Planning a Home Birth after a Caesarean

Here's a guest post by Niamh C on planning a Home Birth after Caesarean (HBAC). We wish Niamh loads and loads of good vibes and best wishes to achieve her goal of a homebirth.

My first pregnancy was a gentle surprise so hadn’t really thought about what type of care I would like; to be honest I didn’t know I had a choice. I went to my GP, had my pregnancy confirmed and asked for her advice on which hospital to attend. She told me they were all the same so I picked the one closest to my work. I decided to go semi-private so I didn’t have to wait in the public clinic for my appointments.

For the most part, until my last appointment, I was happy enough with my antenatal care. In my last appointment at 41 weeks, with some protest, I was booked in for induction at 41+4. By this point I had done some research and wanted to avoid interventions as I knew there was a higher risk of assisted delivery or c section. I had also decided that if I had more children I would consider having them at home.

My experience of the midwives and care on the induction ward was unfortunately not positive, nor was my delivery which did end up in an emergency c section. Mine and my son’s postnatal care was mixed with positive and some very negative experiences. I got home and got on with life with a newborn but as time went on realised I needed to heal from my birth trauma. As I went through this process I knew I wanted to avoid a c section for any subsequent births so started to research Vaginal Birth After Caesarean (VBAC).

My research assured me that this would be safest and best option for me. One of the main concerns for VBACs (and HBACs) is the possibility of uterine rupture due to scar separation. The research shows that in the setting of a large Irish maternity hospital with strict guidelines for a Trial Of Labour After Caesarean, the Uterine Rupture rate was 2 per 1000 (0.002%) overall, and 1 per 1000 (0.001%) for women in spontaneous labour who did not receive oxytocin augmentation (Turner et al, 2006).

I lusted after homebirth but I knew it was against HSE policy so it would never be a reality.  Then I heard of a private midwife company that had recently entered Ireland and was supporting mums to have a Home Birth After Caesarean (HBAC). I refocused my research and started looking into the safety of HBACs.  Again, from all the evidence I trawled through it became apparent that HBACs were actually very safe for uncomplicated pregnancies and that I was much more likely to be successful in my quest for a vaginal birth with this option.

I live a ten minute or less ambulance ride from the hospital and a skilled midwife who knows you well should pick up on any issues long before they become and emergency and you would be transferred to hospital. Also repeat c sections are not without risks. So when I got pregnant I contacted the private midwife company. I asked lots of questions and decided to send my notes from my previous birth to get reviewed by their obstetrician to see if I was a good candidate for HBAC. I was given the all clear. I joined a Homebirth Facebook page and started soaking up all the information and the wonderful stories. One day I thought to ask in the Facebook group what was the best thing for you in your homebirth and below are some of the answered shared. All names given with permission. 

Not having to think about when to go to hospital, being in my own space, being able to point to exactly where my baby was born. If I moved house I think I'd cut out that piece of the floor and bring it with me – Lisa

Having the bedroom windows open looking out onto the woods by our house and breathing in the air it felt like pure freedom and space – Abigale

Everything, Continuity of outstanding care, home visits, comfort of my own bed and not leaving the older child. – Sinead

Being able to labour to the sounds of Madonna, have a home made Thai curry, showering in my own shower and finally the 3 of us falling asleep in our own bed as a new family! Bliss! – Dil Wickremasinghe

Everything - the relationship you build - it's the only set up whereby you know who your midwife will be at delivery which is so important - cuts out the panic of "I hope we have someone nice/respectful of my wishes”. Visits in your home - no need to have other kids minded and have to get to a hosp. The fact that the whole family are part of it - get to know the mw too. Not having to transfer to hospital mid labour I always hated that bit - the nerves kicked in and so did the pain. The environment is home not a clinical room. The getting into your own shower and then into bed - my [son] arrived home from Montessori to meet his new brother and still says the reason why Ted loves him so much is because he saw him first. There is no rush to get out of where you gave birth no worrying will I get a room? People can come visit you whenever you like. The aftercare is amazing. It's platinum service – Emma

So many things. What stands out most for the first birth would be being in the pool by the roaring fire and Christmas tree and so much love in the room and for the 2 births to follow nothing could compare to waking our eldest up within 20minutes of each birth and watching her hold her brother and sister and without any prompt begin to sing to them. Can't sign off without saying on top of the list would also be our midwife Kate who made us feel so empowered having made the decision to have a home birth – Mellissa

Other common themes included older siblings being present, feeling respected and powerful, continuity of care and the relationship built with your midwife, sleeping in your own bed afterwards with partner present and the post birth meal of whatever you wanted and not just tea & toast!

I’m about half way through my pregnancy now and feeling very positive for a homebirth. I’m also really excited about the labour and birth process; I’m actually looking forward to it, after my last birth I never thought that would happen.

For more information on homebirths check out www.homebirth.ie

Niamh