[Bassgirl]

I had originally planned to do a hospital VBAC but got dropped from my local provider. Now I either need to HBAC or drive an hour to VBAC in a hospital.

I am concerned about complications, whether related to VBAC or otherwise and am afraid I will not forgive myself if something goes wrong. Nonetheless, I feel that based on my experience with local obstetricians I am very unlikely to have a successful hospital VBAC.

I should add that my first (and only) C-section was done by doctors I trusted and I do not feel I was pushed into it. They let me labor for 60 hours and only diagnosed failure to progress while I was pushing and the baby's HR was getting too high for comfort. They told me I should have no problem with a VBAC, but for professional reasons they do not deliver babies anymore. Otherwise I'd be with them.

Please tell me how you made your decision and how you came to terms with risk issues.

 

[hikingmommy]

I never considered trying for a hospital VBAC. I used a hospital-run birth center w/ #1 and had a terrible experience with them, ending in what was probably an unnecessary c-section. All I've heard about doctor/hospital VBACs is filled with "trial of labor", limits on when labor must start, augmenting/inducing labor w/ Pitocin, etc. I knew that my chances of having a VBAC were greatly reduced by having it in the hospital. I have a great deal of faith in my midwife and I'm 10 min. from the nearest hospital if we need to transfer. This is my second and last child, and I need to have a natural, vaginal birth. I'm 11 days past my EDD and still waiting, and I've never once doubted my decision. This pregnancy has been so much easier having a laid back, calm, and experienced midwife, v/s the CNMs at the BC I used last time.

 

[wombatclay]

I had a more or less positive hospital birth experience with dd1 despite the c/s at the end (like you, everyone was very respectful, I labored a long time with a great deal of support, no one pushed any interventions, and it turned out dd1 was posterior/asynclitic and there was no way short of a miracle that she would have come out on her own).

I had an amazing hospital VBAC with dd2. I had a husband/wife OB team that was gung-ho pro-birth. They had no standard interventions for vbac mamas and the only hospital vbac interventions were a heplock, checking maternal blood pressure/fetal heart tones with a doppler every 15 minutes during pushing. I had full use of the birth pool, a staff supportive and familiar with alternative birth techniques (I used hypnobabies), and I pushed for 4 hours without anyone getting worried. There were a few complications at the very end that were handled calmly and with a minimum of drama and overall I was very very happy with the pregnancy and birth.

With this pregnancy I planned a homebirth since the OB team no longer attends births and the local hospital is no longer as birth friendly as they were (they changed insurance companies and have had to "toe the ACOG line" in a number of ways as a result). However, as I did more research into the specific complications of my previous births and as I spent more time with the homebirth midwife (only one available in my region) I came to the decision that I was simply not comfortable with a homebirth. Although I do believe homebirth is the safer choice, and a better choice for most women, I am not confident that (given my specific medical history and the resources offered by the one available midwife) that a homebirth was "right" for me/this babe.

My current choice is whether to travel 30-40 minutes to the next closest hospital (allows VBAC and has a decent success rate, attended by hospital midwives who also have a decent success rate) or travelling 3.5 hours to the closest birth center where the vbac success rate is simply amazing and where the midwives follow a true midwifery model of care for vbac clients. It's a tough call. While I know my vbac chances and chances for a happy birth are much better at the birth center, I don't currently see how (with two older children, one with special needs, and a DH who works extremely long days and often weekend hours) I'll be able to travel that sort of distance regularly or during/near labor.

However... the core of your question is how did I decide. I meditated, journaled, used guided dream work, made birth art (using the birthing from within book), used cards and a pendulum to try and access my unconscious emotional reaction to different options, spoke with birth therapists and couselors from groups like Solace and ICAN. I "tried on" different scenarios and tried to judge how I'd feel in different situtations (What would I regret if? What would I do if? What would I feel in five years if?). I used the hypnobabies home study program to prepare and to work through fears left over from previous births. I interviewed dozens of care providers, quized freinds who delivered with different providers and in different settings, visited hospitals and birth centers and midwife office not just once but over and over to see them at different times/different days/different on staff people and get a feel for the atmosphere. I talked a lot... with mamas here on mdc, with members of my ICAN group and LLL group, with women on Solace and the HypnoBabies yahoo group, to myself in the shower.

