Hospital VBAC vs Birthing Center VBAC - Page 3

[suchende]

I don't drive because I am uncomfortable with car accident risks. We live in a major city and use public transportation to mitigate the risk. We haven't moved to the suburbs for the same reason.

That said, I don't think the OP has any reason to fear birth center VBAC at this time. It sounds like she found a high-quality facility. I still believe, however, that information is power. Which is why I encouraged her to ask more questions of the facility. I think the best way to combat fear is with honest, complete, accurate information.

[Simonsez2u]

OP when I was pregnant with my daughter I decided to have a VBAC.  The way I approached my decision on where was by doing just what you are currently doing, researching, reading, and asking questions.  In the end, for me, it came down to what would make me feel most comfortable and what I was able to accept.
 

[sambelina]

Hugs mama! I'm planning a VBAC as well. I am sending you my strongest encouraging vibes. I hope you find peace in your decision soon. It took me several weeks to fully feel comfortable with mine. Take care!

[LoveIsla]

I don't normally like to play the victim, but wow thanks for all the lack of support and sympathy ladies. Just know op, if anything - god forbid - should go wrong, don't expect your story to be taken seriously. I don't post much on baby/pregnancy sites because it is hell for me to even login.
I didn't choose to bare my soul to fear monger or to pass on an "anecdote," I chose to post because I wish I had heard about one negative outcome to open my eyes to the genuine risks before I had made my decision.
Do we all take risks even getting pregnant in the first place? Absolutely. But as the pp stated we do things to mitigate those risks. Would it be a lot more convenient to take my daughter out of her car seat and drive with her on my lap at times? Absolutely. But there's no way I'd ever do it. For what it's worth, I would take a serious infection or injury from a csection over my son's death in a heart beat. And at least if something were to happen to me during a section I would know there was a medical team ready to take care of me. If you want only supportive comments what was the point in posting? I was under the impression you were being smart and trying to weigh your options. Don't be the ostrich I was. Open your eyes to the fact a home vbac is gambling on your baby's safety. I may represent an anecdote but boy does it hurt to have your story dismissed as though your baby's life didn't count.

[lisa_nc]

Love isla, I am truly sorry for your pain. I grieve my son as well and I don't wish to minimize what happened to you. Regardless, anyone's personal stories (including mine) are not objective data, and thus the term anecdotal evidence can be applied. She's not talking about a homebirth VBAC. She's talking about a birth center VBAC with CNMs. I think it's vital to let people know that it's terrible to be a part of the 1% that things don't end well for. There are people behind those numbers. It's horrible and devastating to lose a child and I am sorry for the loss of your daughter. Hopefully the OP will weigh what happened to you along with te positive outcomes, look at research, and come to the decision that is best for her. Respectfully, just because someone weighs their options and comes to a decision that you don't agree with doesn't mean they didn't hear your story. I'm sorry that I came across as minimizing your loss. I know that while it's words on the Internet for us, it's the world you are living and it is all consuming. I'm sorry you have to be there and I wish that things had turned out differently for you and your daughter.

[LoveIsla]

Lisa, sorry you misread my post. My son died, my daughter (csection for breech) is a perfect only child. I apologize for conflating birth center with home, I meant out-of-hospital ie too far away for your "anecdote" to survive a rupture. Just understand what 1 in 200 can "anecdotally" mean even when lined up with 199 successes; an only child with broken parents and a lot of trauma and guilt to live with.

[rnra]

Are there actually any differences (in terms of skill level, emergency equipment availability, response time, outcome of mother/baby) between a freestanding birth center and a home birth?  Aren't they essentially the same in regards to the care that is/can be provided?

By freestanding birth center I mean not one that is directly attached to a hospital (and managed by the same personnel/company as the hospital).

From what I've seen there are no differences (safety wise) between giving birth at a birth center or giving birth at home.  Midwives with various levels of education practice in both environments.  There seems to be a false sense of security surrounding birth centers.  Many women think that a birth center is somehow a mid-way point between a hospital and home; but, in reality they're just home without the chance of staining your mattress or waking the neighbors.

LoveIsla--I'm sorry for your loss.  I appreciate, respect, and admire your efforts to prevent that heartache in other families.  Thank you.

[fayebond]

rnra, I think you are right.  At least, that is what the birth center told me when I went for my first consult.  Its like a bed and breakfast that agrees to host your birth.  The main thing I wanted from it was to be closer to the hospital, and not have to clean up my house enough for people to come over. :) Also, that false sense of security that I really don't need but do very much want.

