Hospital VBAC vs Birthing Center VBAC - Page 2

[mandib50]

Originally Posted by suchende 

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. 

right, but depending on where you are, you can phone ahead to the OR, you can draw a woman's blood while preparing to transport, start an IV and have her ready to go straight to the OR when she is in the hospital. regardless, it may be in the comfort level of the OP to accept this risk, and i hope she does not feel judged in a negative light for making such a choice.

[Alenushka]

Straight to the OR, would occur in the hospital not in the case of the outside transfer.

If the birth center is ran by CNMs then IV could be started but not if it ran by CPMs. Type and Cross takes a while. Getting a doctor takes a while.  Many of the things are done ahead of time just in case is someone is already in the hospital.

2.7 % is not such low number. It means, practically speaking, that 3 out of 100 people.

My sister in law just had lovely natural childbirth in the hospital birth suite.  No one shaved her, restrained her, forced an epidural on her. She has small heplock instead of IV . Nurses encouraged her. Everything from a tub to birth ball was at her disposal.

[LoveIsla]

I understand how hard this is when you hear what you want to hear from ICAN and a midwife and other women who had a vbac at home, but as KoryO said there are those of us with horiffic stories who wish that someone had given us a story with a bad outcome so we could have been better informed. This is the problem with statistics that seem so small; it seems like it almost never happens, could never happen to you, noone has ever heard of it happening etc., and then it happens to YOU and YOUR baby and you realize that statistic exists because it has to happen to someone. Again, as KoryO mentioned, we have a whole group of women active on fb who ruptured. Let me know if you'd like me to put you in touch so you can hear their stories.

My midwife had never heard of anyone rupturing, but she stopped doing home vbacs after my rupture. It only takes the experience of one case to have a huge wake up call. Of her existing clients whom she told of my story, one carried on with her hbac and was ok. The other elected to go to hospital and ended up with an emergency section because she had started to rupture. My OB told me he was seeing more and more cases of dehiscence or windows though he couldn't explain why.

I should have mentioned that although my dd was only 7lb 4 my son was 9lb 2 and that would have been a factor in my rupture. I did not have gd and my midwives thought he was under 8 lbs.

You will, most likely, have no issues with your vbac. But if something goes wrong, and I pray it doesn't, just imagine which decision you would have to live with. I live with crushing guilt every single day.

[Buzzbuzz]

This blog has one of the better summaries/analysis of actual transfer times I've seen...

http://safermidwiferyformichigan.blogspot.com/2012/06/hospital-is-only-12-minutes-away.html

[bgwitty]

My experience is with having a hospital VBAC.  If you are stubborn and determined and willing to do the research involved, you can be successful in the hospital.  Even though I was with a midwife practice, I had to fight for my vbac (they were wanting to induce, have me laying on my back, continuous EFM, etc.)  I fought hard and knew I was right that inducing was unnecessary (and more likey to create rupture problems), that movement was necessary to keep labor going, and that I could avoid continuous EFM by not getting to the hospital too early, taking frequent "bathroom trips", etc.  I got to the hospital in transition and only spent 4 hours there until ds was born.

This time around I'm planning another hospital VBAC.  I would love a birthing center experience, I think it would be more intimate and empowering, not to mention safer in many regards, but my dh is not as convinced as I am.  So, the consequence for him is that I make him read "Pushed" by Jennifer Block, and the Bradley Method book while I'm pregnant so that he is fully aware of what is going on in the hospital and how he can best support me.  It worked last time around (he kicked the mouthy nurses out of the room when they started suggestion various interventions), and I'm confident it will work again. 

Having said all that, I think you are perfectly justified in feeling good about a birthing center vbac.  Research completely supports you in thinking it is a safe option.  The myths surrounding vbac can be frustrating.  Of course there are the rare bad experiences.  But, there are just as many rare bad experiences with hospital birth in general, not to mention repeat c-sections.  As long as your birth is a physiological birth, you are giving yourself and your baby the best chance for a healthy and successful vbac. 

In sum: do your research, know everything you can, ask your provider loads of questions about various scenarios, prepare yourself mentally and emotionally for an intervention-free birth, keep yourself healthy throughout pregnancy and don't pack on the pounds, and then pray and have faith in whatever you decide to do.  Good luck!

