To homebirth or not

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Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380
To homebirth or not

So... at 16w pregnant and having found an ob would has agreed to deliver me, I am still wondering if this is the right choice for me. So I have the name and number of a local mid-wife who would most likely deliver me if I called her. I really want a totally natural birth experience. I also want a care provider who will have full trust and faith in my abilities. But I also have slight fear of rupture. One of the ladies in our ICAN group did rupture. Her and baby are ok. So... what to do. I am so torn. What would you do.

Just as a side note for those who don't know I am a VBA3C scenario. Smile

jooniper's picture
Joined: 08/27/07
Posts: 780

I'd say, no harm in TALKING to the midwife, right? Discuss your concerns and fears... most midwives will do a free consultation, so you can see if it feels right for you.

krazykat's picture
Joined: 08/11/07
Posts: 1143

Well, from what my MW said, if someone is giving you good care and paying attention they will likely notice the potential for a rupture WAY before it happens.

One thing that made my mind up about it was a presentation I watched that showed that the average time to get staff in place and someone from their hospital room and into a prepped operating room to begin surgery is about 30 minutes. If you are within a 30 minute radius of the hospital, you have the same chances of getting there and started within the same amount of time according to the presentation; assuming that you or your MW call when you are on your way so that they can begin setting things up.

How far are you from a hospital?

If it is a nagging feeling for you to HB, I definitely think you should look into it further. Check the MW out and discuss your fears with her and see how you feel afterwards. A big number of ruptures occur when other interventions are in place. The chance is really so small. And what a lot of people don't know is that even if you are a first-time mom, there is still a chance of rupture.

GL with your decision!

TyrantOfTheWeek's picture
Joined: 12/26/05
Posts: 1147

"jooniper" wrote:

I'd say, no harm in TALKING to the midwife, right? Discuss your concerns and fears... most midwives will do a free consultation, so you can see if it feels right for you.

What she said.

Also, an OB may look good at first, but change their stance as the pregnancy progresses. Like, add more and more restrictions each visit. (How long he will "let" you stay pregnant, how long he will "let" you labor, how long you have to stay strapped on the monitor, etc)

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

"TyrantOfTheWeek" wrote:

What she said.

Also, an OB may look good at first, but change their stance as the pregnancy progresses. Like, add more and more restrictions each visit. (How long he will "let" you stay pregnant, how long he will "let" you labor, how long you have to stay strapped on the monitor, etc)

Right, this is my main fear. I can't legally get a homebirth with a CNM because none of them here would be allowed to deliver me. So, I am essentially stuck with choosing a CPM that is underground. I am actually OK with that part of it. I am afraid of what could happen if I go farther down the road and the doc decides to put restrictions. I talked with these midwives when I was pg earlier this year (when I had my m/c) and they had agreed to deliver me. My only concern is that one of the midwives seemed not too keen on the idea of my vba3c status and the other was totally fine with it.

Ariel - I have 5 min from a hosptial at the most. Smile

Joined: 05/31/06
Posts: 4780

Speaking strictly personally I would not VBA3C at home, but that is just me. You have to do what feels right for you. I'd probably go with the OB and see if I could have the CPM that I liked attend me as a doula, as her advocacy/advice would be important to me.

MrsMangoBabe's picture
Joined: 04/09/07
Posts: 2276

I really can't know what I would do because I'm not a VBA3C. Only you can decide what is best for you, and I know it is tough because there are so many things to consider...good luck with your decision.

Spacers's picture
Joined: 12/29/03
Posts: 4100

I would love to say, "Of course I'd choose homebirth!" because I wholeheartedly believe that's the best place, short of something happening that makes the hospital safer, which includes not having competent caregivers. But... I have to be honest: three uterine surgeries makes me a bit queasy. I would have to have a lot of faith that my last doctor did a bang-up job in putting everything back together, and I would probably spring for an independent ultrasound (i.e. not one that would report any results to my OB) to examine the integrity of my incision if the information wasn't offered at my regular 20-week anomaly scan. I would have to have enough time between births to feel that I healed as well as I possibly could, and I would have to be very close to a good hospital that has a good decision-to-incision rate. But most of all I would have to feel 110% confident in the ability of my chosen caregiver to Angel recognize a problem quickly and (b) deal with it appropriately.

I wouldn't outright dismiss an OB, but I have reservations about both Angel and (b). Many OBs tend to sit at a desk & watch their clients labor via EFM, so their recognition of a problem is when the EFM doesn't look right. A midwife will there with you, listening to you & baby, feeling your belly, talking with you, watching for changes in how you sound or move or breathe, so the recognition of something wrong is likely to happen sooner. And, for too many OBs, their method of dealing with any anomaly is to operate, which would be appropriate in a rupture but not for everything, and as a VBA3C you risk having an OB jump the gun when something like a position change might be more appropriate to try first. You'll need to trust that your OB won't be the "sit & watch, jump the gun" type. I would ask for VBAC references that you can contact, and I'd also Google him to see if any former clients have posted anything about him, good or bad.