[krr1]

Isnt the whole point of having a baby and giving birth is to make sure your baby arrives safe and sound no matter what? I guess I just dont understand why anyone in their right mind would put themselves and their "ideal idea" of a birthing plan ahead of their own and their babys health. It doesnt matter if you dont progress and you end up having to use a pit drip or end up having a c-section. At least YOU and YOUR BABY are safe and are able to see your loved ones again.

All of you women so concerned about your birthing experience need to get over yourselves and do whats medically safe for you and your baby. 

Its childbirth, not a vacation!

[sewingmama]

I'm not a VBAC mama, so take my opinion with a grain of salt, but this caught my eye.  I had my first at a birthing center many years ago with CNMs, and then my second with CNMs at home, and some of the concerns I had are similar to yours.  I think you can look at the odds and risks all you want, and honestly, it doesn't matter if the risk is 1% or 10% -- if you and your baby fall into that 1%, it doesn't matter if you're the only one that something's ever happened to.  The reality is that sometimes bad things do happen. 

What I found helpful (aside from prayer and a lot of internal soul-searching, which I do every pregnancy, because each one is different) is to discuss emergency protocols with my providers.  Are your CNMs experienced in doing VBACs?  What can they tell you about how they monitor you and what they'd be watching for?  Aside from "ten minutes from hospital," what is their actual time to get surgery if they call and say it's an emergency?  Those are the kinds of questions I'd want to ask.

On the flip side, what can the hospital offer you?  Are they experienced with VBACs?  Is their emergency c-section time significantly better?  If they're offering you a reasonable chance for drug-free birth, including letting you walk around, maybe that means intermittent monitoring instead of continual -- in that case, I'd be asking if their response time is significantly better.  I think you need to talk to the providers at the hospital too, to see what they can do for you.  You might find yourself more comfortable at the hospital, and you might find yourself more comfortable at the birthing center.

At some point, you can ask all the questions you want, but when it gets down to it, you have to accept that sometimes things do go wrong.  There's no guarantee at either place.  I wish you the best of luck as you find the right place for you.

[TheDivineMrsM]

I can't tell you what to do, but I can tell you what I decided based on my own (extensive) research and with the help of my ICAN chapter. I'm going to a VBAC-freindly hospital with experienced CNMs and hired a doula that does almost entirely VBAC births. There are no birthing centers within 20 miles of my house, and I'm personally not comfortable with a HBAC for a number of reasons. The risks of rupture (or the 726519 other things that can arise during a birth) are tiny... but they're there. If there are complications for myself or my baby, I want them to be able to be handled quickly and safely by experienced staff. If everything goes textbook perfect, my MWs and hospital are well set up for normal birth and encourage delayed cord clamping, immediate skin to skin, BFing support, etc - just like a birthing center would. 

[mandib50]

pookieprincess, i have deleted your post from this thread as it does not facilitate a supportive and welcoming atmosphere for this discussion, as per the Birth and Beyond forum guidelines.

likewise, krr1, i would ask that you remove the last 2 sentences of your post for the same reasons.

as some of you may have not read the Birth and Beyond guidelines, please remember to post accordingly:

To facilitate a supportive and welcoming atmosphere for everyone, we ask that you post with sensitivity and compassion to respect the diversity of birth experiences.

[bfw0729]

You cannot negate the fact that hospitals have a history of causing injury to baby and mom. Even a “vbac-friendly” hospital has red tape and rules by which they need to follow. There are a number of different physicians in a hospital (e.g. hospitalist, anesthesiologist, obstetrician) and one can “trump” the other. I know from personal experience, with a very respected and veteran obstetrician, that he was trumped by another physician in the room because of various reasons. I trusted my obstetrician – he had delivered many twins vaginally and is highly revered by the nurses and physicians on staff. BUT there are limitations and “red tape” in the hospital. Because of a conflict that involved my doctor, he immediately changed his demeanor toward me, and consequently, I ended up with a cesarean birth for the second twin. This resulted in a one week stay in the hospital and with two blood transfusions. Without stating it lightly, my recovery was insane. Even at one-year post-partum, I had recovered to about 80% of my health. I didn’t complain – I knew that I had a lot of work to do to get my health back in order. Because of my blood loss and transfusions, I had issues with breastfeeding. My milk didn’t come in until almost two weeks post-partum. I was so determined to nurse these babies. I didn’t have any other children at the time so I was able to fully focus on nursing and making it a success, which thankfully it was (after six months of pumping and using the supplemental nursing system and essentially nursing 20 of the 24 hours a day). I’m stating all of this because BAD THINGS CAN HAPPEN IN THE HOSPITAL as well!!!  AND create a cascade of other problems such as breast-feeding issues, depression (thank God I didn’t experience this issue), or the inability to have more children (i.e. hysterectomy). These issues can be CAUSED or highly correlated by a doctor’s or nurse’s interference in the birth process. I’m also not negating the fact that issues can arise in the home environment. I don’t really need to touch on that issue because it has been discussed in detail on this thread. Birth is such a charged topic and people will respond based on their own personal experience. Based on my experience, I have developed anxiety about birthing in a hospital setting. I don’t feel safe in that environment. I personally saw what can happen if paths are crossed in a negative manner, which resulted in a change in the course of my birth and health. I can VERY EASILY say that a homebirth would have resulted with a better experience (i.e. my health and both babies birthed vaginally). I had fraternal twins that were in vertex position and maintained great heart tones. I try not to think about that because I believe in God’s will – and part of that was for me to safely birth my third child at home.

