VBAC in hospital or birthing center... what would you do?

[sonflawah]

9 months ago I delivered my first via c-section (fetal distress, failure to progress). I wish I knew then what I know now about birth, I'd turn back the hands of time and go to a birth center.

Now, surprise, I'm pregnant! 6 weeks along today. I'm definitely going for VBAC. There are VBAC supportive hospitals and doctors in my area (southern california) so that is an option. But there are also VBAC supportive birth centers in my area. I would be all for a birth center, except that slight possibility of catastrophic rupture scares the #@*! out of me.

So.... just wondering. What would you do if you were in this situation? I sometimes think it's a bit foolish of me to opt for a birth center when the option of hospital vbac is available, especially being that the deliveries will only be 18 months apart.

[alaskanmomma]

I would -personally- VBAC at the hospital, especially with the back-to-back pregnancies. While I trust that my body knows how to birth, that "just in case" factor would be in my mind the whole time at a birth center or home birth, therefore probably adding extra stress onto the situation.

It's something to really look into, maybe a compromise so you have the best of both worlds? Are there any birth centers attached to the hospital for an almost immediate transfer in an emergency situation?

[liberal_chick]

Have you toured the facilities you're looking in to?  I didn't have the option of a birth center birth (for me it was homebirth or hospital), but I found a supportive provider for ds2 (my first VBAC) and thought I was pretty set until I toured the hospital.  It was a nightmare!  They take the baby away from you in the first hour to weigh and measure it and then stick it under a warmer to make sure it can hold body temp for an hour.  They weren't super encouraging of nursing.  And, the big deal for me, after your water breaks you WERE NOT allowed out of the bed. They made you use a bedpan if you needed to pee.  They demanded constant EFM and an IV, so you couldn't get out of bed once hooked up to that stuff either (EFM came off of you to the right, no telemetry, and IV to the left).  All "hospital policy."  So I ran as fast as I could to a homebirth midwife and never looked back.

[CoBabyMaker]

I think looking into hospital policy like the PP suggested would be a big deciding factor.  For me the care provider would make a HUGE difference.  So that would be a something I would look into before deciding.  I had originally planned to go with a hospital  VBAC with DD2 but the doctor (who is the ONLY doc in my area who will do VBACs) was not very supportive and I didn't feel like I would get an honest chance.  It sounds like there may be some great supportive docs or midwives in your area.  That being said, if you are comfortable with it the birth center could be an awesome option.

[stacyann21]

I agree with alaskanmomma. I would choose a hospital with a VBAC supporting provider for this particular situation.

[OceansEve]

My DD2 was born 17 months after my c/s w/ DD1. I went to the only local hospital for VBACs. I looked into the only midwifery I knew of at the time, but they were a good distance from my home, their price was pretty high, and after discussing their transfer numbers I decided to just stick with the hospital. The hospital has the same mumbo jumbo constant monitor, heplock, blah blah another poster mentioned. I agreed to the heplock but told them to bugger off on the rest of it till a friend of mine that was learning to be a doula suggested I take the pain meds since labor was not going anywhere. She told me I was probably so tense and freaked out because my first birth went so wrong that I was not allowing my body to progress. That pretty much locked me in to all the other stuff they wanted to do anyway, but after 24 hours of labor post water breaking I didn't care at that point :p She was born 39 hours after my water broke.

Even if the hospital has "policy" that doesn't mean you have to agree to it. I stayed away from there are long as I could hold out with my last birth, but I used some natural methods to augment labor which was almost as painful as pitocin. I only went in to get the pain meds so I was getting their slew of policy anyway. Lesson learned, I'm not augmenting labor in ANY WAY this time, natural or otherwise!

That doesn't mean you can't do it at a birth center! Rupture is very very scary, but not that common so it depends on your comfort level. If you look into the numbers and feel safe at a birth center, then go for it. If you feel more at ease knowing your bases are covered if things go wrong then go with a hospital! You just have to decide where you feel safest.

[sonflawah]

I was leaning towards birth center yesterday, but the one that does VBACs is a little over an hour away. It looks great online (pictures, reviews, etc) and I still plan on touring it, but I have reservations about it for a few reasons. It is right across the street from a hospital, which is great.... except for the hospital it is right across the street from has a very low VBAC rate and an above average c-section rate so if I get transferred for any other reason besides rupture (transfer rate is 3% at this facility which is great!) I would probably end up with a csection at that hospital as they don't really support VBACs. Another reason I have reservations is the hour distance is in no traffic. There is always traffic in Los Angeles, so it would probably be more like 2-3 hours. :-/

The hospital I am thinking about is a very pro-VBAC hospital, actually Loma Linda University Medical Center which I have seen mentioned on here a few times. The doctors at the facility are all pro-VBAC, and they have a relatively okay csection rate. It's still about an hour away, but much less traffic so it will probably really be an hour. 