I personally have no problem with an unlicensed midwife in a state that doesn't license them; I prefer to think of them as "pre-licensed" since if/when licensing becomes available, most will do it. The problem with pre-licensed midwives is that it might be difficult to know if she has had problems in the past, but if she has good word-of-mouth & no criminal history then she's probably good. Ask her for lots of references, including some where her client transferred or things didn't go well, not just all the happy homebirthers, because IMHO it says a lot when someone who didn't get her homebirth still has good things to say about her midwife! And I would want assurance that I won't be abandoned, that she will accompany me as a doula if I have to transfer. In my perfect world, I'd do dual care so I have the OB on board in case things go wrong, but I have my homebirth assuming things go well.

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

He is the only doctor in the entire town that I know of that would even consider letting me vbac, so my choices are very limited. My son just turned 2 years old so it was more than 18months between pregnancies. I wanted a vbac with my last birth, but couldn't find anyone to do it. Went into preterm labor at 36w and they just sectioned me. Sad I was shaking I was so upset. Sad

I called the midwife. I got a voicemail with no info other than the phone number. She hasn't called me back. Now I am wondering if that really is her number or not. It is so underground here. I didn't even know her last name. I might have to email my midwifery group and ask again for referrals.

JennsDesertCrew's picture
Joined: 09/09/10
Posts: 200

Like a few others said I would talk with the midwife and see how you feel. A good midwife will give you an honest opinion. With the OB is it a practice with others? Is he/she sometimes not on call and if so does the partner(s) agree with the VBAC.

emommyof2's picture
Joined: 09/26/10
Posts: 310

I totally know how you feel hun, while I'm not VBAC I'm concidered the same risk as a VBA2C. I suffered Placenta accreta giving birth to my second child (because the doc thought pulling on the placenta was a good plan) and then ruptured again with my third. I have chosen to do a natural childbirth with a midwife at the hospital. This of course depends on your midwives having hospital privilege, while standard here in Alberta might not be everywhere.

I would suggest looking into having a natural birth in a hospital. Midwives can be great advocates even in a hospital situation and will work with you to get as warm and calm and home like as possible while being in the hospital where if anything should go dramatically wrong you can be cared for instantly. Like you I would love a home birth but the risk is just too great for me (90% chance of rupture) so while its not my ideal I'm doing as close to as possible.

As someone who has ruptured twice now, please it is not something you want to risk, so I totally say get the care that will work best for you but not as risk to your life. With the first rupture from placenta accreta, I bled out in two and a half minutes and it took multiple blood transfusions and weeks in the hospital recovering, I still have very little memories from that time. It almost cost me my ability to have children ( i was being strapped to the OR table to have the hysterectomy when the doc stemmed the bleed) and more importantly my life.

batgirlandrobin's picture
Joined: 11/07/05
Posts: 163

I kinda doubt you'll get a natural birth at a hospital and since you want one so badly....I really strongly urge midwife...you can always transfer and I'd trust a good, experienced midwife over an OBGYN any day! I'd love to see you get a calm, successful birth...and honestly., IMHO you'll only get that at home since you've already had 3 c-sections....

Joined: 12/10/05
Posts: 1681

The point about the decision-to-incision time is really important. I *think* I would consider a homebirth, but only if you are close to the hospital and are confident in your mw assessment skills.

What sort of labor history do you have with your other 3 births?

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

I was induced with my first. Labored for 15 hours. The whole experience was traumatic. Had a c/s at 4 cm dialated because the doctor was impatient.

I had a scheduled c/s with my 2nd. I tried for a vbac, but ended up with pregnancy complications. The doc wasn't willing to do an induction, so I was scheduled for surgery.

I had pre-term labor with my 3rd. Went into labor on my own at 36w. I was given no option by my care provider. Once I came in they decided to just section me.

I blame myself for a lot of it. I wish I had done more research after my 2nd birth to find a providor that would have let me vbac. The problem is that I loved my doctor's office. The staff in his office is totally fabulous. He was really great after my m/c and I am grateful to him for that. I switched to a different doc that I heard would do a vba3c. He seems good so far. He asked if I wanted the first trimester screening. I said no. He said 'eh' it has a high rate of false positive anyway. I loved that. I talked to the homebirth midwife today. She is going to have her partner see if they have any info on my doc. He has a solo practice so I am not 100% sure who backs him up. I should find that out.

HockeyTownMom's picture
Joined: 05/20/02
Posts: 417

Trust your gut. Any fears you're having could hinder the birth process. If you know a homebirth is right for you, but the fears are holding you back, over come the fears by talking with as many midwives (in person or email) about their VBAC experiences.