It can be a tough decision, and every mama brings a different set of experiences and a different set of needs to the party. Every mama deserves to give birth in a location she where she feels safe and with attendants with whom she is emotionally and physically comfortable. And you're the only person who can decide where that location is and who those people are.

Good luck and happy birthing!

 

[writteninkursive]

I would love to have a HBA2C, but like you, I'm a little wary of it being so uncharted for me. I'm having a VBA2C, but laboring at home as long as humanly possible. I have a great midwife and I'm really hopeful that she'll do me well in the hospital, but I don't entirely trust hospitals. My last two births were pretty lame and I know what they're capable of. So I have my doubts about the hospital birth. My theory was that if this VBA2C goes well in the hospital, then our fourth child (if we decide to have a fourth) will be a HBA2C. In the hospital, things get limited and I hate that.
My advice to you is to get a doula immediately! My doula is a wealth of information. She pointed me to the midwife I have currently (I couldn't find any practice that would accept me before), and she also had the information where I could contact a homebirth midwife if I chose to go that route.
What truly keeps me from wanting to birth at home is that a) I don't love my house. It's too small and doesn't feel very homey tome. It's just a house we rent and maybe if I had a house I loved, I'd feel differently. b) My 3-year-old and 18-month-old daughters. I do NOT want to have to listen to them fighting and whining and crying while I'm giving birth! We live near no relatives to just come take them home with them, so anyone watching the kids will be HERE and I don't want to deal with that. c) I want to lounge in the hospital AFTER the birth for a day or two and recover without having household duties to attend to. I enjoy the bonding time of just me and Daddy and baby in the hospital right after birth.

 

[snowmom5]

There are a number of reasons why I prefer the hospital, but naturally these are specific to me and may not apply to others. Basically, it boils down to where I feel safe, since that is where I will be able to relax and be able to labor "better" (if there is such a thing). That's the key thing I'd like you to know. So you need not read this whole long thing since none of it might apply to you. Here are a few of my reasons:

- I like the fetal heartrate monitoring (for the purpose of detecting rupture). I labor laying on my side anyway; I really cannot move once I get to a certain point in labor (well before transition) so wanting to be mobile is not an issue for me. I've had continuous monitoring in all three of my vbacs. In my last one, once active labor started suddenly at home, I was having some sharp pains in the area of the incision - it seemed like some pointy body part of the baby was poking and pressing on it during contractions - and the nature of the sharp pains was really quite scary re: rupture. Fortunately those pains were gone by the time we left for the hospital, but it was scary enough that I was much better able to concentrate on relaxing the appropriate areas of my body once I was hooked up to the monitoring and knew my baby was ok.

- I'm not particularly concerned about the labor process itself, based on my prior labors. My section was for breech, and my three labors have been relatively fast and uncomplicated, and always prior to my due date. I also tend to have a very "favorable" cervix to start with. It's hard to keep in mind that things could go awry for random reasons that I haven't experienced before and haven't prepared for, or simply take longer (the baby in the wrong position, etc.), but I'm confident that if he or she is in the right place, chances are very good that labor and delivery will go smoothly and quickly.

- I have tons of confidence in my OBs. I have had three successful vbacs in two different states, with two different OB groups (three separate docs). I love my OBs - pretty open-minded but also very current on the latest research, etc. (I've had so much experience with strange medical issues in my life and that of my kids that I really count on them to know their stuff and that is really important to how well-cared-for I feel. It's part and parcel of what makes vbac feel safe for me.) One of them is even the child of a midwife and has read Birthing from Within personally, and is simultaneously top-notch medically.

- My hospital experiences have been positive, so there's no real downside to the hospital for me. Baby rooms in. My ped does rounds on her new patients at my hospital. Plus having had so many other kids, the nurses leave me alone. It's not a teaching hospital (unlike my first hospital) so no med students or residents waking me up for rounds before the crack of dawn (however I did have a vbac of twins at a teaching hospital and no one batted an eye - something to consider if you're having trouble finding a vbac-friendly hospital). Carpeted (quiet) postpartum rooms. Room service food from a menu - sounds and looks better than it tastes but I can get it anytime.

- I really need those two days alone with the baby before heading back to the mayhem of what will have become six children, ages 8, 6, 6, 3, 13-months and 0.

- I'm on anticoagulants so planning to deliver anywhere else really is not an option anyway.

