Thursday, November 14, 2013

Preparing to Share a VBAC Homebirth Journey

Hello second trimester! I’m 14 weeks pregnant this week!

As the reality of a new pregnancy sets in, I can't help but reflect on my only other pregnancy. When I found out that I was pregnant with Jadon, I knew that I wanted a "natural" birth, but I didn't really know all that it would involve. I expected to take my prenatal vitamins, attend a childbirth class, and do my best to refuse pain medications during labor. I dutifully scheduled my doctor visits, watched what I ate, and avoided fumes and other pregnancy no-no's.

Little did I know, my "natural" vision would lead my husband and I to Bradley classes, a Weston Price inspired diet, and midwife interviews! When I was six months pregnant, we hired a midwife in preparation for birthing Jadon at home. At the time, I wasn't sure what people would say in response to our decision, so I wasn't zealous about advertising our home birth preparations. I needed all the positive support I could get, especially being a first time mom-to-be.

Only God knew that our plans would change dramatically during Jadon's labor. Jadon turned breech after my water broke. We discovered his positioning after about four hours of contractions at home. At seven centimeters dilated, I decided that we should transfer to our back-up hospital, where was Jadon born via c-section. Even though it was vastly different than the home birth I planned for, my c-section was a wonderfully positive experience. You can read the entire birth story here.

Shortly after Jadon was born, I remember talking with my midwife about future home birth options. I didn't know if a previous c-section would automatically disqualify me from the "low-risk" status required for home birth candidates. I remember her explaining that I needed adequate time to heal (18 months), and a consulting doctor, in order to pursue a home birth VBAC (Vaginal Birth After C-section). My husband and I resolved to wait 18 months before trying for a second child.

Imagine our surprise when I discovered I was pregnant about a year after my c-section! I was thrilled with the news, but thought, Oh well, I guess we'll have to try for a home birth with our third child! A few days later, and six weeks pregnant, I was a little more down about the prospects of another hospital birth, so I decided to call our midwife, just to see what she had to say.

My spirits revived upon hearing that we needed to wait 18 months between a c-section and the BIRTH, not a c-section and the CONCEPTION of a second child. Jadon and Baby #2 are going to be over 20 months apart, so we made the cutoff! My midwife congratulated me and shared how happy she was to support us in our VBAC journey. We discussed the next steps I needed to take, primarily setting up my first appointments with her and a consulting doctor.

The first appointment with my midwife and her apprentice was like having a reunion party. I was eight weeks pregnant and so happy to see these women again. After talking and catching up on each others' lives, we finally got down to business. We updated my paper work, discussed the financial agreement, and determined the estimated date of delivery (May 14! This just got real!). We also talked about any concerns I had in this pregnancy. My one and only concern centers around the fact that I have been through labor, but never actually pushed a baby out of my body! In this way, my second birth will be like I'm experiencing labor for the first time. We agreed to address my expectations, the mechanics, and the optimal healing process for vaginal birth in the coming months.

In the case of a VBAC, a consulting doctor is required for a Wisconsin licensed midwife to assist with a birth. That way, if any risky complications arise during pregnancy (that rule out home birth as a safe option), you have a medical professional that is familiar with you, your pregnancy, and your wishes. Granted, some doctors are not in favor of home births at all, and would not want to be the "back-up" option. Luckily, I had been keeping my ears open for a "home birth friendly" doctor, and I knew who I wanted to meet with.

Dr. W was recommended to me by two close friends of mine. One of these friends used him as a consulting doctor for her home birth. She reported that he was very accommodating of her home birth plans, and did not pressure her to consider the “safer” hospital option. I wasn’t sure if he would be as flexible with a home birth VBAC, however. I figured that the words “uterine rupture” would come up in the very least. 

But I know the statistics about VBACS. Uterine ruptures occur in 0.07% of ALL births. That number rises to about 0.5% in VBAC births (check out this article for more information on uterine ruptures), and I am considered very low risk for uterine rupture. Furthermore, about 75% of women who attempt a VBAC are successful. Your chances of success increase if you have a low transverse incision, and if your uterus was stitched up with a double layer uterine closure (check, and check!). Furthermore, if you maintain a healthy weight, begin labor naturally, and have a doula, you are more likely to avoid a repeat c-section. All of these factors were true of my first pregnancy and labor, and I plan on keeping it that way this time around. 

You are also more likely to have a successful VBAC if the reason for your c-section is not present in the later pregnancy. You hear that Baby #2? Keep that head DOWN!