"Once a Cesarean section (C-section), always a C-section."

That’s what many doctors tell women who had a previous C-section, as they believe the risks are “too high” to have a vaginal birth.

Does it mean Anna, who gave birth to Jere, our firstborn, via a C-section, has no other option but another C-section? No!

In this blog, we discuss why we opted for a Vaginal Birth After Cesarean Delivery (VBAC) at home for our current pregnancy despite the risks.

A Quick History Lesson of Our First Birth

Anna was considered low-risk throughout her previous pregnancy, which was with Jere.

On November 16, 2021, Anna began experiencing contractions, so we went to the hospital.

Upon arrival, Anna was checked and confirmed to be 4 cm dilated, indicating active labour.

We were given a labour room, but after about nine hours, we were told to leave because Anna had “failed to progress.”

We had to choose between going to the antenatal room and leaving the hospital. We decided to stay.

A few hours later, a new midwife started her shift and put Anna on continuous monitoring.

Jere’s heart rate dropped during a contraction, prompting the midwife to press the emergency button.

About 10 doctors rushed in and found Anna to be 8 cm dilated, which meant she shouldn’t have been in the antenatal room.

The situation quickly escalated, with doctors recommending a Cesarean due to Jere’s heart rate dropping during contractions.

The doctors challenged us and argued amongst themselves, creating an intense atmosphere.

We attempted to challenge the doctors’ recommendation. But because Jere’s heart rate was recovering each time, we ended up agreeing to the C-section.

After the procedure, we asked if Jere was okay, and we were told he wasn’t distressed.

A Look at Cesarean Birth

A C-section is a surgical procedure to deliver a baby through incisions in the abdomen and uterus, often used when vaginal birth is unsafe.

The procedure is common, with about 31% of UK and 32% of US births being C-sections.

While it can save lives and prevent certain complications, it carries potential risks, such as infections, excessive bleeding, and longer recovery times for mothers. Babies born via C-section may face breathing problems and developmental issues.

Given the associated risks, opting for a C-section, whether necessary or not, gives expecting parents a significant decision to make.

Continue reading here to learn more about C-section, and its pros and cons.

Vaginal Birth at Home After a Previous Cesarean Delivery

"Do not put yourself or your baby in an unnecessary, dangerous position by opting for a C-section when you don’t need one," said OB-GYN Rebecca Starck, MD.

As Anna prepares to give birth to our second child, we find comfort that a Cesarean delivery isn't our only option.

Women like Anna, who had a prior Cesarean delivery, can have a VBAC.

In our case, we're opting to have a VBAC at home, which we believe is the safest environment for Anna to give birth.

Benefits of VBAC at Home

Increased Maternal Satisfaction and Empowerment

In the UK, pregnant women have to be 4 cm dilated to be admitted into the labour ward. Otherwise, the hospital will likely advise them to go home.

Imagine the stress of having to go to the hospital thinking you're going into labour, then being told to go back home!

As we continued to educate ourselves about VBAC at home, we figured the hospital environment was quite counterproductive.

The pressure to progress quickly during labour doesn’t only come from hospital staff. In cases where there’s a limited number of beds in a hospital, a pregnant woman may feel the pressure to rush herself thinking someone else needs the bed and medical attention more than her.

Being pressured to be dilated at a certain point can reduce a pregnant woman's levels of oxytocin, which is crucial for initiating and maintaining uterine contractions during labour. This hormone helps dilate the cervix and facilitate the baby's passage through the birth canal.

Dim lighting and pleasant smells like lavender also help increase oxytocin levels. These things are less likely to be possible in hospitals.

Eliminating the unnecessary pressure from a hospital setting, we believe a VBAC at home allows the natural birth process to occur.

Don't get us wrong–– we're not trying to counteract how hospitals work. But we'd like to be in control of how Anna's labour progresses and how she gives birth to our child, especially since she has a low-risk pregnancy.

Women who achieve a successful VBAC at home often report feelings of pride, empowerment, and a more positive birth experience compared to a Cesarean delivery.

Personalised Care

At the hospital, pregnant women receive care from various healthcare professionals, with one team supporting pregnancy and another handling the birth. This is the case if you choose to give birth in a labour ward, making the process feel more procedural and less personal.

When Anna gave birth to Jere, we encountered different midwives for each stage of her labour.

We understand hospitals are short-staffed and are driven by whatever formula works for them. Still, that experience was exhausting for us, as it felt like the midwives helping us deliver Jere didn't have enough time to get to know us and our preferences.

We benefit from the midwifery continuity of care model with a VBAC at home. The same team of midwives handling the initial consultation also attend the birth and provide postpartum care, offering consistent support throughout the process.

The continuity of care that comes with a VBAC at home allows an expectant mother to develop a trusting relationship and improve communication with her midwife. Leading to a more personalised care, it helps ensure the mum’s preferences and concerns are understood and honoured, and that the birth plan is followed to the end.

