Hospital VBAC vs Birthing Center VBAC

[shakyjelly]

Hi everyone. I'm new to this area of the forums (and I haven't been very active period in awhile!). I'm around 7 weeks pregnant and hoping for a VBAC. My first birth was traumatic. It was a battle from the moment I checked in to the hospital due to the size of my child, my nausea (due to eating in a panic since I was afraid the hospital wouldn't have gluten free food, silly I know), and my back labor. I ended up getting an epidural out of panic since my doula wasn't there yet which is a decision I greatly regret. Due to the size of my son and the epidural, I stalled out at 5cm and developed an epidural fever so eventually, I was told it was time for a c-section. I was tested for GD, but was cleared. Despite that, I had an 11 pound 2 ounce son. :D He's still a big boy now (very tall and musclely) at almost 3 years old! 

ANYWAYS... I'm debating right now over a birth center or hospital birth. I must admit, the first OB I saw so far has me freaked out a bit about the risks, which only scared me more when I went to the AWESOME birth center near my house. I was about ready to sign on the dotted line, but when I saw those emergency risks again... I thought, maybe I would be better at a VBAC friendly hospital? The birth center is AWESOME. The women are wonderful and while they were a little hesitant due to my son's size, they are totally on board with me trying for a VBAC, especially since I eat a modified paleo diet now (so no more carby treats for me!) The only thing that freaks me out is that if there is an emergency...it's not like they can immediately move me to the OR. The hospitals are near by and they are equipped for an emergency (like a level 1 hospital), but still. I don't know. Despite my major distrust of doctors, they have engrained a fear of not having them into me. I am still definitely leaning towards the birth center since I know I won't have to FIGHT there for the birth I want, but still... I'd love to hear your thoughts & experiences.

All I know for sure is that I do NOT want another c-section. I want to give my body a chance to do what it was meant to do.

[shakyjelly]

I'd still love to read your stories, but after browsing through years of threads with HBAC vs Hospital VBAC debates... I've made my decision. I'm going to go to the birthing center. :D

[fayebond]

I had the same experience! The long version is here http://www.mothering.com/community/t/1099931/vbac2c-in-portland-or#post_17034240   The OBs, the hospital midwives, the nurses, they all looked at me and you could just tell that they weren't seeing me.  They were seeing thier own fears.  And given that the actual risks are so low, I am not at all interested in going ito birht with me in fighting mode and them in fear mode.   I totally fell in love with the birth center environment, even the receptionist there treated me like a person (not some alien pod carrying a baby that needed extracting).   I found that the longer I kept my options open, the more I felt sure that I wanted to go back to the birth center people (I can't actually give birth there but I can get the midwife I liked there to attend a homebirth). 

Do what's best for you and your baby, but read about those risks if they are what's holding your brain and your gut apart.  I liked ICAN's website (and their meetings!) and have been reading "Obsteric Myths versus research realities" by Henci Goer.  The sheer number of studies that show EFM to be ineffective swayed me, but maybe something in there will pop and you'll find that you really want the hospital badly enough to fight for it.  

[rnra]

Here's how I made my decision--make a prioritized list of the things/experiences that are important to you regarding this birth.  The prioritized part is important--put the most important thing first, then the next, and so on.  Then go through each item and write next to it if that item is most realistically accomplished at the birth center or at the hospital.  For example, mine looked something like this (note that this is not intended to start a war--this is how I chose to categorize things, you will likely have a different list and categorize them differently)...

1.  Have a baby who is alive.  Hospital.

2.  Be alive myself.  Hospital.

3.  Have a baby who does not have any permanent mental or physical disabilities due to birth injuries/emergencies.  Hospital.

4.  Avoid permanent disability myself.  Hospital.

5.  Have a birthing team that I trust is capable of correctly and swiftly handling an emergency situation.  Hospital.

.

.

.

9.  Have a vaginal delivery.  Birth Center.

10.  Have a birth team who is hands off and lets me labor as I choose.  Birth Center.

.

.

.

Then, using that information I chose to go to the hospital.  Yes, risks are slim.  But slim does not mean zero.  Someone's baby has to be the one that dies and someone's uterus is that one that ruptures.  No I do not trust birth, or umbilical cords, or placentas because there is no reason to trust them.  Nature/birth doesn't care if you are the one who dies or if it ends up being the woman in the next state.  I realized that although items 8-12 on the list were very important to me and were most likely accomplished in a birth center, they were not the things that were of greatest importance to me.  Yes, the experience of a birth center would be more comfortable and accomodating but not at a price (meaning the potential death of my child or me) that I was willing to pay.

[shakyjelly]

Wow. I understand that was how you broke things down, but thanks for frightening me. 

[shakyjelly]

And is this just how you broke it down for your own confidence or based on facts? Is your hospital's OR on standby while you're laboring? The birth center I'm looking at is just 5-15 minutes away from 3 hospitals, has an OB on call, pediatrician downstairs (if in evening, on call), and is armed with all the emergency equipment of a level 1 L&D room, emergency room & neonatal ambulance. 

