I had planned a home birth with my first, but ended up with a hospital C-section b/c of what we thought was toxemia. Turns out, my blood pressure never went back down after he was born, so it was simply adult-onset hypertension (genetic from my Dad's family).
Second baby attended by OB in hospital, induced, had fourteen hour labor on Pit and magnesium sulfate (so I was bedridden) with no painkillers (except 5 mg morphine which I couldn't even feel). Tore 7cm in vaginal wall, also other tears, BP plummeted after birth, lost blood & required 4 unit transfusion. It was bad.
I have been informed of a few things by my lay midwife and/ or OB....
1. Toxemia, if it happens, *usually* only happens with first baby and doesn't reoccur with subsequent ones.
2. Diet makes a huge difference (Brewer's). In my case it didn't seem to work because, as we found out later, it wasn't actually toxemia.
3. VBAC is a risk in later deliveries but only if you're induced. If it's a natural labor there is almost zero risk of rupture. Lay midwives in my area are more than willing to undertake VBACs. It's totally normal for them. However, OB's and CNM's would definitely consider VBACs a high risk and you'd probably be precluded from even using a CNM. Also, it seems that although the risk is reduced after a subsequent natural birth, once a VBAC, always a VBAC to the medical community.
4. Lay midwives in my area are also more than willing to undertake a woman who has had toxemia or pre-eclampsia. The key is diet and monitoring your BP for trouble. You can always transfer to an OB if you need to. That's what they're there for - true illnesses!
I am now pregnant with my third (due in August) and am truly conflicted about who will attend the birth. I still have high BP, am scared to go back to the hospital because of the terrible experience last time, but at the same time am losing confidence in my own ability to birth/ safety of birthing at home, for me. Let me say that I am STRONGLY supportive of homebirth in general and believe that it is the safest alternative for most women. If I had had true toxemia you'd better believe I'd have birthed my second at home.