If you’ve had a cesarean birth, you might be hoping for a vaginal birth with your next pregnancy.
A cesarean birth is often stressful, especially if it’s unplanned. And for many women, the search for a vaginal birth after a cesarean leads them to the midwifery model of care. Because the midwifery model emphasizes the ability of a woman’s body to give birth without intervention, women whose primary caregiver is a midwife are much less likely to give birth by cesarean.
Depending on the providers available in your area, it might be that a direct-entry home birth midwife is your best option for receiving quality midwifery care.
Is HBAC Right for You?
Generally, home birth is best for low-risk women. But having had a cesarean doesn’t necessarily mean you’re too high-risk for a home birth.
Before you consider this option, learn what the safety guidelines are. If your cesarean delivery was more than 18 months ago and you’ve had no more than two cesareans, it could be safer for you to have a vaginal birth after cesarean (VBAC), according to the American College of Gynecologists. If the reasons why you needed a cesarean the first time aren’t repeated in this pregnancy, then your chances of having a vaginal birth this time are very high.
However, home birth could still pose risks over a vaginal birth in a hospital. The biggest concern is the possibility of uterine rupture, which would require emergency transfer. If your home is a significant distance from the nearest hospital, then a home birth could mean being too far from surgical help if you need it. If you live within 15 miles or less from the closest hospital, then a home birth after cesarean could be the best choice for you.
The Pros of HBAC
One of the biggest advantages of home birth is the ability you have to control your environment and your choices.
Vaginal birth works best when you’re able to relax and listen to your body, which is easier for many women at home than it would be in a hospital. Another advantage is the decreased likelihood of being exposed to germs and possible infections, which you’re more likely to contract in a hospital.
Finally, some hospitals follow protocol in labor and delivery care that makes a vaginal birth less likely. For example, some hospitals routinely use Pitocin to induce or augment labor. Drugs that strengthen contractions can increase your risk of uterine rupture after a cesarean. If you choose a hospital VBAC, discuss the dangers of inducing or augmenting labor with your provider and your labor nurses.
The Cons of HBAC
The biggest danger of a home birth after cesarean is the possibility that you will need surgical assistance and you won’t be able to transfer to a hospital in time.
However, in most cases, a second cesarean delivery would be indicated for reasons like difficulty progressing or difficulty with size of the baby. Problems like this aren’t usually emergencies that require immediate surgery. As long as your home is close enough to transfer in a short amount of time, an HBAC may be an option for you.
How to Safely Have an HBAC
The most important step when planning your HBAC is choosing a qualified provider. Look for a certified professional midwife or certified nurse midwife, and ask about their experience with home births after cesareans. Find out what complications they have the equipment to manage at home, and make sure you understand what would happen if you needed a transfer.
Second, it’s a good idea to have a backup obstetrician in case you do need to transfer. Some direct-entry midwives have a relationship with a doctor who’s on call for their clients if a hospital visit is necessary.
If your midwife doesn’t have a relationship with an obstetrician, you may want to consider getting parallel care. That means you would have both an obstetrician and a home birth midwife as your prenatal providers. You would go to prenatal visits with each provider separately, with the understanding that the doctor would only be attending your birth if you needed to transfer. That way, you would have an existing relationship and prenatal records on file with the hospital if you transferred.
Next, it’s important to prepare physically for your HBAC. Your midwife will discuss prenatal health with you at each visit, and answer your questions about how you can optimize the likelihood that you’ll have a vaginal birth. They may want to monitor your nutrition to make sure you’re eating healthfully and that you’re not at risk for gestational diabetes.
They’ll also probably want to check your baby’s position as you get close to your due date to make sure your baby is in the optimal position for birth. If your baby is breech or posterior, they may recommend trying an external cephalic version. This is a procedure in which your midwife or doctor tries to turn your baby manually.
Your midwife may also recommend you see a chiropractor who’s certified in the Webster technique, which can help turn babies to a more optimal position. They may also recommend that you do exercises to help adjust your baby’s position for birth.
If you’re nervous about giving birth or afraid of having another cesarean delivery, it’s also important to prepare mentally and emotionally for giving birth. Stress hormones can slow down or stop labor, so staying calm and relaxed during labor will help your labor go more smoothly and decrease your risk of a repeat cesarean.
If you are worried about labor, talk to your midwife about what you can do during pregnancy to prepare emotionally for birth. Activities like journaling and art therapy can help you process your emotions about your cesarean delivery, and a VBAC childbirth class can help you feel more prepared for your upcoming birth.
Finally, you’ll need to gather supplies for your HBAC. Your midwife will probably give you a list of supplies to purchase that they personally recommend, or they may have a specific customized birth kit that they want you to buy.
In addition, you’ll need a good supply of old towels for cleaning up mess, some high-energy snacks to eat during labor like protein bars, and something sturdy to protect your bed and furniture like a plastic shower curtain. You’ll also need a list of important phone numbers, including babysitters for your older kids and the numbers of family members to call after the birth. And a good camera for birth pictures!
A home birth after cesarean isn’t the right choice for every woman.
If you felt disempowered or dissatisfied with your previous cesarean delivery, a home birth can help you have much more control over your labor and birth experience. Avoiding the dangers of induced labor can increase the likelihood that you’ll have a vaginal birth. Being at home can help you feel more relaxed and comfortable about your labor.
If the thought of laboring in the hospital again makes you nervous and your pregnancy this time is low-risk, it could be that HBAC is the right choice for you.