Planning a homebirth

Awhile ago, I wrote a post called “Choosing a VBAC care provider.” Obviously I am now pregnant and am planning not only a VBAC, but an HBAC (homebirth after cesarean) and am choosing a midwife.

Almost 2 months ago, I received a late comment on that post. It has been sitting in my email inbox since then… I knew I wanted to address it, but wasn’t ready. Here it is:

I am an Ob/Gyn resident and I have delivered 2 of my 3 children naturally with a midwife.  I defiinitely recommend CNMs!  However, I felt compelled when reading this to encourage you to deliver in a hospital setting.  Although the risk of uterine rupture after 1 prior cesarean is low, the results are catastrophic.  I think you can get everything you want out of the birth experience without compromising the safety of your unborn child or your own safety – find a CNM, be open about your hopes, and then remain flexible because labor/delivery is often unpredictable.  Any provider who offers to deliver you at home is not invested in your best interests – a home birth can be amazing, but should be reserved for a very carefully selected patient without risk factors for complications.  A 1% chance of uterine rupture doesn’t sound like much, but what a tragedy that would be for you and your famliy if it happened at home.  Best of luck to you in this wonderful endeavor!

First–I appreciate that the comment was kind and friendly. Most that have a differing opinion on birth, VBACs, midwives, etc. are not so nice. So I read this comment about 5 times. And thought about it for days.

And I came to this conclusion: the part where her comment goes wrong is where it says “I think you can get everything you want out of the birth experience without compromising the safety of your unborn child or your own safety.”

One of the biggest things I struggled with when choosing a homebirth was the question–am I being selfish? Am I putting myself and our baby at risk to get this birth experience?

And the answer is no.

A repeat c-section is more dangerous to both me and the baby. The best thing possible for both of us is a VBAC. Now, you have to understand where I live. My city is birth-backwards. It’s completely birth-unfriendly. We have 3 major hospitals. Only 1 clinic of CNMs/OBs “allows” VBAC patients and there’s a strict time limit put on those patients–labor must start spontaneously by 39 weeks (yes, I have personally spoken with them). Seeing how Ryan came after 41 weeks (9 days late), I can’t even fathom this baby will want to come at 39 weeks. And then what? I’m screwed. Repeat c-section. Yes, there are some CNMs I could see at the hospital, but as a VBAC patient, they are not “allowed” to see me alone. I’d be paired with an OB who would have to present the whole time as well. I might as well just be seeing the OB. I explained it in my previous post:

…even classified as a low-risk birth, I would have a nearly 90% chance of having a repeat cesarean section. That’s just based on the national averages. My city and state are statistically and legislatively more anti-VBAC, anti-homebirth and anti-midwife than most.

I am nearly positive that if I go to a hospital, I will end up with a repeat c-section and most likely an unnecessary one. That is more dangerous for myself and for our baby. Not to mention it will probably land me in the nut house. Labor and birth should not be a fight.

Obviously if it comes down to it, I will not be selfish, and will transfer to a hospital if needed. In that case, it would be a necessary cesarean and that is something I can prepare myself for and be okay with. I read Pam England’s book “Birthing from Within” (AMAZING, empowering book) and she made a great point that I’m going to stick with. She said if you’re feeling any reservations about a homebirth, just make a plan to labor at home. If everything is going well and fine, it will come time to push and a baby will be born. At home. However, if things aren’t going as planned and issues arise, you are free to transfer to the hospital for more assistance.  In most all cases, there is plenty of time and it is not an emergency.

I’ve done my research and I know my stuff. I’m sure there will be more posts throughout this pregnancy with stats and more info for others who are interested in planning a VBAC. You can do it!!!

Have you had a VBAC? A homebirth? Any wonderful words of wisdom?

42 comments to Planning a homebirth

  • Sara

    (Unlike the koi water birth!) this seems like a completely logical and well thought out plan. My only question from a friend perspective is how quickly could you realistically get to a hospital? Where I live now, I could be at a hospital in under 10 minutes. D and I have talked about the fact that when the time comes I totally plan to “labor” at home. Good luck with your plans. Hope everything goes smoothly and you can have a good birthing experience which is best for you and your family!

    [Reply]

    babydickey Reply:

    Thanks Sara! Where we live right now, there’s a hospital a few blocks down the road… sooo about 2 minutes away lol. But we will be moving before this baby comes and being close to a hospital is important. Where I live, with 3 major hospitals, it’d be hard to be far from one… but if we do end up farther than 10-15 minutes, I have other “home”birth options I’d be okay with… my parents’ house, Steve’s parents’ house, etc… one midwife I’m considering actually transfers (if she has to) to a hospital in WI (because it’s more birth friendly) and that’s like 45 minutes away. That just shows that MOST of the time, it’s not an emergency and there is usually plenty of time.