[KoryO]

The thing is, being "only XXX minutes from the hospital" is always a calculation based on you being in the ambulance with lights and sirens, ready to go.  It doesn't start when it should, which is the time when your attendant first thinks, "oh, @#$%!  we have a problem here!"  It doesn't include the time getting you to the ambulance, loading you up, and strapping you in.  You may be graceful and nimble in everyday life, but in the middle of hard contractions.....you aren't going to be able to get on the gurney as quickly as you would want.  And like Alenushka posted above, you may be delayed because of things like blood typing and assembling the team (it will take longer if they don't notify the hospital they are coming, which has been known to happen.)  Your actual time to the OR could be 30 minutes or more when you are talking about the time from "we have a problem" to the repeat c, in case of rupture.  

LoveIsla didn't have that luxury of time.  Neither did I.

And speaking as a former 911 operator......you can't always count on "the closest" ambulance to be available.  Yes, there may be paramedics just down the street, but you can't guarantee that when you need them that they won't be taking care of someone else having an emergency, like a diabetic crisis or a car accident.  So tack another 3-7 minutes on top of all that to call in the next closest available crew......

What mandib50 posted about calling ahead, etc., sounds pretty and nice, but......that's not realistic.  In case of emergency, otherwise rational people tend to fall apart, especially if they have never seen that kind of thing happen before.  How much experience does that birthing center actually HAVE with rupture, or transports for reasons other than a woman deciding she wants an epidural, anyway?  If they have had one or more, how did it go?  What did they learn from it to improve outcomes the next time it happens?  How close is their working relationship with the hospital (and did you verify what they said with the hospital)?

I know those are a lot of questions, but it's better to ask them now, before the Braxton-Hicks start, right?    

[suchende]

Originally Posted by mandib50 



right, but depending on where you are, you can phone ahead to the OR, you can draw a woman's blood while preparing to transport, start an IV and have her ready to go straight to the OR when she is in the hospital. regardless, it may be in the comfort level of the OP to accept this risk, and i hope she does not feel judged in a negative light for making such a choice.

I understand how my post could have been interpreted as judgmental, but that isn't at all where I was coming from. OP expressed that stories of rupture frightened her, but she also had faith in her center. It seems appropriate to me to ask more questions about how they have treated ruptures in the past, and how much experience they have doing so.

Now, for me, if a center/hospital/midwife/OB told me they had never lost a baby, I would be as much disconcerted as comforted, because not all babies survive birth, so that is an indicator to me of lack of experience rather than competence.

[womenswisdom]

I agree with mandib50. You have to look at the risks of vbac in the big picture. No one is denying that rupture is real and sometimes devastating. However, you must look at that risk in the context of the other risks that exist during labor OR during a repeat cesarean. There is no right answer here, no matter what anyone says. Each woman needs to think about all the different factors and weigh them based on her own values, prior experience, etc. Women who have lost a baby or experienced a rupture are going to have a different analysis than those who have not. Women who have been horribly traumatized by a hospital previously are going to have yet another analysis. No one is right, no one is wrong. IMO, an OOH vbac is a reasonably safe option. At least one of the pp who is posting in opposition to a home vbac is against home birth in any circumstance, so you have to take that background mindset into account as well.

[KoryO]

She's not talking about a HBAC.  The OP is talking about a birth center vs. VBAC friendly hospital.  Anyone's viewpoints on homebirth, in this context, are irrelevant.

[womenswisdom]

Originally Posted by KoryO 

She's not talking about a HBAC.  The OP is talking about a birth center vs. VBAC friendly hospital.  Anyone's viewpoints on homebirth, in this context, are irrelevant.

Out of hospital birth whether at a freestanding birth center or in a home entail the same risks. The equipment and availability of emergency care are the same. The only difference might be the distance from the hospital. I am unaware of any other differences.

[mandib50]

Originally Posted by Alenushka 

Straight to the OR, would occur in the hospital not in the case of the outside transfer.

If the birth center is ran by CNMs then IV could be started but not if it ran by CPMs. Type and Cross takes a while. Getting a doctor takes a while.  Many of the things are done ahead of time just in case is someone is already in the hospital.

2.7 % is not such low number. It means, practically speaking, that 3 out of 100 people.

My sister in law just had lovely natural childbirth in the hospital birth suite.  No one shaved her, restrained her, forced an epidural on her. She has small heplock instead of IV . Nurses encouraged her. Everything from a tub to birth ball was at her disposal.

not sure what the 2.7% rate is referring too ... uterine rupture rates are lower than that, 1.0% is the highest i've seen overall in the research/guidelines. i guess things work differently in the US then as far as transferring, they seem to have run much more smoothly here, but then midwives have hospital privilages. that is too bad.

you can have a lovely natural childbirth in a hospital, yes, but that does not make it a lovely out of hospital birth with a midwife, which is completely different philosophy of care and atmosphere. i don't think it is fair to compare the two experiences and equate them on an equal playing field because their are so many inherent differences.