I'm sorry to seem sassy, but I just don't see how it was productive to break it down in such harsh terms for ME. You could have just said you made a list with things you felt were important. No need to be a fear monger and try to scare me into a hospital birth.

[rnra]

This is how I broke it down based on my own experience.  There was no intent to fear monger--I clearly said that your list would likely be different than mine.  Mine was mearly an example. Everyone has a different list, different experiences, and different priorities.  

[shakyjelly]

True, but seriously, that was a pretty harsh list that you knew would be very upsetting. It basically implied to me that if *I* choose a birthing center based on my own list... that basically, I was putting my child's life and my own life in peril. That may be your beliefs, but there was no reason for you to share your particular fears in such a harsh and polarizing manner on here. It was incredibly upsetting. You could have phrased it simply as "I made a pros/cons list and for my own comfort, I chose a hospital VBAC, but everyone is different!" There was no reason to be so harsh and cruel by sharing your list. 

Edited by shakyjelly - 7/7/12 at 9:58pm

[rnra]

You may not agree with my list.  That's fine.  Really.  Message boards are intended for opinions and discussion, and I have the same right as you do to post my thoughts and decisions.  

[shakyjelly]

I guess I always just taught to be polite and kind. You can have opinions without being outright rude and cruel while delivering them.

[MovnMama]

Originally Posted by shakyjelly 

I'd still love to read your stories, but after browsing through years of threads with HBAC vs Hospital VBAC debates... I've made my decision. I'm going to go to the birthing center.

I'm glad you decided this. I just had a hospital VBAC 36 hours ago, and I really wish it could have been at a center - I would not have ended up with all the interventions that did happen. Sadly, a birth center was not an option legally.

[Alenushka]

So, I think there is simple exercise that can help you decide if you should try for a VBAC in the hospital in proximity to fully equipped OR and NICU. Or if you should do int the Birthing Center. Lets just assume , even thought is not physically possible, that you can get form the birthing center to OR in 10 minutes via ambulance.

Now, close you eyes. Think positive thoughts and hold your breath for 10 minutes.

Can you do it? No? Neither can you baby.

5-15 minutes away means that

1) MW calls 911

2) Ambulance is on the way. It may take 10-20-30 minutes if there is traffic, accidents, rain or what not

3) You are loaded in the ambulance, perhaps bleeding, baby in troubled. EMT really can;t do much for you but give you O2. Paramedics can start an IV. No one will do C-section in the ambulance

4) 10-20 minutes ride to the hospital

5) Unloading

6)Checking in

7) Assessment, blood type and cross. Anesthesiologist is paged, OR is assembled.  In emergency, there no time for epidural or spinal, so it is general.

8) Finally the surgery is commenced. I

That is is not a very natural experience.

Many people, including my friends and relatives had very nice natural childbirth in the hospital. They also had piece of mind knowning that is something went wrong, the help is is around the corner.

[TCMoulton]

Originally Posted by shakyjelly 

I guess I always just taught to be polite and kind. You can have opinions without being outright rude and cruel while delivering them

While I understand that the pp's list may have some scenarios that are scary on it she certainly presented it in a way that was not inappropriate considering your original question. Reality is while the possibility of complications with a VBAC are small they are very real and should absolutely considered when planning your birth. I can't see how you can accuse anyone here of being rude to you, she just posted things that you feel uncomfortable with and maybe that means you have more thinking to do before you choose a location for your upcoming birth.

[Sanveann]

Alenushka makes some very good points. I know of a birth center near me that advises moms that the hospital is 10 minutes away. MAYBE it is ... if you're in an ambulance with lights and sirens on, going pedal-to-the-medal the whole way down the city's main drag at 2 a.m. with zero traffic. But of course, someone needs to call the ambulance, then they need to get to the birth center, then they need to assess you, then load you up, then get you to the hospital, then unload you, then check you in, then the hospital needs to assess you and decide what needs to be done, then assemble the team, etc. So it's usually at LEAST 45 minutes, all told, based on the experiences of women I know who transferred.

Personally, I would absolutely go with the VBAC-friendly hospital, especially because your first baby was so large. Do any of the ones near you have an in-house birth center, or CNMs on staff? Hire a doula. If you're not happy with your current OB practice, try to find one that you're a better fit with. I've had three really fantastic, intervention-free hospital births with my OB practice, and frankly, I was delighted with all of them. They were SO not what I was told hospital birth would be like!

[LoveIsla]

I remember my CNM asking me if I was fearful of the pain of laboring. "No," I said, "I'm fearful of a repeat csection." it never crossed my mind that my biggest fear really should have been rupturing and losing my son. But that's exactly what happened. Pp is right. We live 8 mins drive from the hospital. Between one contraction and the next his heart rate went from 135 to 50. There wasn't enough time to get to the hospital never mind an OR. Don't gamble on your baby's life even if the odds are stacked in your favor (but remember 1 in 200 vbac attempts result in rupture). It is not worth it. Go to a vbac friendly hospital and know you are a safe distance from an OR. Please?

