went wrong or had to be transfered, he would do my c-section. I feel very confident in Dr. Fishbein and his team (whom I have yet to meet).

I am so happy to have a choice. Yes, it will be a bit out of pocket, but they are going to work on getting anything reimbursed after the birth with their insurance coordinator, but its going to be a bit out of pocket expense we were not planning on and at bad timing, but we feel it is worth it.

Thanks for the support everyone! Ill keep everyone updated.

Edited by activealli - 9/19/12 at 2:52pm

[Ivy53]

Oh, I'm so glad he's working out for you! Sounds like you'll be in good hands.

[Buzzbuzz]

Is that Dr. Stuart Fischbein?  You may want to search him on insider pages or google him -- his license was previously subject to probation.

[activealli]

I am aware of the reports on google. From what I understand, he had slept with a patient shortly after his divorce. It was consensual, and only happened once. While I understand this is against the "doctor/patient rules" it has nothing to do with his skill or his ability to care for his patients. To me, what he chooses to do in his personal life is none of my business. I don't think his license should have been up for probation due to a lack of judgement in his personal life.  I have the up-most confidence in his and his midwives skills to deliver my baby safely.

[Buzzbuzz]

When you have sex with a patient that is not part of your personal life.  The barrier between doctor and patient is a very important one, to ensure that the doctors do not abuse the position of trust and responsibility that they have.   In my mind, the closest parallel is a college student having sex with a professor.  They may both be beyond the age of consent, but there is an imbalance in power.

Obviously, if it doesn't bother you, it doesn't bother you.  However, there are very good reasons for these sorts of rules to be in place and personally, I believe the suspension was completely appropriate and necessary.

[tangledblue]

Two things to consider:
Doesn't it seem a little fishy that the only doc or midwife willing to do this is someone who has been suspended? That would be a red flag for me if so many others thought it wasn't safe.
Second, you said that your c/s was only a year ago; a short time between pregnancies is a known factor in increasing risk of uterine rupture after a first c/s. You said you hadn't looked at risks much...probably would be a good idea to make an informed decision. I am surprised no hospital will let you try for a vbac? There must be a vbac friendly hospital in that part of Cali?

[activealli]

I never said I wasn't informed of the risks. I am well aware of the risks of a vbac. I am well aware of the even bigger risks to my baby and myself of having another c-section. Contrary to popular belief, a c-section is MAJOR surgery and carries risks of infection, bleeding, and death.

Also, as far as no other doctor or midwife willing to do a vbac. I live in Santa Barbara, CA, in a high "sue happy" and small part of the state. .The closest hospital that allows vbacs is UCLA. That is 4 hours away with NO TRAFFIC. With traffic it could be 6-7 hours. I would have to rent an apartment there to have a hospital birth, which is not possible to be away from my son and be all alone in LA for weeks waiting to have a baby. There are a lot of Dr's and midwifes who I have spoke to who believe in vbacs, but would lose their insurance if they did it, and therefor would no longer be able to be a Dr or midwife. Its not a matter of whether they think its safe, its a matter of legalities. I refuse to lose my ONLY chance at having a natural birth. With my son, everything about that pregnancy was horrible, down to the depressing c-section. I knew my son would be born with medical problems and I never got to see my son after he was born for hours! I sat ALONE in a recovery room for 2 days until I signed a against medical advice form to get released early because they had issues arranging time for me to go to the NI CU to see my son, so I just sat in my room listening to every other mother in the recovery wing caring for their child. I spent the first 5 months of my sons life wondering if he would live to see his first birthday, and if he did, how severe his disability would be. I would do it over again in a heartbeat in order to have my son, but this time around, I would like to have a joyous birth. This being the home birth forum, I'm sure many of you have had the chance to experience this. I just don't want my choices to be determines by insurance bureaucrats.

Edited by activealli - 9/19/12 at 2:52pm