Now, what would be perfect is if I could find a midwife who has privileges to deliver at Loma Linda and would could take care of my prenatal care instead of an ob-gyn.... I haven't found one yet.

I'm setting up a tour of the birth center and hospital for next week. That should help me make my decision. If Loma Linda looks half decent which I'm sure it will based on their website, reviews, and what I've heard (a friend of mine VBAC'd there 12 months post-csection), I think I'll go the hospital route.

[waterbirthmama]

I gave birth twice at birth centers in Los Angeles: The Hollywood Birth Center in 2002 (now closed) and The Sanctuary Birth & Family Wellness Center in 2011. While I can't speak to the medical concerns you have as you pursue VBAC, I would encourage you to consider a birth center birth as a first option, which would give you midwifery care throughout your pregnancy. Your chances of having a successful natural VBAC are greatly increased by having nurturing, whole person and whole family care while you are pregnant. Plus midwifery care gives you lengthy prenatal visits and the kind of warm, personal attention I have always missed with a typical OB (my OB visits at the beginning of my pregnancies were 5-7 minutes, never involved asking how I was feeling or what I was eating or anything!) At The Sanctuary they have an OB on staff who is a champion of natural birth for VBAC, twins and even breech babies. I'd say you should definitely at least meet with them to discuss risks and how to assess the safety of you birthing outside a hospital. It's such a huge difference in care, and if you say you wish you'd done it at a birth center last time, you kind of owe it to yourself to explore the option, right? They are in Mar VIsta area - is that near you?

[rnra]

Personally, I'd go to the hospital.  I realize that there is a small chance of things going wrong; but, if they do, I want every resource available immediately for me and my baby.  Even being across the street in a birth center wouldn't be close enough for my personal comfort.

[liberal_chick]

Another factor that pushed me toward homebirth was that, even in an emergency, it'd take 30 minutes for them to be ready to do a c-section.  That's just getting the OR ready, assembling the staff, etc.  I was under 10 minutes away from the hospital so even if I had an emergency at home I could call ahead, get there, and I'd still have to wait on them.  So that's another question for the hospital when you go, "decision to incision."

[rnra]

Originally Posted by liberal_chick 

Another factor that pushed me toward homebirth was that, even in an emergency, it'd take 30 minutes for them to be ready to do a c-section.  That's just getting the OR ready, assembling the staff, etc.  I was under 10 minutes away from the hospital so even if I had an emergency at home I could call ahead, get there, and I'd still have to wait on them.  So that's another question for the hospital when you go, "decision to incision."

This information is not true for all hospitals.  It is true for some--especially smaller, rural hospitals where anesthesiologists and other staff members are not always in-house and need to be called-in.  However, many (I dare say most) hospitals have a much shorter "decision to incision" time for emergency c-sections with patients who are already in the hospital (already being monitored, labs have been drawn, IV in place, etc.).  With patients who are already in the hospital, I have seen many emergency c-sections take place where the baby has been out in under five minutes.  One was timed and it was less than three minutes from decision to baby.   

[sonflawah]

Originally Posted by rnra 

This information is not true for all hospitals.  It is true for some--especially smaller, rural hospitals where anesthesiologists and other staff members are not always in-house and need to be called-in.  However, many (I dare say most) hospitals have a much shorter "decision to incision" time for emergency c-sections with patients who are already in the hospital (already being monitored, labs have been drawn, IV in place, etc.).  With patients who are already in the hospital, I have seen many emergency c-sections take place where the baby has been out in under five minutes.  One was timed and it was less than three minutes from decision to baby.   

Yep, I had my csection in about 10 minutes. If the hospital allows vbacs, there should be certain protocol they follow, like the doctors and anesthesiologists there right away. 

[loveandgarbage]

I might choose the hospital just because it's closer! I had a fast labor with my VBAC and would've hated to be in a car for more than an hour as I transitioned in the car.

[liberal_chick]

Originally Posted by rnra 

This information is not true for all hospitals.  It is true for some--especially smaller, rural hospitals where anesthesiologists and other staff members are not always in-house and need to be called-in.  However, many (I dare say most) hospitals have a much shorter "decision to incision" time for emergency c-sections with patients who are already in the hospital (already being monitored, labs have been drawn, IV in place, etc.).  With patients who are already in the hospital, I have seen many emergency c-sections take place where the baby has been out in under five minutes.  One was timed and it was less than three minutes from decision to baby.   