As everyone knows, life isn’t black or white (or safe or not safe). There are risks and benefits, especially in large-scale decision-making. I view homebirth as having many benefits and some risks. I view hospital-birth as having some benefits and many risks. I am speaking from my personal experience.

[Lynann]

Originally Posted by krr1 

Isnt the whole point of having a baby and giving birth is to make sure your baby arrives safe and sound no matter what? I guess I just dont understand why anyone in their right mind would put themselves and their "ideal idea" of a birthing plan ahead of their own and their babys health. It doesnt matter if you dont progress and you end up having to use a pit drip or end up having a c-section. At least YOU and YOUR BABY are safe and are able to see your loved ones again.

All of you women so concerned about your birthing experience need to get over yourselves and do whats medically safe for you and your baby. 

Its childbirth, not a vacation!

I'm sorry to say this but krr1 this post is offensive. As a HBAC mama I did NOT view my choice to birth at home as lightly as taking a vacation. For VBACs it DOES matter if you get pushed into a pit drip, as that will increase the risk of complications ( and is contraindicated with a scarred uterus.) Also it is not my only goal to see that my baby arrives safely, but also that I survive the birth. RCS is riskier for the mama than a VBAC. Not all hospitals are VBAC or natural childbirth friendly so comparing your hospital birth to another at a different location doesn't mean much in reality.

I know for me personally it wasn't a decision made primarily about the "Experience." I chose to HBAC because it presented fewer long term risks, especially since I hope to have more children in the future. If I had a choice between a hospital VBAC and a HBAC I may have chosen differently, but I will never know for sure because in the area I live my only choice was RCS at the hospital or HBAC.

To the OP, only you can know what the best choice for you is. Your risk of rupture is only slightly higher than a first time mama, there are other risks in childbirth in general that are higher. If the Birth Center has qualified experienced staff and facilities, which it sounds like it has, then I know I personally would feel very confident birthing there. I hope you are able to find peace in the final decision you make, and are not scared by the unneccesary fear mongering that has been happening.

[kdorrain]

Originally Posted by 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.

I just want to cheer you on.  If you can fight this horribly pessimistic thread with the stats  meant to terrify, you will have your VBAC.  Keeping reading (Thinking Woman's Guide to a Better Birth, Pushed, Ina May Gaskin, etc).  Learn for YOURSELF what the stats are.

Remember, if you have a repeat c-section, you have a 100% chance that your uterus will rupture (under the knife).  At a birth center, you have a 99% chance (or greater) that it won't. Like you, I do not live my life in fear of the 1% risk.  But in US hospitals, there is a 15-30% chance of c-section (depending on your hospital), and probably close to 60% chance of interventions (not counting continuous monitoring or heplock) and probably close to 100% chance of pressure for interventions.  Those are NOT the risks I am prepared to take.

Kristine

[TCMoulton]

Originally Posted by kdorrain 

I just want to cheer you on.  If you can fight this horribly pessimistic thread with the stats  meant to terrify, you will have your VBAC.  Keeping reading (Thinking Woman's Guide to a Better Birth, Pushed, Ina May Gaskin, etc).  Learn for YOURSELF what the stats are.

Remember, if you have a repeat c-section, you have a 100% chance that your uterus will rupture (under the knife).  At a birth center, you have a 99% chance (or greater) that it won't. Like you, I do not live my life in fear of the 1% risk.  But in US hospitals, there is a 15-30% chance of c-section (depending on your hospital), and probably close to 60% chance of interventions (not counting continuous monitoring or heplock) and probably close to 100% chance of pressure for interventions.  Those are NOT the risks I am prepared to take.

