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HBAC - THE FACTS & PROOF



I was always told as a child

If you stand for nothing you'll fall for anything. "Malcom X"     

    

According to some midwives and obstetricians, women who've had a previous c-section should not consider a home-birth because the risks outweigh the benefits. But what do home-birth Midwives say about women birthing at home after a c-section?


Why are more home birth midwives speaking volumes of HBAC's when the guidelines say women who've had a previous c-section should avoid having home births and should birth anywhere in the hospital except in the comfort of her own home.


Is there a gap in our knowledge that needs to be addressed and do we need more women and midwives to speak about their experience to bridge the gap, so we can add the missing data to the research already available?


Is fear driving our perception of home births after a previous c-section, or is having a HBAC as dangerous and irresponsible as its been suggested by many professionals?


All these questions need answering and hopefully as time draws on, we can have the answers to them.


Uterine rupture is a real serious subject that many mothers and professionals want to know the answer too. Not only will we break the ice and allow more mothers to have informed choices, we will create a new generation of birthing mothers and birth supporters, who will approach a vaginal birth after c-section differently, confidently and fearlessly. 


The new ACOG Guidelines state:

There can be a risk of uterine rupture and other complications, therefore home birth is contraindicated for all women undergoing TOLAC. ACOG recommends TOLAC and VBAC only be attempted at Level I facilities or higher. This ensures that emergency care is available if the life of the mother or fetus are in jeopardy and an emergency C-section needs to be performed.


When we think about uterine rupture, we know it's a real-life complication that should not be taken lightly. But we also need to look at the information with a balanced approach, and remember under 1% of  VBAC attempts end up as a uterine rupture. As I said earlier, it should not be taken lightly, but now we have room to explore whether a Vaginal birth at home is a safe option. 

Having a HBAC, brings about so many benefits for the mother and baby. such as:


being able to snuggle up in bed straight after you have your baby.

Having a team of midwives attend to you antenatally and during labour that you know but as we know having a hospital birth has some benefits also such as if there were any emergencies, all the medical team and equipment is available instantly.

I interviewed home-birth Midwife, Anna-Lee, who works for one of Londons busiest trusts but wishes to stay anonymous for obvious reasons..


Anna-Lee has been a Home-birth Midwife for over 17 years. She's been around for a very long time, and during the early part of her career, she spent five years working in a busy London maternity, labour ward. She says She's only seen three uterine Ruptures at home while attending an HBAC, but she's seen more uterine Ruptures in the hospital during a c-section birth. In her opinion, when midwives are undertrained, they tend to make poor judgement calls for mums which sometimes has a massive impact on the birth outcome and hospitals are scared of lawsuits if anything goes wrong during a VBAC in hospital but more-so at home.


The first mother had four previous c-sections but had health issues with her scar. Before pregnancy, her scar had fused to her bladder. In the 3rd Trimester, she was experiencing pain in her scar, and during labour which was at home. She was suffering from severe bleeding, not to be mistaken for a bloody mucus plug or show. 

Anna Said the bleeding was different from a show. We could see this was serious and we needed to act fast.


The Midwives, due to their confidence and expertise, rushed the mother to her local hospital where she received an emergency c-section. Mum and baby survived, and the professionals told the mother she had experienced a uterine rupture that was close to a complete uterine rupture.


When we have midwives who are skilled and trained to support women with a prior c-section, we create change. We allow the professional to be birth ready, birth supportive and encourage the mother to feel confident and super empowered.


Being a Midwife means observing, not necessarily touching or interfering. But, what I see is many midwives do the complete opposite. They interfere, disturb the natural processes of birth and on top of that, they make poor, lousy judgement calls for the mothers who then turns a healthy, calm physiological birth into a medical situation involving lots of pain relief and lots of hands-on procedures. That's not to say sometimes we need to be hands-on, but from my research and observations, the professionals destroy birth experiences and then blame it on the mother's body or her lack of control, says Anna. This is why we have mothers feeling like they've failed their body and baby.