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  • You brave mama! I love it!

    I was supposed to have a VBAC with my 2nd. 39 weeks came along ‘oh you are getting to big let’s c-section you’ and without knowing any better I said ok get him out of here!

    If I had to start all over in the birthing process ~ a homebirth would definitely be something I would research hard. Can’t wait to hear about your experience :)

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    babydickey Reply:

    Thank you!

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  • You’re making the right decision for you and your family. Trust your instincts!

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    babydickey Reply:

    Thanks Christa!

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  • I love that you are pursuing a homebirth! I’m looking forward to hearing more about your plans!

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    babydickey Reply:

    Thank you :)

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  • I haven’t had a VBAC or a home birth (but I was born at home.) I think that you are definitely making the right decision for you and the baby. I know that you’ve done a TON of research and have totally clear, flexible, level-headed expectations. I can’t wait to see how this birth journey ends for you! ♥

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    babydickey Reply:

    Thanks so much, Tamara! I’m excited :)

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  • You are going to rock it. Visualize perfection. Trust your instincts. Don’t listen to the naysayers. You know what is best for you and your family, and you also know what the female body is capable of.

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  • natalie

    I had a vbac and was not given very good odds of a vaginal birth as the prior c-sec was classified as “cephalopelvic disproportion”. I chose to deliver in a hospital… and after 3 days of labor, I pushed in a standing position (how I wanted it) and felt what it was like to have baby come out naturally-not by the knife. I am a big advocate of the woman having a choice of a vbac. The hospital in my little town doesn’t allow them so I drove to the next big town just so I could have one.
    And then we became pregnant w/ our third and planned another vbac. Instead of being a long 3 day event, I reached 8+ cm in just a few hours! However, because of having a scar, I am not a risk taker and asked for internal monitoring of my little girl (a little thing attached to her head in utero to track her heart rate). And it was a good thing I had this precaution (they do not usually do that w/o having some history such as a prior csec). My little girl’s heart rate was dropping to 30 bpm with each contraction. As soon as the contraction was over it would shoot back up to normal. This is not the normal dip that my midwife described. It was dangerous. I labored for the next 45 minutes trying every possible position to try to loosen whatever was pressing against her cord. Then it got really scary and she was born via csec. And I am just as thankful for that c-section as I am for having a hard yet amazing and magical 2nd delivery!
    My point is, if they just had been monitoring the baby’s heartbeat between contractions, they wouldn’t have known of the cord tightening and the blood flow being cut off. This was just a fluke but I am so glad I was right where I was with the monitoring I did have.
    Be careful and I wish you an amazing, successful experience! I love the birthing experience and wish you the best!

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  • kia

    I love your scientifically-trained mind and know you have informed yourself as much as possible with this topic. I had a successful homebirth and in my process focused on everything I could to increase my chances of being healthy enough for the labor. My whole pregnancy was a focus on stats and taking actions to increase the likelihood of a desired outcome. I look forward to cheering you on in this next step of your motherhood journey.

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  • Lisa

    I’ve had 2 home birth VBACs. Not only that, they were also UBAC. And I’m planning a 3rd in January.

    The only advice I have, and this is more based on reading hundreds of birth stories, is don’t give over your responsibility or your decision making, no matter how much you love your care provider. Trust yourself first; don’t let your concerns be brushed off.

    There’s less than a 1% risk of rupture in a VBAC, which means a more than 99% chance it won’t happen. I don’t know about most people, but I’d be thrilled for over 99% odds for anything. And even if it does, there are signs that are often earlier than would show up on fetal monitoring and there’s no law that says if you start at home, you have to stay there.

    Hope you have an awesome birth!

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  • Hands down the best decision. I can’t wait to read your birth story..which will be here before we know it!

    We’ve had 4 homebirths and our #4 was a transfer. H.A.T.E.D. that I had to transfer but THAT is what hospitals are for–emergencies. All went well at the hospital but boy was I glad to redeem birth with #5!

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  • No vbac’s, but I had all 3 of my kiddos at home. My first one was breech, 2nd one… my water broke and then labor didn’t really begin for a day or two, my last one was pretty ‘textbook’. So, my first 2 totally would have been c section had I been in the hospital! Just listen to your body. Your body was made to do this! And truly, if you have any questions along the way, feel free to ask. There are no dumb questions!

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  • You know, if you’ve done all the research (and you have) and it feels like the right decision for you and your family, then it is.