This model is associated with improved birth outcomes.

With the continuous presence of a known midwife, women can have a significant confidence boost and a greater sense of security during labour.

Women receiving this type of care are:

• 16% less likely to lose their baby;

• 24% less likely to experience premature birth;

• Less likely to require interventions, such as epidurals, episiotomies, and assisted births;

• Less likely to have C-sections and inductions; and

• Less likely to use pain relief.

A pregnant woman under continuous care is more likely to have a spontaneous vaginal birth and a shorter labour duration.

Further, women report higher satisfaction with antenatal, intrapartum, and postpartum care when the same midwife provides it.

During the perinatal period, which is from the moment a woman becomes pregnant to a year after she gives birth, continuous care can also help reduce maternal anxiety and depression.

With midwifery continuity of care, babies are more likely to be born healthy and at term, with reduced chances of admission to special care nurseries.

Fewer Interventions and Quicker Recovery

Several studies indicate that planned homebirths, including Homebirth After Cesarean (HBAC), are associated with fewer maternal interventions, inductions, instances of augmentation of labour, operative vaginal deliveries, chances of having an episiotomy, and chances of Cesarean deliveries, and reduced use of epidural analgesia.

With fewer interventions come fewer complications, minimising the need for further medical procedures.

Planned VBAC also results in lower rates of maternal morbidity, such as postpartum haemorrhage.

Mums like Anna can have a quicker postpartum recovery with fewer interventions and no surgery than with a repeat Cesarean delivery. Reportedly, with a successful VBAC, they experience less abdominal pain.

When a mother recovers quickly, she can quickly initiate breastfeeding and foster a bond with her newborn.

Higher Chances of a Successful VBAC

A 2021 Canadian study found that planned VBAC at home was associated with a 39% decreased odds of having another Cesarean compared to planned hospital VBAC after adjusting for various factors.

The chances of a successful VBAC at home are high. According to VBAC.com, an evidence-based resource for birth options after a previous C-section, VBAC at home has an average success rate of 87%.

In comparison, the success rate of planned vaginal birth after one Cesarean in hospitals ranges from 70% to 75%.

After a successful VBAC, the chances of an uncomplicated vaginal delivery in future pregnancies also increase.

Avoidance of Risks Associated with Repeat Cesareans

By achieving a successful vaginal birth after a prior C-section, women can avoid the increased risks associated with multiple Cesarean deliveries.

With each repeat C-section, the risks of bladder and bowel problems increase.

The risk of uterine rupture significantly rises in multiple C-sections, from 0.43% after the first C-section to 4.34% after the fourth.

With a higher risk of excessive blood loss, blood transfusion rates also increase from 4.05% after the first C-section to 5.35% after the fourth.

A higher incidence of abnormal placentation can occur in a repeat C-section, which may lead to severe haemorrhage and necessitate a hysterectomy.

The formation of Cesarean scar tissues is common and increases with the number of C-sections, making each subsequent surgery longer and more complicated.

Repeat Cesareans are linked to a high risk of postoperative infections and thrombotic events in the legs or lungs, which can be fatal.

Risks of Vaginal Birth After Cesarean

It's crucial to note that VBAC at home also carries risks.

Uterine Rupture

One of the most pressing concerns for VBAC at home is the risk of uterine rupture, where the scar on the uterus from the prior Cesarean delivery weakens and opens. The C-section scar opening ultimately can have serious consequences and be life-threatening for both the mother and baby.

The chances of uterine rupture during a VBAC at home is around 1%. Inducing labour increases these chances.

Other Complications

The risk of postpartum haemorrhage is greater in VBAC than in elective repeat C-sections.

There's a 1% chance that women opting for VBAC will need a blood transfusion.

In VBAC, the chances of a baby dying or being brain damaged are no higher than in an elective repeat C-section.

Emergency Transfers to a Hospital

If an urgent medical concern arises during a VBAC at home, it’ll take some time to get to the hospital.

A 2014 systemic review revealed that the rate of transfers from home to hospital in planned homebirths ranges between 9.9% and 31.9%. Common reasons for transfers include labour dystocia or slow labour and fetal distress, which may require an emergency C-section.

In our area, we found comfort in the fact that the emergency response time for women in labour is only seven minutes.

The Bottomline

After a thorough analysis of the pros and cons of all the options available to us, we concluded that a planned VBAC at home was the choice that made the most sense to us. We were comfortable to take on the risks associated with our decision.

The decision to attempt VBAC at home should be made after weighing all the associated benefits and risks against those of other options, such as a hospital VBAC and elective repeat Cesarean, with the guidance of qualified healthcare professionals.

Once you've decided to go for VBAC at home, ensure appropriate emergency backup plans are in place.

What are your thoughts on VBAC at home and Cesarean? If you’ve had a prior C-section, would you consider VBAC attempts if you're a good candidate for it? We'd love to hear your stories, so please comment below!

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