[mandib50]

Originally Posted by KoryO 

The thing is, being "only XXX minutes from the hospital" is always a calculation based on you being in the ambulance with lights and sirens, ready to go.  It doesn't start when it should, which is the time when your attendant first thinks, "oh, @#$%!  we have a problem here!"  It doesn't include the time getting you to the ambulance, loading you up, and strapping you in.  You may be graceful and nimble in everyday life, but in the middle of hard contractions.....you aren't going to be able to get on the gurney as quickly as you would want.  And like Alenushka posted above, you may be delayed because of things like blood typing and assembling the team (it will take longer if they don't notify the hospital they are coming, which has been known to happen.)  Your actual time to the OR could be 30 minutes or more when you are talking about the time from "we have a problem" to the repeat c, in case of rupture.  

LoveIsla didn't have that luxury of time.  Neither did I.

And speaking as a former 911 operator......you can't always count on "the closest" ambulance to be available.  Yes, there may be paramedics just down the street, but you can't guarantee that when you need them that they won't be taking care of someone else having an emergency, like a diabetic crisis or a car accident.  So tack another 3-7 minutes on top of all that to call in the next closest available crew......

What mandib50 posted about calling ahead, etc., sounds pretty and nice, but......that's not realistic.  In case of emergency, otherwise rational people tend to fall apart, especially if they have never seen that kind of thing happen before.  How much experience does that birthing center actually HAVE with rupture, or transports for reasons other than a woman deciding she wants an epidural, anyway?  If they have had one or more, how did it go?  What did they learn from it to improve outcomes the next time it happens?  How close is their working relationship with the hospital (and did you verify what they said with the hospital)?

I know those are a lot of questions, but it's better to ask them now, before the Braxton-Hicks start, right?    

that is so interesting, the transports i have seen have run much more smoothly than you described, so i guess it just depends on where you live. that being said, i do completely agree that a woman does need to understand that time from a hospital should be a factor, and it is not unwise to ask those questions.

but, breaking down the decision to having a VBAC based soley on time to transfer to a hospital for some women is not the only factor many women make their decision on. bottom line is that VBAC is a safe option for women, and that includes a birth center VBAC.

[KoryO]

Originally Posted by womenswisdom 


Out of hospital birth whether at a freestanding birth center or in a home entail the same risks. The equipment and availability of emergency care are the same. The only difference might be the distance from the hospital. I am unaware of any other differences.

Depends on the birth center.  Some are bare bones, with CPM's.  Others have more equipment and CNM's, who are trained to a much higher standard.  There are also some that are basically hospital annexes.  The OP didn't state what kind of center she was considering.  You can't make any assumptions about a facility strictly on the name "birth center".

[shakyjelly]

I had actually mentioned in a reply that this was a birth center equipped for an emergency. It has the equipment of a level 1 L&D room and a neo-natal ambulance (their words). They are CNMs.

However, to be honest, I'm inclined to step away from this conversation. Obviously, there is still some disagreement in the community about what the facts actually are. Like, for example, where did the 2.7% number come from? I have read 1% or LESS almost everywhere else in my research. 

I will be having a VBAC. I know this for certain. The risks are the same if not higher with a c-section. Where? I'm not sure as of right now. There are a lot of factors (including financial) and I'm going to be doing research on my own. I had hoped for more helpful information here and while I appreciate the input, I am a bit disappointed in the fear mongering that I feel has occurred here. I thought mothering.com was a board for more open minded people. I don't know why my post brought a few of you out of the woodwork (since you only have a few posts each, mostly in this thread), but I regret posting here. 

And also, remember this - you talk about the risks and how they are low, but low does not mean non-existent. Do you not drive a car because of the 1 in 84 risk of getting in a fatal car accident? Or what about the 1 in 38 risk of a fatal hospital infection? (Life time risk #s from http://well.blogs.nytimes.com/2007/10/31/how-scared-should-we-be/). While I will seriously be considering a hospital as well as the birthing center, I realize that I can't just use the risk of rupture as my only reason to make a decision. After the bad hospital experience I had last time around, maybe I don't feel hospitals are the safest place on the planet. People die there too, ya know. They aren't perfect.