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  • That’s great that you’re planning a homebirth. I delivered my second son in the car on the way to the hospital so I’m definitely thinking a homebirth is the way to go next time :-)

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  • I would love to have a HBAC. I don’t have a very progressive state, but not too backwards either. Although I would love to have an HBAC, I don’t think I will pursue one. First I am 35-40mins from the nearest hospital if I were to need one. Second, my first out of hospital birth experience was difficult and ended in a trip to the hospital with a needed c-section, so I think my hubby would be scared to death if I tried to have an HBAC. Third, it is illegal in my state for a licensed midwife to attend a HBAC. I don’t know if I could find someone I could trust in order to attend my birth.

    I wish you the best of luck! I am jealous :) :)

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  • Maria

    This is antecdotal of course…I had never heard of a person who actually had a rupture. Well there have been at least 3 in my natural birth/other groups. Guess what? No “catastrophic results.” In fact, since they were unmedicated, they were able to recognize that something was wrong and get a necessary c-sec. Mom & baby were fine in all cases.

    This is out of dozens of successful HBACs.

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  • Maria

    Another thing I’ve thought of…I could be at a hospital in 20 mins or so (and I’m less than 5 mins from several fire depts.) If we called on the way I could likely be in an OR just as fast as if I were in the hospital. At most hospitals, even “emergency” (what does that even mean anymore, it’s used as an antonym to scheduled anymore) c-sec won’t get you in the OR in 2 mins.

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  • Heidi

    I have not had a VBAC or a homebirth, but I am fortunate enough to have amazing midwives who deliver at the hospital. My last birth a few months ago was 100% natural. If you even have an inkling you won’t be allowed that, then by all means I think you’re 100% safer at home!! Good for you knowing what’s best for you and your baby!! Best wishes!!!!

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  • Courtney

    I just could never. Reading stories like this: http://hurtbyhomebirth.blogspot.com/

    I know I would never forgive myself. I couldn’t live with myself.

    I pray that yours goes smoothly.

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    Beth Reply:

    Why would you send Emily negative info???? Why???

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    babydickey Reply:

    Courtney, I’ve seen that site. I refuse to ever go back to it again. You can find the same horror stories about hospital births or OBs. The problem is that there are way more GREAT stories out there, but it’s the negative/scary ones that stick in your mind or that get the most attention. I have no fear of a home birth and hope that people don’t try to make me fear one just because of their own fears.

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    Beth Reply:

    :)

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    Leah Ambrose Reply:

    I’ve seen that site as well. I’d rather not take the risk either, but if the birthing experience is so important to you,as it is with many women, I wish you the best with your home birth.

    One question though: how will you know if you need to be transferred to the hospital?

    [Reply]

    babydickey Reply:

    How will I know?? I’ll have trained medical professionals with me. I’m hiring a certified midwife (and a doula). Most often, situations are caught sooner at homebirths because 1) your midwife is with you constantly, whereas an OB barely pops in your hospital room until the baby is coming and 2) because you aren’t on any type of pain meds so you feel everything your body is doing and more frequently are able to FEEL something going wrong much sooner than it’d be seen in a hospital setting. Most transfers are also not emergencies. :) Thank you for the well wishes!

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    Erin Reply:

    I don’t ever comment, but honestly, that is awful! Why would you send her that link? That site is horrendous. If you don’t agree with what she’s doing, then fine. But there was no need to leave that link.

    [Reply]

    babydickey Reply:

    Thank you, Erin :)

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  • I planned an HBAC with my son born in December and I will be planning an HBA2C with our next born. I cannot plan a hospital vba2c in my town and I am confident that a home birth is the safest possible option for myself and my baby. I trust my midwives, especially after seeing how they handled my transport and I have full confidence in their ability to keep myself and my baby safe. A cesarean is much riskier for myself than a planned VBAC. I think the risks of something catastrophic going wrong either way (with a planned RCS or a planned VBA2C) are very low, but I am more comfortable with the risks of an HBA2C than the risks of a 2CBAC. It is not the right choice for everyone, but it is the right choice for me. I am the kind of person who takes responsibility for every decision I make, and the decisions I make WRT to birth are no different.

    The thing about birthing in a hospital–if things go wrong, no one is going to “blame” you. If things go wrong at home, everyone will say “see, that’s why you should have been in the hospital.” Home birth is not for those who are not willing to accept total responsibility for their births IMHO.

    I think it’s great that you are planning the birth that you feel safest with and I have confidence that your birth will be a safe and healthy experience for you and baby.

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  • Melek

    Also, on Natalie’s comment….I’m so glad you and baby were safe. But just so we are clear, midwives monitor the heart rate during contractions as well. No, it’s not continuous, but it’s just not “between contractions” as you said. And opting to not have CFM really doesn’t have anything to do with being a risk taker.

