Jan 162013

“I’m supportive of home birth but it still won’t ever be a safe option for you.” – Certified Nurse Midwife to mother at the 6 week postpartum visit for after her second VBAC in the hospital.

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 January 16, 2013  CNM, Midwife, postpartum, VBAC  Add comments

  30 Responses to ““I’m Supportive Of Home Birth, But It Still Won’t Ever be A Safe Option For You.””

  1. I would say it could be safe (depending on the reasons for those sections, medical history, incisions, stitches) but it may never be legal…
    At least, it may never be legal for someone to attend her at home.
    OP, sorry you got this mean comment.

  2. That sounds like a personal opinion to me bc it doesn’t match what evidence I’ve read.

  3. Define “safe” in this context. Safe is a relative term.

    So “safe enough for me to be comfortable with your homebirth” may not be the same as “safe enough for a homebirth midwife to be comfortable with your homebirth.” And it may be that neither of those is equivalent to “safe enough for the birthing mother to be comfortable with a homebirth.”

    But nothing is ever perfectly, totally safe. The question is relative risk and whether the mother is willing to accept that risk.

    • Yep. And define why. For example, home birth probably ISN’T a safe option for me. Since I have had two babies, both delivered vaginally, with both I hemorrhaged, with the second I had a severe blood pressure drop shortly after. I’m just as glad to deliver in the hospital – I don’t consider the risks remotely worth it in my case.

      But then, I’m responding to my experience and the evidence around it…this sentence in isolation, without “…because of X, Y, and Z” gives the mother nothing to go on except their trust in the practitioner and whatever they already know about their own circumstances.

      Not cool, and also not helpful.

      • A friend just had her first homebirth (out of 4) and her first birth with no hemorrhage. While I would never encourage someone to have a home birth they weren’t comfortable with, I don’t think post partum hemorrhage necessarily rules out homebirth with future pregnancies.

  4. Really.
    I have had 2 c-sections, and then I had 2 VBA2Cs. Those were all hospital births, but the next will be at home (hopefully). I have talked to two midwives, both would be willing to attend me. And they both said that the majority of midwives in this area wouldn’t have a problem with it.

    I have a feeling that’s just YOUR opinion.

  5. This is my post! :)
    My first DD was a c-section for breech presentation. 19 months after her birth I had a complication free,12 hour labor and VBAC’d my 2nd DD. then this year I had my second DD- another vbac- easy, complication free 4 hour labor.

    I’m in NJ where UBACs are legal but its illegal for a MW to attend a HBAC. I mentioned to my MW at the 6wk visit that I was bummed I didn’t get the HBAC and she said that. This midwife had 2 homebirths of her own so she IS HB supportivebut said I was still too risky to ever do that- which is nonsense. Research shows my uterus has proven (twice now) that it can handle labor and can fit a baby out of it. My risk factor is the same as any other btdt birthing mom out there now.

    • My 2nd was my C-section, my 3rd and 4th were very quick (stupid unnecessary pitocin!)and I found a supportive midwife and got a homebirth for #5! So far, still legal in Ca.

  6. Where did you get sections, plural? I got that this woman had more than one successful VBAC.

  7. Hmmm. I’ve found 2 different midwives already that would attend my HBA2C. I had 2 sections, and then 2 VBACs so far. And one of those midwives said that it probably wouldn’t be a problem for most of the local midwives.

  8. Can someone explain what “DD” stands for? I see it all the time on here but for the life of me I cannot figure it out!
    I am pretty certain that having more than one VBAC does not increase the risk of rupture. I believe that it stays the same. I also don’t think it has anything to do with what the midwife was talking about. If uterine rupture occurs the safest place to be is in a hospital so you could immediately be taken to the OR. Just bc you have already had 2 successful VBACs doesn’t mean that it can’t happen. Even if you live 2 mins from a hospital it would STILL be too late by the time you got there to save the baby and possibly even your own life.
    I am all for VBACs. Research shows that it is safer than repeat sections. Research also shows that it is safer to have it in the hospital instead of any where else.
    I know I’m going to get the argument that birth is totally safe and natural. And it is. The problem is IF something goes wrong it needs IMMEDIATE attention. Most of the time this does not happen. Things generally go beautifully. But when it goes wrong it goes WRONG. And sometimes that delay on getting adequate medical care can be the difference between life and death.
    I am asking that I do not get attacked for my opinion. It goes against the majority of the posters on this site but it is MINE. Please respect that people can have opinions that go against the majority. Thank you.

