VBAC Mamas! Which is better - homebirth or hospital birth?
To be honest, I had an elective c-section. I was just worried about giving birth, and I was going through a lot of stress in my life. My doc didn't bother to tell me all the complications that can happen with c-sections. He just said that once I had a c-section, I'd have to get sectioned with all subsequent babies.
50% is higher than the mortality rate I was quoted for rupture. I personally would prefer not to take that risk, but I think it's substantially less than that.
A great deal of my concern is situational--specifically, in some areas, things are such that the midwives who will do HBAC are the ones willing to push the envelope, which brings up a whole host of other issues.
From a safety perspective, if you have a hospital that does VBACs regularly, you are safest there. The argument against is that hospitals typically demand things such as EFM and IV access. With good providers, however, the success rate is close to that of home.
I regularly see things phrased as absolute "bests"--they aren't--they're ranking of priorities and risk-benefit analyses. I wound up with an RCS (my choice) but I preferentially ranked low intervention below safety. (In fact, I passed on the hospital with the highest VBAC rate for other reasons, although my personal choice was complicated by additional risk factors in my pregnancy which also effectively ruled out an HBAC. A midwife who would consider me for home birth is probably a midwife you don't want to use.)
I don't have a source so large grain of salt--but the figure I had was 1/5 and I recall that safety improved in larger units (I believe this study was NHS, which ranks "large" units as over 3000 a year. Caution should be applied using that exact cutoff though, given different organization of maternity units in the 2 countries--being clear as mud no doubt).
Study results have varied a little on exact rupture rates--if we limit it to spontaneous, unaugmented labor, the rate of rupture drops below 1%, often quoted as 0.5%. The risk of rupture on an unscarred uterus is substantially lower than that, in order of 0.01%.
The gamble is on an event with a small likelihood of occurrence, but fairly large chance of negative outcome IF it occurs. You have to decide for yourself how you prioritize different risks and benefits. Depending on one's hospital choices, the difference in VBAC chances may be small. It can be difficult to predict personal odds from large groups.
That's exactly what you would expect, though: between 1 in 100 and 1 in 200 women will rupture. (And since these aren't predictable, you could probably attend several hundred VBACs with no sign of rupture; and someone else has managed to get 2 in a short time span. Statistical flukes not changes in practice.)
As an aside, an extremely low transfer rate can be worrying, just as a very high transfer rate is.
I originally was going to go with a hospital, but in the end, decided to stay home, and am glad I did. There were some minor complications with the birth which likely would have netted me another c-section if I were in the hospital.
I think the 2 main things to consider are how comfortable you will feel at home vs the hospital. I knew I wouldn't be able to relax and properly birth a baby in the hospital after my first rotten experience in the hospital but that is not the case for everyone. Lots of people are scared to stay home and feel more comfortable in the hospital. The second thing is where are you going to have the most vbac supportive provider? good luck with your decision.
I could have never achieved my vbac at a hospital. The freedom of no EFM or IV and using the birth were paramount in my success. On top of that, I pushed for 5 hours, something that never would have been allowed in the hospital. My dd was big, 9lb, 9oz, and I hemorrhaged after she was born. We made the appropriate decision and transferred to the hospital (only 10min away), no transfusion needed though. I am a massage therapist that specializes in scar tissue, and in my opinion, a scar that has had plenty of time to heal is no more at risk than an unscarred uterus. No one realizes that unscarred uteruses rupture as well and they are usually much more catastrophic than an already scarred uterus.
None of these things are true. You may have an opinion as an LMT, but we have hard data.
Healed scars still rupture at a higher rate than unscarred uteri and the healing time has been studied, which is why they advise 18 months between deliveries. Secondly, doctors DO realize that unscarred uteri may rupture. It's just rare. I haven't got the numbers off the top of my head, but there is a baseline rate of rupture and it is usually included in the literature.
Oh, in fact, I cited it upthread. 0.01% rate of rupture in an unscarred uterus. That's not "no one realizes."