Right, which is why I said she should ask.  Our hospital is small and rural and, even though they do VBACs, they go against the recommendations to have those people on hand during labor.  So they actually have to call them in, then get everything ready, etc.  I'm sure the OP won't have that problem seeing that the hospital she's looking at is big and well known, but it is worth considering.

[OceansEve]

With my first (a non vbac hospital btw) they attempted a spinal twice and then knocked me out. She was probably out in under 10 minutes, including the time it took to wheel me to the OR, but I honestly wouldn't know I was knocked out because she needed to get out fast. My husband wanted me to add the nurses were still trying to get him dressed and they had already pulled her out, that's how fast it happened.

I know our VBAC hospital has everyone needed in house, it's mandatory for their insurance to cover VBACs. Unless something has changed I was told there is only one insurance company in the US that will cover VBACing hospitals/surgeons/OBs and that on call surgeon is not negotiable. Then again it's been 5 years since I asked, maybe something has changed.

I think it all has more to do with the situation than anything else as to how quicly they can pull their resources.

Edited by OceansEve - 11/13/12 at 2:21pm

[fayebond]

Given the similar time to get to either the birth center or the hospital, in thsi case I'd go birth center.  Mostly because even a very good rate of VBAC at a hospital is NEVER going to be 97% (the number given for birth center births who don't transfer).  97% is a really high success rate, and its clearly close enough to the hospital to fit into the ACOG guideline of 30 minutes to CS.

[rnra]

Originally Posted by fayebond 

Given the similar time to get to either the birth center or the hospital, in thsi case I'd go birth center.  Mostly because even a very good rate of VBAC at a hospital is NEVER going to be 97% (the number given for birth center births who don't transfer).  97% is a really high success rate, and its clearly close enough to the hospital to fit into the ACOG guideline of 30 minutes to CS.

What is the overall rate of success for all attempted birth center VBACs?  A statistic that excludes women who transfer to the hospital seems irrelevant because it is purposely excluding the women who did not have a successful VBAC--thus artificially inflating the birth centers' appearance of success.  It's like having  a bowl with a large quantity of oranges, a large quantity of apples, and a few bananas.  Then someone asks what your percentage of apples is.  So, you remove all the oranges, set them on the counter, and then report that you've had 97% apples all along.  Doesn't make sense.

Also, what happened to the other 3%?  If they don't transfer--how are those 3% delivering?  A birth center cesarean?

Edited by rnra - 11/13/12 at 4:49pm

[sonflawah]

I've spent a few days weighing the pros and cons of each option, and I've decided hospital delivery. I decided against using Loma Linda though and found a better doctor who specializes in VBACs and a better hospital to deliver at. :) Thanks everyone for your input!

Also, you definitely need a csection before 30 minutes if the reason you are being csectioned is because of uterine rupture. A family member was in that situation and the baby was out within a few minutes... they both still almost died.

[moonstones]

I'm a southern California mama too and am attempting a VBAC in January at The Sanctuary Birth Center.  They have a very high success rate for VBACs -- the midwives are supportive, compassionate, and full of wisdom. The birth center itself is really non-intrusive and inviting too.  Is this the center you're considering?  If not, you may want to look into it.  

 I think the choice is really just yours to make personally, and you need to test the water for yourself. When I met with one of the two OBs who does VBACs at the hospital in my area, I knew that it wasn't a match and that I wouldn't be comfortable or supported enough to do a VBAC with him, and so I started searching out alternatives and came across the Sanctuary.  I decided the 40 mile drive would be doable and worth it. Since the risk of rupture is something that worries you, be sure to talk to the midwives about it when you visit.  They should be able to reassure you that the risk for full uterine rupture is statistically so small for women who do not have identifiable risk factors, and they should be able to help you work through these fears too, it's a wonderful thing about midwifery care. These fears are completely normal, and working through them is a part of the care you should receive.  

Good luck, and if you ever want to chat, PM me! 

[roadfamily6now]

I have had hospital VBACs.  I would never choose to birth in hospital again with out a major medical need.

You should investigate BOTH options thoroughly and set up consults with a few OB's as well as the Birth Center Midwives.

You are blessed to HAVE to option to have an out of hospital VBAC. As the Midwives in Alaska are not allowed to attend out of hospital VBACs. :(