VBAC in hospital or birthing center... what would you do? - Page 2

[cinderella08]

Rupture is rare, rare, rare - but it *is* a risk.  It never really became 'real' to me until I saw it.  Worst case scenario happened.  Mom was in the OR and baby was out in 3 minutes from the time it happened - literally.  There would have been zero chance for either of them had they been at home.  Is this typical?  Absolutely not.  Again, it's rare, rare, rare - but that risk is there.  So for *me* personally, I choose to VBAC in hospital.

[Floretta]

There are usually signs of rupture before it actually happens, though. An attentive and experienced midwife should be able to read those signs. A friend of mine attempted to VBAC at a birth centre and was transfered due to suspected imminent rupture. She said that her midwife went by her reporting pain in between contractions and the belly looking abnormal during contractions. She had a c-section during which the midwife's diagnosis was confirmed. Her uterus was "paper-thin" around the old scar.

Is there such a thing as a midwife assisted hospital birth in your area?

[cinderella08]

Originally Posted by Floretta 

There are usually signs of rupture before it actually happens, though. An attentive and experienced midwife should be able to read those signs. A friend of mine attempted to VBAC at a birth centre and was transfered due to suspected imminent rupture. She said that her midwife went by her reporting pain in between contractions and the belly looking abnormal during contractions. She had a c-section during which the midwife's diagnosis was confirmed. Her uterus was "paper-thin" around the old scar.

Is there such a thing as a midwife assisted hospital birth in your area?

True, but not always.  In the case I've seen it was immediate.  Everything was 110% FINE and then FHT in the 30's and wouldn't come up - no other signs at all.  No way would it have been detected OOH unless FHT happened to be listened to at that very sec (she had CEFM in the hospital that picked it up immediately).

[azzeps]

The chance that you'd need the hospital at all is small, so I'd go with the birth center that is across the street from the hospital.  It is more likely that you'd need to transfer for non-emergent reasons, so at that point you could choose a different hospital, if the one across the street isn't VBAC friendly. 

Get a doula, especially if you decide the hospital route.  Labor at home as long as possible because you will be more comfortable there. 

I had a homebirth attended by midwives because I did not want to labor as long as possible at home unattended.  I wanted someone monitoring me and the baby, hence the midwives.  Also, I am 5 minutes door to door from a hospital, if the need were to have arisen.

Best of luck with your VBAC.  Look up an ICAN group in your area - lots of support!

[Harmony96]

OP, I'm glad that you have made a decision and are at peace with it.

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.   

My c-section wasn't rupture related, but it was definitely an emergency. I am another mom where it was three minutes from decision until baby was born (and that included the time to wheel me into the OR and a bit of time where I took the anesthesia mask off my face and requested a low transverse incision (which they did) and a double-layer closure (which they did not)). It was general anesthesia and the indication was a complete placental abruption (caused by my waters breaking two and a half weeks prior).

We lost our baby after a month, and wanted to try again soon (since even if he'd lived, we still wouldn't have felt like our family was complete at only three children), but also wanted to have a VBAC. We talked to several OBs about the timing (including the one who actually did the surgery, who told me even in recovery that I should have no problem VBACing) and started trying at just four months after the surgery, and surprise, it only took the one try this time. So that meant just a 13-month interval between the surgery and the next birth. In addition, my uterus had to grow for an additional 15 weeks past the time of when it had been cut.

I saw an OB for my whole pregnancy, and at around 36 weeks, decided to do a homebirth, and also saw my midwife that last month as well. I kept in contact with her throughout the pregnancy, since I kept going back and forth and back and forth. My HBAC did have some complications, but no rupture.

[LambQueen]

Our local birth center (Philly suburbs) does not allow VBACS.  And my home birth midwives in the area won't do VBACs - PA restrictions on their CNM licenses.  So,  I will birth in a hospital with a hospital-based midwife.  I could have opted for a HB midwife who also will deliver in the hospital but I got the feeling that she isn't terribly comfortable there, they don't really know her and I want the entire experience to be as smooth as possible.  In terms of advocating for me, I feel like my hospital-based MW where she delivers there all the time will be better--receieved in this same hospital.

That all being said, they require CFM!  Is this standard in VBACs?  I am pretty bummed about that.  I can deal with no birth tub but they have a shower with unlimited hot water (hopefully...) but if I have that darn belt strapped around me, you think I'll be showering?

It's like, might as well just get the darn epidural , like a kid in the candy store with her hands tied behind her back...

Sort of sad but the psychological element is helpful in that I am happy to be in a hospital for the what-if of uterine rupture...

interesting that one MW said pitocin does  not cause greater instance of uterine rupture in VBAC, while the other (the homebirth based MW) said yes, pitocin can lead to higher instance, which is what my previous HB midwives also said.  Which fact is true?

[CookAMH]

I would use the birth center if I was comfortable with the experience of the midwives.  VBACs are not allowed in WA, so I did a home birth (went great) and am planning another one this fall. I did a lot of research and personal searching when we made our birth decisions and felt a hospital was NOT the supportive place I'd need it to be to achieve a VBAC.

[bmcneal]

Originally Posted by 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.

I'm glad you found a solution that works for you and you are comfortable with. That is what is most important, IMO.

[Calladona]

I too would choose the hospital with my first VBAC.  Now that I'm onto my third VBAC, I'd happily birth in a birth center, IF one was within about 30 minutes of my house and IF they were allowed to have me there.  Unfortunately I live in a state where liability insurance forces VBACs into the hospital (or on very very rare occasion homebirth, but I am not comfortable with that). So, I will have another VBAC in the hospital.  I've done it twice before, it wasn't that bad, I'll do it again.

I have to say, aside from specific set in stone hospital policies (like post birth handling of baby/etc), I'd opt for specific providers first over specific hospitals.  A hospital's VBAC rate/section rate/etc is only a general.  Specific providers have their own rates based upon their own care practices.  In my case, I am opting for a great midwife practice (actually they are a birth center practice, but they do hospital birth for cases like mine) at an OK at best hospital that does have great post-birth procedures in place (well, compared to other hospitals).  I'm comfortable with this, though I'm looking forward to touring the hospital to get a better feel.