Can I have a homebirth if I have had a previous caesarean?
Every woman has the right to birth at home, no matter what her previous births have been like. Women with one or more previous caesareans may choose to birth at home in order to ensure a safe birthing environment for herself and her baby and the one-to-one care of a midwife during labour, rather than sharing a midwife on a busy maternity unit. It is well known now that home is just as safe for babies as hospital and is safer for women wishing to avoid unnecessary interventions. Home is the birth place most likely to result in a healthy and happy VBAC (Vaginal Birth After Caesarean) for mum and baby.
If you are considering your birth options after one or more caesareans, you may find that your local hospital runs a VBAC clinic, there may also be a birth choices or VBAC support group facilitated by peer supporters separate from the NHS. There are also many online support resources, such as this Yahoo group.
You may find it helpful to contact the Head of Midwifery at your local maternity unit early in your pregnancy in order to advise her of your birth plans and ask her to assign you supportive midwives.
Many hospitals will ask that women planning VBAC see a consultant. This is optional, however, and many women find that their consultant is not the right person to talk to about planning a normal birth at home, midwives are the experts in this. You would still be able to see a consultant at any point in pregnancy or labour should the need arise.
The main risk that midwives and consultants are concerned about with VBACs is uterine rupture, however, this is a much misunderstood and extremely rare occurrence. The vast majority of uterine ruptures will not result in mortality for mother or baby. Rupture can also occur in an unscarred uterus and can happen before labour begins, which means that it can happen whether you plan a VBAC or an elective caesarean.
A recent study in the UK found that for women with one previous caesarean, the risk of uterine rupture was just 0.2%, of these, 12.4% of babies died – that’s 12.4% of the already small 0.2% risk – so basically, if you plan a VBAC there is a 1 in 4000 chance that your baby could die. This is an extremely small risk.
There are certain situations that increase the risk of uterine rupture: multiple previous caesareans, less than 12 months since the last caesarean and induction or augmentation of labour with syntocinon and other drugs.
Many health care providers feel that the best protection against uterine rupture is for women to birth in hospital with continuous monitoring, however, continuous monitoring has been shown to increase the risk of caesarean without improving outcomes and experienced midwives have found that the first signs of rupture occur in the mother, rather than the baby’s heart rate. Midwife Mary Cronk (OBE) talks about her experiences attending VBACs and monitoring scars here.
A recent NICE Guideline review on Caesarean Section states:
“The GDG agreed that whilst it is right to give women all available information when planning mode of birth, for women planning birth after one previous CS, the important thing to underline is that serious adverse outcomes, including maternal and neonatal mortality, uterine rupture, need for blood transfusion and hysterectomy are very rare, no matter whether planned repeat CS or VBAC is chosen.”
Risk is relative, all births carry some risks. The risk of cord prolapse, which can happen in any birth, is 5%, yet midwives and obstetricians do not warn every pregnant woman of this risk. So why do they warn women planning a VBAC of the risk of uterine rupture, which is so much lower? Of course women need to be aware of all of the risks and benefits associated with their birth choices in order to be able to make a fully informed decision, but if your care provider does decide to emphasise the risks of home VBAC perhaps you could try asking them to also tell you about the risks of repeat caesarean sections, hospital birth, continuous monitoring, and any other interventions that they may recommend?
Ultimately, the risks of VBAC are extremely low, and may be reduced further by birthing at home. Women who achieve their HBACs report feelings of euphoria and empowerment, their birth stories and videos are some of the most powerful ones available on the internet.
Midwifery Today – Home Birth After Caesarean
Midwife Thinking – VBAC: Making a mountain out of a molehill
AIMS Journal – VBAC – On Whose Terms?
Science & Sensibility – Is Elective Repeat Caesarean Surgery Truly Safer Than Planned VBAC?
BirthRights – UK organisation protecting human rights in childbirth
Written by Holly, mum of 2 who planned a home birth after a previous caesarean.