So you claim that those who have posted realistic stats are trying to terrify her but look at your second paragraph - pot meet kettle. And calling a c/s a uterine rupture is inaccurate and misleading. No one here has said that a VBAC was an unattainable option but knowing the risks before birthing is a smart approach.

[fayebond]

I find the ongoing discussion of risk about VBAC very interesting.  There are risks in trying for a VBAC, but the medical side of risks are only a fraction greater than the normal risks faced by any pregnant mama.  The caregiver side is where the variation seems so great.  At most birth centers or at home, your risks are limited mostly to the medical side, and for many women who go for an HBAC, the overall results show a lower than average risk for major problems.  But at the hospital, your risks are associated with the stats of whoever is on duty when you show up.  If they happen to be the doc with a 46% CS rate who finds the ACOG guidelines on VBAC restrictive, your odds of having a problem go much higher because that doc will intervene as much as possible (and each intervention ups the risk factor).  

Having a vaginal birth is not about the experience.  Birth is something that a woman's body is fundamentally designed by G_d to do.  Of course its not perfect (other bodily functions go wrong or are made harder for some as well), but its a design feature that, if left largely alone and helped as needed, works very well.  So, yes, a vaginal birth is an easier experience on the mom- not just emotionally but physically as well, and I think its healthier (assuming that the CS is not medically necessary, and arguably a large part of them are not).  I want a health baby and a healthy me, and the healthiest mom and baby combo is when a normal, uncomplicated pregnancy is allowed to come to a normal, uncomplicated birth process with breastfeeding at the end of the day.  Unless you ahve some rare, hard, thing happen, there is no reason not to see this as a normal, uncomplicated pregnancy.  

Also, healthy mom, healthy baby, is the stated goal of every CS.  A healthy woman's body is designed to give birth normally (barring other circumstances).  The only difference is a tiny risk that a) the hospital did technically cause and b) is going to involve more red tape if I want to go back there again.  Why should I submit to things that put my body and my baby at higher risk, so that the doctor can feel safer about litigation?  I won't.  Its my body, my health, and I won't compromise it for someone else's convenience even if that someone is a doctor (who I happen to like and respect, btw).  You can feel differently, and that's your choice, but for me its about picking the most reasonable option.

[upstgeu]

Yup! This....

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.

[Lynann]

Originally Posted by upstgeu 

Yup! This....

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.

I'm so glad you have such a positive outlook in life, and that NOTHING ever goes wrong in a hospital either.

Oh, wait things do go wrong in hospital births too.

The OP has already mentioned several times that the Birth Center has facilities for dealing with complications and very experienced staff. At this point in the discussion your fear mongering doesn't actually help or support the OP.

As for the claim that you know people who have had very nice natural births in the hospital I think that greatly depends on your definition of natural. Do you just mean vaginal birth, or do you mean a birth that was intervention free with spontaneous pushing when the mother was ready, with only occasional monitoring of heart tones and the freedom to move about as much as the mother wanted, AND the ability to eat and drink as desired by the mother too so she can keep up her strength and energy for the work she is doing.

How we birth does matter for some mothers. I know from my own experience that being watched, poked and prodded hindered my already difficult and long labor. Then with my HBAC birth being left alone with just my husband to support me in the privacy of our own home really helped me to stay relaxed enough for the labor to progress quickly and for me to easily push out a heavier, longer baby that had their hand up on their face and their elbow in the way. I'm a very private and modest woman in real life, and so being able to maintain that modesty was an important part of the birth process for me, and something that was impossible in the hospital setting. Had I been in the hospital for my second son's birth I would have ended up in surgery again instead of the very uncomplicated natural vaginal birth I had at home.

But before you start bashing me about home birthing for a VBAC it is important to remember that this post isn't about home birth. The OP is using a Birth Center if she doesn't go to the hospital. I was merely trying to illustrate from my own experience that for some of us WHERE we birth is important and that the hospital doesn't always provide the kind of environment that some birthing mothers require for a natural birth.

[Alenushka]

To me, outcome is more important than some sort of "natural" checklist.  It is that simple. 

No one force my sister in law to do anything in the hospital.

She had tub, balls, bars. Intermittent monitor. No epidural. CNMs  Pushed at will. 10 lbs baby vaginally. She had some stitches.