[KoryO]

Go for the VBAC friendly hospital!!!  

I can't emphasize that enough.  I tried for a VBAC when I had my daughter.  I was one of the ones who ruptured, even though everything looked wonderful to my providers (no pit, low transverse that was almost 3 years old when I conceived her....you name the positive factors, I had 'em.  As close to textbook as it gets.  And it still happened, much to everyone's shock.)  

I would not have had enough time to make it to the hospital from a free-standing birth center, and neither would my daughter.  Even if I had been right across the street from the hospital, I would have been too far away.  I lost two liters of blood in minutes, and spent two hours getting sewn back together.  We NEEDED that OR down the hallway.    

I know you don't like mra's tone, but listen to what she is saying.  It may be harsh, but it doesn't compare to the frightening reality that I and LoveIsla faced when we had our ruptures.  I am a member of a UR moms group, and believe it or not.....I'm one of the lucky ones.  My daughter is still here.  She's doing beautifully, and is a completely normal little girl.  I'm doing fine, too.  Too many of the mothers there have had to say goodbye to a much-cherished baby, far too soon.    

I hope your VBAC goes well, and I hope you choose the VBAC-friendly hospital.  Please give your new little one.....and yourself, too!.....the safest option.  You have a little one already here who needs you both, not to mention other people who love and care for you, too.  

BTW, does the hospital have CNMs?  

 

[shakyjelly]

I appreciate the input, ladies. It's interesting since I'm getting completely different info from the women I've met through ICAN. I'm so conflicted. :( This article (http://natural-forces.com/essays/vbac.htm) also make it seem a lot less scary. The hospital is 1.1 miles away from the birthing center and they've NEVER lost a mommy or baby. They transfer early rather than trying to push things until the last minute. I really feel like they make birthing center VBACs safe.. but I must admit, you guys have me truly frightened. 

[kgdg]

Rupture isn't a gradual process, it, like many emergent issues in birth and labor is extremely sudden. There is no such thing as transferring "early" in a uterine rupture.

[suchende]

Originally Posted by shakyjelly 

I appreciate the input, ladies. It's interesting since I'm getting completely different info from the women I've met through ICAN. I'm so conflicted. :( This article (http://natural-forces.com/essays/vbac.htm) also make it seem a lot less scary. The hospital is 1.1 miles away from the birthing center and they've NEVER lost a mommy or baby. They transfer early rather than trying to push things until the last minute. I really feel like they make birthing center VBACs safe.. but I must admit, you guys have me truly frightened. 

Read your link: 

"When a true rupture occurs, a cesarean must occur within 30 minutes (ideally 20) to prevent neurological damage to the baby. Death does not occur immediately. Most women attempting a home VBAC are well within 20-30 minutes of a hospital, particularly if 911 is called."

Being 20 minutes from the door of a hospital is totally different than being 20 minutes from the OR. How quickly has your birthing center gotten their ruptures from the center to the OR? And how many VBACs have they done? How many of those had a uterine rupture? According to your own source, uterine ruptures are relatively rare (1:1,000 VBACs) so if they've done, say, 1,000 VBACs, we would only have expected them to have encountered one "catastrophic" rupture. 

[mandib50]

to the OP, it can be difficult to get black and white information about VBAC because you really do have to dig around for accurate information, and i am not even sure that we have good research on out of hospital VBAC's (that i can think of off the top of my head anyway). we do practice in a culture of fear and litigation which can cloud information that is being passed along. and aside from involving the "risks", choosing a VBAC is also an emotional journey for many women that cannot be defined and limited to the risk of uterine rupture.

yes, uterine rupture occurs. it is very rarely a cause of death in mothers, but causes death in babies in 1.9 out of 10,000 women compared to women who have repeat c-sections. to keep things in perspective, i love what murray enkin says:

"To put these rates (of rupture) into perspective, the probability of requiring an emergency caesarean section for other acute conditions (fetal distress, cord  prolapse, or antepartum hemorrhage) in any woman giving birth is approximately 2.7 percent – or up to 30 times as high as the risk of uterine rupture with a planned vaginal birth after caesarean.”

we don't rule women out of home births or birth center births because they might have a cord prolapse or a baby with fetal distress.

have you checked out any of these sites yet?

http://www.childbirthconnection.org/article.asp?ClickedLink=293&ck=10212&area=27

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

http://www.aom.on.ca/files/Health_Care_Professionals/VBAC/VBAC.pdf

http://consensus.nih.gov/2010/vbacabstracts.htm

i personally do not think you are putting your life or your baby's life in jeopardy by choosing a birth center birth. dig through the information and trust your gut! good luck :)