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    babydickey Reply:

    Thanks for clarifying. And I’d say that HAVING a CFM is being a risk taker 😉 I wouldn’t want one!

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  • Beth

    I think it is fantastic that you are comfortable with your choice, Emily. There is no way you are going to change your mind and this is best for you. So people out there, glad you are backing Emily. She needs to hear allll the positive!!! :) :) This is going to be a wonderful birth for you, Emily! :) Can’t wait…..I’ll be lurking in the next room! lol

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  • Beth

    I agree with “summer…” Visualize perfection! Love that!

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  • THANK YOU!! For all the supportive and wonderful comments, it is much appreciated :)

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  • swennam

    Emily, I’m so glad you have now had a VBAC and you both are doing well! A VBAC that goes well is best for both in retrospect! The only reason I am going to mention the following is because I know you are an ICAN leader so I think you should have proper info. I know it is common in the NCB to believe VBAC is always best for mom and baby, even if presented with other info, but I still thought I’d try because really both RCS and VBAC can be great options, depending on the person. VBAC is GREAT for many moms, but not everyone. RCS is statistically more dangerous for mom and future pregnancies. But VBAC is statistically more dangerous, in terms of mortality, for baby. I think it is unfair to only give women part of the truth. It doesn’t mean that VBAC is a bad choice or always bad for baby, but that STATISTICALLY, there is a greater risk of death for baby. Please see the following links. I am glad you promote VBAC, but the whole truth is that RCS has it’s benefits, too, so it really depends on the person, the baby and the situation. I hope you will consider and I hope you don’t mind my sharing! Thanks! Here are two links:

    http://consensus.nih.gov/2010/vbacstatement.htm

    http://givingbirthwithconfidence.org/2-2/a-womans-guide-to-vbac/weighing-the-pros-and-cons/

    [Reply]

    babydickey Reply:

    Thanks, I appreciate the info. As a mother preparing for birth – and as an ICAN leader – I know all the facts and stats. I completely agree that not everyone is a candidate for VBAC and it depends fully on the person and their very specific and unique case.

    “The real question for a woman contemplating VBAC is, “What are the odds that my baby might die if I attempt VBAC?” When looked at from this perspective, the risk of fetal death among the 13,115 women attempting VBAC was 0.038 percent (5/13,115). Thus the risk of a baby dying in association with VBAC was 12 times lower than the risk of a baby dying from non-rupture-related causes. No amount of medical intervention can reduce the fetal mortality rate to zero; death will always be a part of birth. Using the very rare risk of fetal death to convince more women to undergo unnecessary surgery still cannot guarantee the parents a live baby.” from: http://www.ican-online.org/vbac/fighting-vbac-lash-critiquing-current-research

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  • swennam

    Thanks! Yes, I was pretty sure that you, personally, knew all of the facts, I’m just addressing that is common in the NCB to hear ‘vbac is safer for mom and baby’ when really that would be like others saying ‘vbac is dangerous because there is a higher statistic of the baby dying’. Both are only part of the truth. But vbac is safer for most, in hindsight, so I definitely agree that it should be supported! I just worry for the percentage of women that aren’t the best candidates but become convinced that there are because they only hear part of the truth. It could still turn out okay, as can anything, but there is more risk for some and they may not then be aware of it. Take care!

    Probably not the best time to bring this up with you! I found out about you through the NgM FB page and I’ve been reading your blog.

    That link is pretty old, though. I’ll have to see if it has been updated or if it is still the information that is used for the NIH VBAC statement. Certainly none of us ever know it all, but thankfully, the science and research behind some of this will continue to increase and it can be made even better and more available.

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  • swennam

    *sorry that ‘take care’ ended up in the middle instead of the end! criminy!

    [Reply]

  • – I shot this before he had guitar techs to clean his guitars for him. Actyllau, Flame was not as clean as it may seem. This was shot seconds after the other shots you refer to, so they are all the same cleaning. -JG

    [Reply]

  • Tá. O filme do Al Gore é de 2006. E se vocês estão se referindo ao Oscar, vocês deveriam saber que Oscar de documentário é assim: ganha o mais popular. Ganhou o Oscar por que é mais famoso. E em 2004 teve um pequeno filme chamado O Dia Depois do Amanhã que falava as mesmas coisas, de forma mais interessante, sem ser uma vídeo-palestra.Viu, se forem esse os argumentos, não é o no ano passado.Sério, gente, não precisa de agressividade. Eu tive uma dúvida, porque não está claro no texto. Eu realmente não entendo nada de meio ambiente.

    [Reply]

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