The ideal birthplace for the VBAC mother, especially if she feels that the initial cesarean was unnecessary, may be in the home. Fear surrounding vaginal birth after cesarean (VBAC) is related to the high level of medical interventions common within hospital birth, all which increase the risk of uterine rupture and catastrophic outcomes. This fear is sound because medical interventions are exceptionally hard to avoid in the hospital environment. However, it is inappropriate to extrapolate that risk to VBAC women birthing at home.

The incidence of uterine rupture in physiologic birth ranges from 0.1-1.2%. This incidence is no greater than any other sudden obstetric emergency, such as placenta abruption, cord prolapse, and unexplained fetal distress. The Nurse Midwifery team at Believe Midwifery Services, LLC is as equipped, if not more so, than the local remote hospital to handle obstetric emergencies and to date, has a 100% VBAC success rate.

The key might be in appropriate candidate selection, avoidance of interventions such as prostaglandins and pitocin, or the continual presence of doulas and one-on-one care of the Nurse Midwife.

Believe that the universe is friendly and life is on your side.

The American College of Nurse Midwives strongly supports the practice of vaginal birth after cesarean (VBAC) for women who are appropriately selected, counseled and managed. This position is consistent with current research which reports that successful VBAC results in significant benefits and fewer risks for women and infants than repeat cesarean delivery (2000).

ACNM (2000) further states that “midwives are qualified to manage care during pregnancy, labor and birth for women planning a vaginal birth after cesarean if appropriate arrangements for medical consultation and emergency care are in place.”

Repeat Cesareans are Not Necessarily Safer

There is no evidence that a repeat cesarean is safer than VBAC. To the contrary in fact. A plethora of evidence exists regarding the risks of repeat cesarean delivery, including:

• Higher risk of infection, adhesions, intestinal obstruction, chronic pain, ectopic pregnancy and placental problems compared to mothers who have a successful VBAC.
• Increased risk of hemorrhage severe enough to require a blood transfusion due to placental problems from accumulating cesareans.
• Higher likelihood of being re-hospitialized for complications related to the surgery.
• Decreased fertility and increased risk of miscarriage in future pregnancies.
• Greater likelihood of difficulty with mother-infant attachment as well as establishing and continuing breastfeeding.
• Elevated risk for premature delivery and serious neonatal respiratory problems in baby.
  

Mothers who have experiened a high number of cesarean sections might be interested in this study by researchers Cahill, Tuuli, Odibo, Stamilio & Macones, published in BJOG in 2010. Please be aware that a history of multiple cesarean sections increases risk and therefore, additional fees apply to secure availability of both midwives within the birth.

Please give appropriate consideration to the spacing between pregnancies, when planning a vaginal birth after cesarean section. The risk of uterine rupture appears to be inversely related to the length of time between deliveries (the longer the interval between deliveries, the lower the risk of rupture). Women who attempt VBAC who have interdelivery intervals of less than 24 months have a 2-3 fold increased risk of uterine rupture when compared with women who attempt VBAC more than 24 months after their last delivery (ACOG, 2004; Esposito et al, 2000).

Currently more than 800 hospitals in this country will not allow a woman to attempt a vaginal birth after a prior cesarean delivery (VBAC). These bans have cause consumers and experts alike to review hospital policies regarding VBAC. The National Institutes for Health recently organized a conference and convened a panel of experts to discuss the current evidence related to VBAC. The panel drafted a statement based on scientific evidence presented in open forum and on published scientific literature.

Mommy to David Timothy and a triumphant 2HBAC.

Another Successful HBAC!!

(Homebirth After Cesarean Section)

Amazing VBAC mother birthed TEN pound, 13 ounce son, Henry David, in water on January 30, 2011 in her home.

Homebirth is very healing for mothers. This family had a previous cesarean birth and therefore, limited options for achieving a successful vaginal birth. Not only did mom succeed, but she did so with her son born in the sunny side up position (forehead molding rather than crown of the head). Mothers and babies never fail to amaze me.