Author: Jaleelah Thats completely true. I was a first-time mother, 40 weeks pregnant and fed up like most first time mothers are of pregnancy at this point. I was introduced to the whole bag of interventions and pain medications, and although I got to 10cm dilated, I  couldn't push my baby out, and so I ended up with my first c-section.


Midwife Anna Lee says hospitals run a very tight ship and the midwives are understaffed and overworked, unlike home-birth midwives. Mothers are discouraged to have a VBACs let alone a home-birth, and when you hear from a professional, who mothers tend to trust, that their baby will die or they will have a uterine rupture or their pelvis is not big enough to have a vaginal birth, the fear factor takes over their thought process. It's a natural human response for fear to overpower how we handle situations. So you will then see more mothers, sidestepping having a home-birth, something our parents did for years.


In the NCBI article entitled:  Women’s reasons for, and experiences of, choosing a home-birth following a caesarean section they say-

Inflexible hospital systems and inflexible attitudes around policy and care led some women to seek other options. Women report that achieving a HBAC has benefits for the relationship with their baby. VBAC policies and practices in hospitals need to be flexible to enable women to negotiate the care that they wish to have.


The NCBI article states women should be able to request support whether they want to birth at home, in the hospital or any other place they feel safe to birth. Unfortunately, we see mothers in triage in hospitals or during their VBAC antenatal appointments requesting support with their HBAC at home, and they're told NO, their rights are denied!Their rights are not given to them, and they are left with a birth plan they feel uncomfortable with and that they have no control over.This same incident happened to me, but fortunately, because I'm a birth professional, I stood up and knew my birthrights. I was told no one would support my HBAC. Clearly they did and my 5th baby was a home birth after 2 previous c-sections.


The Midwife in the London teaching hospital even started shouting at me in a room full of mothers and partners. I was disgusted with the level of care and empowerment I received. To sabotage my HBA2C X3, the midwives even wrote in my hospital notes, I'm a high-risk patient, I have Gestational Diabetes, and I've had a severe Haemorrhage in my previous pregnancies. They went as far as writing my children are on a high-risk social services register and I had a previous uterine rupture....


Thank goodness for being a birth professional and being able to read my birth notes and all the other paperwork they left on the side in the cubicle with me. I was taken aback. I couldn't believe they would go to such lengths to stop my VBAC at home. All the things they listed about me and my children were untrue and could have caused a significant issue if I didn't know what I was doing.


Education is our passport to the future,

for tomorrow belongs to the people who prepare for it today

"Malcom X"


We know why hospitals have inflexible policies and attitudes when we delve into the world of VBAC and HBAC, many trusts do not want to be at the receiving end of a lawsuit. And this is why many hospitals, although we are slowly making changes to the policies, and starting to challenge the behaviour projected onto birthing mothers, still have a no VBAC or Home birth ethos.

The NCBI say:

While most health providers’ recognise VBAC as a valid birth choice, it is often discouraged in both overt and covert ways. Health providers express concerns about safety, backup for emergencies and medico-legal risk.


We must understand what's happening here. because fear and confusion about the actual safety of VBACs mothers are discouraged to have a VBAC. I've even heard mothers say "what is a VBAC? I can have a VBAC? I didn't know it was possible?"


Conclusion

Unfortunately, mothers face the brunt of birth professionals and trusts fears. They are told to have a repeat c-section to eliminate the chances of being sued.


Throughout my whole pregnancy I was uncertain about where to give birth. Like many women, I always wanted a home-birth but I believed things would go terribly wrong for a woman who's had two previous caesareans and 4 live births and even more miscarriages. This whole pregnancy I was indecisive about where I was going to birth until I was a doula for a mum In the comfort of her home.


Witnessing a Home birth made me realise, for the first time, birth isn't a strange, medical event it can be beautiful, if you prepare for it. For the very first time in my life I wasn't scared of childbirth or on edge, I realised three things. 


In order for the mother to have a rich, positive birth experience she needs everyone to CO-OPERATE with labour, Everyone needs to be PATIENT... When we leave the birthing mother alone, this means not asking her QUESTIONS or to make big DECISIONS during labour.

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