    • It’s a common abbreviation in online forums, referring to someone close to you. DD = Dear Daughter, DH = Dear Husband, DS = Dear Son, etc.

    • The problem vbac mothers face in hospitals is that most providers don’t allow them, a lot of providers that claim to allow them are usually secretly looking for any reason to repeat section. It’s so hard to find a truly supportive provider most women are forced to have hbac or at least labor at home practically until push time.

    • I appreciate your recognition that you are expressing an opinion, as opposed to a fact. Im on mobile, can anyone find links demonstrating thg risk factors for vba vs. vba2c, vs primapara etc.? As an l&d nurse i encourage you to read up on this. many moms will appreciate it.

    • Dear Daughter (or darling)see also DS (dear son) DH (dear husband) etc. The risk of rupture must alwasy be wieghed againt the risk of another possibly unnecessary c-section because the doctor/hospital puts you on the clock, tries to induce before your body is ready or otherwise messes up an otherwise normal birth. While I do agree with you up to a point and did attemp VBAC in the hospital twice. I also experienced a window/slow rupture that CAUSED failure to progress and wasn’t diagnosed until they opened me up again. There are lots of situations where things go wrong slowly and stall out because something is wrong. AND the biggest cause of rupture in a VBAC TOL is cytotec which guess what – they don’t give at home! So whether home birth is “safer” depends very much on the policies at the hospitals that would be your other options. Some of them aren’t worth setting foot in.

    • http://www.medscape.com/viewarticle/573948

      Actually, the risk decreases by 50%.

      And as someone who suffered iatrogenic injuries in 4 out of 4 hospital births….

    • You are assuming that being in the hospital means that a patient will get immediate care when it is needed, but in my case that just wasn’t true. My son would have gotten medical care much faster had he been born outside the hospital and then rushed to the ER. Hospitals are great and can save lives when they work as they should, but when they don’t it is like you are stuck on Gilligan’s Island.

    • I’m going to ditto what Carolyn said. There were many times in the hospital when I was left completely alone (they even sent my husband home) or when I would push the emergency call button and not receive help for 45 minutes.

      A homebirth midwife, on the other hand, remains beside the patient the entire time. Early signs of uterine rupture would be caught by the midwife as soon as they began happening, not during sporadic checks by the nurses who are caring for several patients at once, and the midwife could then alert the hospital that they were coming in and to have help ready for an emergency.

      As I’ve said before, if the doctor needs to be paged to the hospital, then you’re not really that much safer at the hospital than at home if your home is about as far away from the hospital as the doctor’s home.

      A woman laboring at home without pain medication is also more likely to feel the sensations of uterine rupture than a woman in a hospital with pain medications. So it seems from an outsider’s perspective that the continuous personal presence of the midwife plus the mother’s ability to monitor her own sensations, plus the fact that the doctor may very well not be in the hospital if an emergency were to happen, means the mother’s safety isn’t that enhanced by laboring in the hospital.

    • A top-level OB hospital is only required to have a decision-to-incision time (the time from when the OB says, “We need to perform a Caesarian immediately.” to the time that the doctor starts cutting the mother) of half an hour.

      This is not to say that some hospitals can’t be faster sometimes, but the required standard of care is half an hour. If you live within a reasonable distance of the hospital, and you are attended by a competent midwife, she’ll be able to call the hospital and tell them to prepare for surgery when she realizes it’s necessary. You’re not necessarily losing any time vs. being in the hospital, where they may not realize the problem right away, and when the nurses realize that there is a problem, they still need to get a doctor to evaluate the problem and decide that surgery is necessary.

  9. Do you vbac moms belong to ICAN (International Cesarean Awareness Network)? It’s website contains lots of scientific, evidence-based information about c-section risks and vbac. So does the website of Childbirth Connection (www.childbirthconnection.org), a birthing-issues think tank that is very well-regarded for its meticulous scientific research and studies. There are numerous studies that have been published recently on vbac after multiple c-sections, the risks to mom and baby of multiple c-sections, the importance of having had a previous vaginal birth, either before or after teh c-section, etc. There is also an excellent website “vbac facts” that you all could check out in doing your research and becoming informed on the relative risks and benefits of each option. Good luck — I hope you have a successful vbac.

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