My last vbac was unmedicated, a short, very intense labor, and ultimately I ended up with the fetal ejection reflex (which I had only the barest awareness of from reading these boards beforehand). It was the middle of the night, in a quiet, dark room. More recently at least one article I saw on the fetal ejection reflex stressed the importance of the mom feeling safe in order for hormones to bring about that reflex. (that is, if you want to experience it LOL - it was not exactly calm and peaceful from my perspective, even if it appeared so from the outside. I was in such physical shock that I couldn't even hold my baby when the doc offered to put him on my chest immediately after he was born. At least the reflex was mechanically efficient!!)

Having had success three times now, and really really not wanting a section this time because I have five kids at home already besides the new baby (i.e. my primary purpose in vbacing is about the recovery), there's always the fear that some unknown complication will pop up and spoil my plan. I've been surprised with so many things in other medical contexts that it's hard to surprise me but still the weirdest things happen. So, I'm trying to consider as many possibilities as is reasonable for how I think it will go. That has often been an approach I take to the unknown in life - knowledge is power, prepare the best you can. That way if some problem should crop up, I'll know pretty readily what to expect or at least to roll with it, so to speak.

My advice would be to try to figure out what happened with that first labor that was so long. For example, was it just position - then I'd go all out to work on position to the extent possible (spinning babies website, etc.). If it was a lack of dilation, then I'd consider things to softent the cervix (EPO?). If you have a good idea what the issue was, do what you can to address it. The hard part is that sometimes there's only so much you can do, and it's important to know that too. You prepare the best you can and then you have to play the cards you're dealt. Hope they're good cards, and I hope you have a wonderful birth!

 

[Friday13th]

I'm not pregnant yet but am planning on a HBAC when the time comes.

For me it comes down to, I hated being at the hospital both during labor and post-partum and I think with an experienced home birth midwife, I wouldn't have ended up with a section in the first place. (posterior baby, very long labor eventually augmented w/ pit which caused said malpositioned baby so far down into my pelvis there was no way he could turn, baby's heart rate plummeted after AROM during pushing and off we went for csection)

 

[catspage]

I have the same concerns as you and I'm leaning towards VBAC over HBAC.

Reasons being:
1. I am terrified of uterine rupture and I would hate myself if anything happened to my baby. My first pregnancy ended in a miscarriage, so I could never live with myself if I lost another baby.
2. If I give birth at home, my DD (who will be 2 then) will want my constant attention. I cannot deal with taking care of her and being in labor at the same time.
3. If I am home immediately after the birth, I am going to want to take care of cleaning/cooking/etc. I would rather have a nurse take care of me and bring me food than to have to worry about feeding my DH, DD, and myself breakfast, lunch, and dinner.

If, however, something changes with the hospital's policies between now and October, I would definitely do a home birth.

 

[christyc]

For me, the decision was simply whether or not I felt I'd be given a real chance for a VBAC (meaning TRULY supportive provider, freedom to move around, freedom to avoid potentially harmful interventions, freedom to push in different positions and possibly waterbirth). For some women, the answer to that for a hospital may genuinely be positive. For me, it just wasn't an option-- I *knew* that given our local birth culture, there was no way I'd have a real chance at a VBAC in a hospital. I could either be honest with myself about what I was up against, acknowledge that I wasn't *really* trying for a VBAC, and go for a repeat c, or I could opt out of the hospital system altogether. I chose to opt out.

 

[maotmsmi]

.

 

[isabchi]

Quote:

Originally Posted by christyc For me, the decision was simply whether or not I felt I'd be given a real chance for a VBAC (meaning TRULY supportive provider, freedom to move around, freedom to avoid potentially harmful interventions, freedom to push in different positions and possibly waterbirth). For some women, the answer to that for a hospital may genuinely be positive. For me, it just wasn't an option-- I *knew* that given our local birth culture, there was no way I'd have a real chance at a VBAC in a hospital. I could either be honest with myself about what I was up against, acknowledge that I wasn't *really* trying for a VBAC, and go for a repeat c, or I could opt out of the hospital system altogether. I chose to opt out.

 

[Chula13]

Honestly after my awful c-section experience I didn't really trust DR.'s and also the few doc's that actually will attend vbac have awful vbac rates , so I ended with amidwife who has 99% vbac rate.

