You may be familiar with the term VBAC, or vaginal birth after cesarean. HBAC stands for home birth after cesarean. It’s essentially a VBAC performed as a home birth.
VBACs and HBACs may be further classified by the number of previous cesarean deliveries. For example, HBA1C refers to a home birth after one cesarean, while HBA2C refers to a home birth after two cesareans.
There are passionate arguments both for and against HBACs.
It’s important to note that the guidelines set by the American College of Obstetricians and Gynecologists recommend that VBACs take place within hospitals. Let’s look at some pros, cons, and other situations to consider as you plan your birth.
Researchers in the United States reported 1,000 HBACs in 2008, increasing from 664 in 2003 and just 656 in 1990. In 2013, that number jumped to 1,338. While still relatively rare, the number of HBACs appears to be increasing each year, which researchers credit to restrictions on VBACs in the hospital setting.
What about success rates? One study examined 1,052 women attempting HBAC. The rate of successful VBAC was 87 percent with a hospital transfer rate of 18 percent. To compare, the study also examined 12,092 women attempting delivery at home without previous cesarean. Their hospital transfer rate was only 7 percent. The most common reason for transfer was failure to progress.
Other research shares that success rates are generally between 60 and 80 percent, with the highest being from people who have already had at least one successful vaginal delivery.
Delivering your baby vaginally instead of via an elective repeat cesarean section means you won’t undergo surgery or experience surgical complications. This may mean a shorter recovery from birth and quicker return to your everyday activities.
Delivering vaginally may also help you avoid risks of multiple cesarean deliveries — placental issues, for example — in future pregnancies, if you choose to have more children.
The perceived benefits of delivering at home are often personal in nature. They may include:
- choice and empowerment
- feeling of control
- lower costs
- attention to religious or cultural practices
- connection to and comfort in the birthing space
And while you may hear negative associations with planned home birth, suggests there’s no increase in infant mortality compared with hospital birth. Moms may even make out better at home, reporting fewer interventions and complications, as well as higher satisfaction with the overall birth experience.
Of course, there are risks with vaginal delivery after cesarean, too. And these risks may be amplified if you choose to deliver your baby at home.
One study revealed that those attempting HBAC risked more blood loss, postpartum infection, uterine rupture, and neonatal intensive care unit admissions compared to home birthing without previous cesarean.
The most serious risk is uterine rupture, which affects some 1 percent of people who attempt VBAC in any setting. While rare, a uterine rupture means the uterus tears open during labor, requiring an emergency cesarean section.
For VBAC mothers, this rupture is usually along the scar line in the uterus from previous surgery. Heavy bleeding, injury and death to baby, and possible hysterectomy are all complications that would need urgent care only available in a hospital.
Chantal Shelstad birthed her third child at home after her first child presented breech and was delivered via cesarean section. She shares, “After my natural birth plans with my first child turned into a cesarean, a rough recovery, and postpartum depression and anxiety, I knew I needed a different birth experience and vowed I’d never do it in a hospital again, if I could avoid it.”
“Fast forward three and a half years, and I was giving birth (VBAC) to our second baby in a natural-birth-friendly center in South Korea, surrounded by midwives, nurses, and a fantastic OB who supported me no matter the presentation of my baby. We would have opted for a home birth if we had been stateside, but the birth center was a fantastic experience.”
When it came to her third child, Shelstad did opt to give birth at home. “Our third and last baby was born in my bedroom, in a birth tub, almost two years after our second,” explains Shelstad.
“When I became pregnant — we knew we wanted a home birth. We interviewed a couple midwives from the area and found one that we clicked with and would support us if our baby was breech. The whole prenatal experience was comfortable and reassuring. Our appointments would be an hour long, where we could chat, discuss plans, and play through different birth scenarios.”
“When it came time for labor, I loved that I didn’t have to leave my home. In fact, my labor was very quick — about two hours of active labor — and my midwife was only there for 20 minutes before my son was born. From the birth tub I was able to go to my own bed to rest and hold my baby, while family gave me food and took care of the other children. Instead of leaving a hospital days later, I stayed inside my home resting and healing. It was amazing.”
Shelstad’s story illustrates some of the criteria that makes a person a good candidate for HBAC.
For example, you may be eligible if:
- you’ve had one or more previous vaginal deliveries
- your incision is low transverse or low vertical
- you’ve had no more than two prior cesarean deliveries
- it’s been 18 months or more after your last cesarean delivery
- there are no issues that might affect vaginal delivery, such as placental issues, presentation, or higher order multiples
- you haven’t previously experienced a uterine rupture
Still, much of the information you’ll find recommends that VBAC should only be attempted in facilities able to handle emergency cesarean delivery. This means that home delivery isn’t generally recommended on the broad scale. Be sure to discuss a hospital transfer plan with your care provider, who can help guide your decision on a case-by-case basis.
Keep in mind that even if you’re a perfect HBAC candidate, transfer to a hospital may be necessary if your labor isn’t advancing, if your baby is in distress, or if you experience bleeding.
“I know HBACs can be scary, but for me, my fear was in going to a hospital,” says Shelstad. “I had more control and comfort at home. I trusted in the process of birth and the expertise of my midwife and birth team, and knew that if an emergency arose, we had a couple hospital plans available to us.”
In the end, the decision over where and how to birth your child is up to you and your healthcare provider. It’s helpful to ask questions and bring up concerns early in your prenatal care so you have the best information available to you to help make your decision.
As your due date approaches, it’s important to stay flexible with your birth plan when it comes to situations that may impact your or your baby’s health.