Of course I do not want to risk the life of my child (or my own), but I also want to make sure that I'm making the right decision for me and not one based entirely on fear.

[mandib50]

shakyjelly,

i hope you choose to stick around, at least on mothering.com! pick the posts that work for you in this thread and ignore the rest. bad things happen, but they happen in everyday life as you've said. it would be too bad if we made all our decisions based on fear.

good luck! if you need support, feel free to pm me. :)

[boobfairy]

Not to be snarky but bad things happen everywhere even in the hospital with an OR down the hallway.You must make the decision for what is best for you and your family.Do the CNMs deliver at the hospital? Can you hire a doula for labor support and labor at home prior to going to the hospital?Look at your options or combination of options that will work for you!

[shakyjelly]

Originally Posted by boobfairy 

Not to be snarky but bad things happen everywhere even in the hospital with an OR down the hallway.You must make the decision for what is best for you and your family.Do the CNMs deliver at the hospital? Can you hire a doula for labor support and labor at home prior to going to the hospital?Look at your options or combination of options that will work for you!

This was precisely my point, boobfairy. Bad things do happen everywhere. I'm looking into my options. These CNMs do not deliver at the hospital, just birth center & home (non-VBAC). I will be hire a doula if I do go with the hospital rather than the birth center. :) 

[Alenushka]

It is absolutely true that bad things happen in the hospital. But hospital has OR< Blood bank, NICU and teams of people. Should, on rare occasions, things go wrongs, there teams of people to work on mom and baby. Teams who run regular drills.

[rnra]

Originally Posted by shakyjelly 

And also, remember this - you talk about the risks and how they are low, but low does not mean non-existent. Do you not drive a car because of the 1 in 84 risk of getting in a fatal car accident? 

Yes, I still drive a car.  Yes, babies still will be born.  

However, I do everything I can to make my car driving as safe as possible, and I bet you (and the vast majority of posters here) do likewise.  I purchased a car with excellent safety ratings.  I have a government-mandated safety inspection done each year on my car.  I wear a seat belt.  When it is dark or there is low visibility I turn on my headlights.  I went through a driver's education course.  I passed a vision test to ensure I could see well enough to drive.  When my commute takes me through mountainous canyons in the dark, I drive slower to lessen my chance of hitting an animal who is crossing the road.  I don't get in the car with a driver I know has been drinking or is otherwise impaired.  I perform preventative maintenance on my car to lessen the chance of something going wrong while I am driving.  The list could go on and on.

Life is full of uncertainties.  It always will be.  But there are always ways to lessen the chance/severity of an unanticipated event.

[lisa_nc]

It's kind of interesting that so many people registered for MDC just to come and tell horror stories. OP, there are SO many factors to consider. I've had two unmediated hospital births, then a cesarean for breech vertex surrogate twins. I carried another set of surrogate twins and I planned a hospital VBAC with them but mother nature had other ideas and I ended up having baby A in my car on the way to the hospital (no traffic, it was late at night--just happened that quick) and baby B in the ER. They were both over 7 lbs so that was 14+ lbs of baby with no rupture. I then lost my son in the second trimester due to a placental abruption (roughly the same odds, if not less than having a rupture) so I know how it feels to be on the wrong side of a roll of dice. I then had another VBAC to a son at home with a nurse midwife and a birth center VBAC this April, also with CNMs. No rupture.

Yes, this is anecdotal, but so are the scary stories and I figured it might be nice for you to hear an anecdotal positive story to keep things balanced.

Fact is there aren't any guarantees in life. A woman in my community recently died because of a post cesarean infection. Maybe she would have lived if she had had a vaginal birth in a birth center. At the end of the day, no one knows so you have to do your research and make choices that are right for you.

To the point of birth centers...good questions to ask are how they handle transfers. My birth center in NM is run by CNMs and has the head of pediatrics at UNM Hospital on its board of directors. They have a working relationship with nearby hospitals that ensures smooth transfers. They also have a lab and do blood work, so all of that is done if you need to transfer. Yeah, it's not as quick as being in the hospital. But you can weigh your risks of hospital based infections, interventions, etc against that and make an informed decision.

It's great that so many people are willing to share their stories because you do need to weigh the good and the bad on an emotional level. Ruptures are horrible things when they occur. So are cord prolapses and placental abruptions. You can choose to live your pregnancy in fear or do a risk assessment and find a decision you are comfortable with (hospital or birth center). At the end of the day there aren't any guarantees.