 

[kltroy]

Like OPs have said, I think it boils down to what you are most comfortable with (and include your DP in this too). For me, I had several excellent nearby hospitals with good VBAC rates to choose from, so travel distance wasn't really a concern. Having never been in labor (c/s was scheduled for breech presentation) I had no idea what labor would be like, but the facilities and expertise available at the hospital gave me peace of mind that if something went wrong there was a good chance everything would come out ok. Plus, I just coudln't get excited about giving birth at home. Let's face it - birth is messy, and I'd rather have someone else clean up the mess! Yes, a trivial detail I know, and easily fixable, but I just couldn't see it working in our 2 bedroom condo with my 2 year old son tearing around. I *leave* the house so that I can relax.

FWIW, my hospital VBAC was really great - completely intervention-free and they followed my birth plan to the letter. It was exactly the birth I was looking for.

 

[AlexisT]

Hospital VBAC, teaching hospital. My decision was based purely on personal risk factors. I am on 2 medications to treat hypertension and had severe preeclampsia in my first pregnancy--this means I have a high chance of recurrence, not to mention the issues with managing my hypertension and meds. While a MW might offer a better labor experience (if I could even find one to take me!), I think OB/MFM is the way to go to manage my pregnancy... and if that doesn't go well, I won't ever get to labor. Plus, while I have an excellent chance at a VBAC if I get to labor (since my CS was not based on in-labor factors and at 38 weeks baby was firmly head down and engaged, a good sign), my higher than average chances of not making it to term (which means automatic CS since I can't be induced) mean I want to know the person cutting me open. I've had one CS with a surgeon I didn't know and whose name I STILL don't know: once was enough.

On top of that I had a significant PPH last time (I saw 2 different figures in my records, both over 1000ml). I've read that hypertension can increase the likelihood of PPH, so I don't feel safe birthing at home. My previous PPH was managed with pit, but I was anemic afterward and felt awful. Just to add to that, I'm O+, DH is AB-, baby #1 needed the bili lights.

 

[lisa_nc]

I had a horrible experience with the medical community and VBACing with my last birth. I was lied to, bullied, coerced, etc. It was so emotionally exhausting, and it was exacerbated because it was a twin pregnancy. I spent so much time learning and preparing myself to argue my case that about halfway through I started thinking a lot about what some other VBACtivists have said--to paraphrase, "you can't go to McDonalds and expect to order a burrito."

That was a surrogacy so I didn't have a lot of choice where I delivered. I got to this point where I said to myself "If this were my child, I would do it this way." And now I am.

I cannot put myself in the position of fighting through another pregnancy. If I have a medical reason to be in the hospital, I absolutely will go in a heartbeat. I'm not anti-hospital. I'm just not signing up unless I have to.

 

[liberal_chick]

Quote:

Originally Posted by christyc For me, the decision was simply whether or not I felt I'd be given a real chance for a VBAC (meaning TRULY supportive provider, freedom to move around, freedom to avoid potentially harmful interventions, freedom to push in different positions and possibly waterbirth). For some women, the answer to that for a hospital may genuinely be positive. For me, it just wasn't an option-- I *knew* that given our local birth culture, there was no way I'd have a real chance at a VBAC in a hospital. I could either be honest with myself about what I was up against, acknowledge that I wasn't *really* trying for a VBAC, and go for a repeat c, or I could opt out of the hospital system altogether. I chose to opt out.

This was me too. I talked to an OB, I toured the hospital, and I came out terrified. I knew there was very little hope of me actually getting a VBAC if I went to the hospital here.

If I needed the hospital, it was only 3 minutes away, and that is how I calmed a lot of my fears. I also made sure that I had a midwife with a plan should something go wrong.

I had a wonderful, empowering HBAC. I'd do it again in a heartbeat.

 

[19spitfire]

I decided when the doctor told me I was not a candidate for a VBAC and had no research to back up his position. I switched doctors. Then the new doctor was great on the first visit and then at consecutive visits she started to pressure me about having a csection. While she never told me I had to have a cs I knew (because at this point I had been researching homebirth) that my chances in the hospital of a cs were much higher than those with a homebirth attended by a quality midwife.

 

[ShwarmaQueen]

I want to have the greatest possible chance at having a successful VBAC, so I'm staying home. I have an experienced, well-referenced MW who believes in my ability to birth. I'll go to the hospital if anything goes wrong.

 

[cairomama]

My c-section was due to breech. It was scheduled and I had no labor. With my second (6 weeks ago), I was in Korea which has an even higher c-section rate than the US and worse VBAC policy so I decided to go back to the US to do an HBAC. Unfortunately, my second baby was breech and I was told at the 20 week ultrasound (in Korea before coming back to the US) that my placenta was low. The homebirth midwife was not comfortable with breech, let alone breech VBAC and she had another VBAC scheduled around my due date so she told me I needed to find someone else. After trying chiropractic since 20 weeks, moxibustion, Spinning Babies, etc. I knew I needed a version. The local hospital community is very conservative and talked me out of a version with my first pregnancy and has horrible VBAC policies so I looked to the nearest big city 2 hours away. There was a birth center which was full and a solo practitioner midwife who delivered at a teaching hospital. He scheduled the version for me at the hospital. It went really well. It was quick and relatively painless (discomfort, not pain) and it worked so I decided to stick with the midwife in that hospital.

I used Hypnobabies and didn't realize I was in labor until I had contractions about 3 minutes apart. It was a 2 hour ride to the hospital, but it wasn't bad at all and I was 8 cm when I showed up. I had continuous EFM, but was able to labor in any position I wanted. 2.5 hours later, my baby was born.

Ask a potential provider what their VBAC restrictions/requirements are and then ask around to local doulas, childbirth educators, other VBAC moms for feedback on the provider before you decide.

You can have a great birth in a hospital if you do your research.

 

[murphysaangel]

I'm VBAC'ing in a hospital for 2 reasons only:

1) I live near a few different hospitals, but I wouldn't go to either one with even a splinter. I'm not comfortable having to go there for a possible emergency. The closest "decent" hospital that I'd consider is about 1/2 hour away.

2) I really, really cannot afford it right now. I'm lucky enough to have insurance that covers nearly 60% of my hb mw's fee, but even then it's not possible. We're struggling as it is.

But honestly? If maybe ONE of these factors changed, I'd do a HBAC immediately. I've chosen the most VBAC-friendly and hands-off hospital that I can find in my area (also over 1/2 hour away) but I'm still terrified of all the interventions, and having to comply with hospital and legal policies like Vit. K and Eye goo on my baby. I transferred from my hb with ds, and laboring at home was amazing. I am really sad I didn't get to birth there as well. My midwife was amazing and it really sucks not to be able to go back with her because I trust her immensely. The new midwife/OB practice that I'm using now, on the other hand, I do not trust. And unfortunately, because I want to birth in this specific hospital, they're my only option at the moment. They're the only ones who take my insurance. If something happens and I can suddenly afford a hb or even a better midwifery practice (there's a great one that births at the same hospital I like), I'll definitely be paying out of pocket for the birth experience I want!

 

[shanniesue2]

Quote:

Originally Posted by murphysaangel I'm VBAC'ing in a hospital for 2 reasons only: 1) I live near a few different hospitals, but I wouldn't go to either one with even a splinter. I'm not comfortable having to go there for a possible emergency. The closest "decent" hospital that I'd consider is about 1/2 hour away. 2) I really, really cannot afford it right now. I'm lucky enough to have insurance that covers nearly 60% of my hb mw's fee, but even then it's not possible. We're struggling as it is. But honestly? If maybe ONE of these factors changed, I'd do a HBAC immediately. I've chosen the most VBAC-friendly and hands-off hospital that I can find in my area (also over 1/2 hour away) but I'm still terrified of all the interventions, and having to comply with hospital and legal policies like Vit. K and Eye goo on my baby. I transferred from my hb with ds, and laboring at home was amazing. I am really sad I didn't get to birth there as well. My midwife was amazing and it really sucks not to be able to go back with her because I trust her immensely. The new midwife/OB practice that I'm using now, on the other hand, I do not trust. And unfortunately, because I want to birth in this specific hospital, they're my only option at the moment. They're the only ones who take my insurance. If something happens and I can suddenly afford a hb or even a better midwifery practice (there's a great one that births at the same hospital I like), I'll definitely be paying out of pocket for the birth experience I want!

It's so hard when insurance gets in the way of making the best decisions for ourselves and our babies. Hugs to you and hoping that you have a successful VBAC.