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VBAC Homebirth (after a Cesarean)

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Narrow pelvic arch?? home birth after c-section

Jan 2009

my family is considering a second child next year, however, our first child, i had to have a c-section as i labored for over 24 hours at Alta Bates. i did not have any intervention (they did break my water bag after beginning labor at 9 pm, registered at 11 in the hospital, labored through the night and they said was not dilating enough and said breaking my water would help move things along) until they gave me pitocin after 24 hours and a few hours of pushing. after the pitocin the contractions were unbearable and i was exhausted. it was then that they said i could keep pushing, the baby was fine but i could push for several more hours. the idea of pushing for several more hours at that point seemed impossible. i was told i have a narrow pelic arch and could only give birth to a 5 lb baby (my baby was 7.7). so i had a c-section. of course i know that the most important thing is/was the health of the baby and mom. however, i feel that i was pushed into the more difficult labor by breaking my water and pushing too early and getting pitocin. i may be wrong but it is just my feeling. so i would like to know, has anyone been told they have a narrow pelvic arch? i have been unable to find anything about it online. and anyone have experience with a natural home birth after c-section? can you recommend a midwife? i was very happy with my ob until at around 37 weeks prego she said, ''oh well, if the baby is too big you can always have a c-section.'' after seeing the business of being born i am so skeptical. just seeking advice before getting prego again. thanks! still seeking a natural birthing experienc


Hello: Unfortunately, my narrow pelvic arch is the only narrow thing about me! When I was pregnant in 2000, one of the first things my OB (Jim Sakamoto) told me was that I had a narrow pelvic arch and that I might experience problems delivering my daughter vaginally. But he never suggested that I should just prepare for a C-Section, either. Because this was my first (and only) baby, he told me to go through my pregnancy without worry, create the birth plan I wanted, and prepare for a regular labor. I voiced my fear about being allowed to labor to the point of exhaustion and then ending up with a C-Section anyway. He told me that if my labor did not progress reasonably, or the baby showed signs of distress, that I should be prepared for an emergency C-Section. I appreciated both his candor and his support for me to try normal labor and delivery. Well, in the end, my labor did not progress, my daughter's heart rate dropped with each contraction, and she was delivered via C-Section. Ultimately, though,I had a healthy baby girl, felt respected by my OB, and was not pushed into surgery unnecessarily. I suggest that you speak with your OB candidly about the kind of birth you want sooner rather than later. I can't speak to the issue of a VBAC, but I wish you a very healthy and happy pregancy and birth. Narrow but triumphant
I have a narrow birth canal, not sure if that is the same thing. I had two c-sections, tried for VBAC the second time. Both my babies were over 8 lbs. I really wanted a VBAC, but in hindsight, am SO relieved I had a c-section at the hospital because I had another complication during the c-section. I work with disabled adults, and I have met many that were brain damaged because the doctor would NOT perform a c-section when they were being delivered. Healthy baby outweighs home birth with disabled child for me. better safe than sorry
I had a wonderful home birth after a C-section with Mason Cornelius, LM, CPM (www.novamidwifery.com) Wishing you a peaceful birthing and a healthy baby, Rasa
Hello I gave birth at Alta Bates hospital two years ago, and had an amazing experience. Midway, I was told that my pervic bone was flat and not curved enough to give birth to my 6.7 lb baby. Bologne, I say! A few hours later my pelvic bone was curved enough, and I gave birth to our beautiful daughter. As great of an experience I had with my baby being born, I must say that Alta Bates hospital is notorious for jumping into c-sections. There are only a handful reasons why a baby must be pulled out via c-section, yet doctors recommend it way more then necessary. You as a mom have to fight for what you think is right, challenge your doctor and make sure that the c-section is really the last resort. Find the hospitals with the lowest percentage of c-sections, really know your doctor, and make sure you read up on things, so that when it's time you are not left in the dark. e
I'm sorry that your first birth experience was not what you had hoped. And I'm so happy for you that the outcome was good all around - healthy Baby and healthy Mom. As you well know, childbirth is dynamic and unpredictable. Our community tends to place a high value on natural childbirth, less medical intervention, and mother/family-driven decision making - all resonable goals to a point. From a population-based perspective, it's true that most women can safely give birth to a healthy baby without any medical intervention. But you are not a population, you are an individual. It may not be safe for you or the baby to attempt a vaginal birth, nor a home birth. Please try to quiet the voice inside (and all around our community) that anything but a natural birth is a failure. Allow yourself the normal emotions of disappointment, frustration, anger, sadness, that you may have another birth experience that is not ''natural.'' But please chart your next childbirth course with safety as your foremost goal, not just mentioned as an aside at the end of your three page birth-plan. Globally, many women and babies die in childbirth. We are so fortunate to have access to care (intervention) that not only prevents death, but optimizes heath. living in reality
I had a similar situation but 60 hours of labor. I wanted as close to a natural birth as possible and they wanted to do a C- Section. I begged them to wait-in the end I had the C-Section. I learned after my first child's birth that I had a birth defect in my uterus that might have prevented me from dilating properly. When I was 30 weeks pregnant with my second child, my OB asked me if I wanted a VBAC or a C-Section. I hemmed and hawed for several weeks and she finally asked me: ''How much risk to this child is acceptable so that you can have the birth experience you want?'' I scheduled the C-Section. Scheduled C- Sections are a much easier experience than an emergency C- section after pushing. I never got that experience that you hope for, but I have two lovely, healthy children and the only thing I would change is a C-Section earlier the first time. I do really like my OB so I would suggest that you get one that you trust more. Mom of two
Please don't have a home birth! If you want to try to VBAC, I would support that, but please do it in a setting where help is available quickly. I am an Ob/Gyn with 20 yrs experience, who is more on the ''midwife'' end of the scale when it comes to obstetrical interventions. And I VBAC'd myself twice, so I am definitely in support of VBAC. But the reality is that someone with your history (a 2nd stage arrest and narrow pelvic arch) has lowest rate of success with VBAC at 50%. Those that have had a C/S for breech or fetal distress in early labor can have a success rate of 80%, but that is not your history. After having seen some real heartbreakers, I really think the potential cost is too high to VBAC at home. The bottom line is healthy mom, healthy baby. First do no harm
I didn't see the original post..but ..after I delivered my first baby by an unwanted CSection ..I was told by my OB that it happened because of my narrow pelvic bone. I then had MRI to measure the bone to make sure this was the case and it wasn't. I then switched to a mid wife and delivered my 2nd baby vaginally. So make sure you have an MRI done. vbac supporter
I had a c-birth after 5 hours of pushing. My daughter's head was 'almost' through my pelvic bones and she would not turn (I had, regretfully an epidural after being induced with pitocin also) Although I was at a hospital with a supposed midwife team, I never had one of any of the midwives present at my birth. I begged the doctors to try and turn the baby's head, but they would not. (I think I knew she was presenting in a way that wouldn't allow me to push her out) Anyway, long story short, I was not told I had a ''narrow arch'' but vaugely told that my baby would not pass through my pelvic bones for having her head positioned wrong. I feel that you have every right to feel suspicious of the interventions such as the ones you mentioned in your post. Have you read Ina May's Guide to Childbirth? There are some very interesting things in there about VBAC. I just read the post from the OB who advised you to not have a homebirth. Myabe not, but research out what happened to you and what a VBAC would take. At the very least, spend the money on a great midwife team that has experience with VBAC, instead of the western model of OB medical ''care'' which often treats pregnancy as a pathology. If you have to be in a hospital setting, have a team of people there who actually have given you quality care, know you well and have experience with putting the correct pressure on your bones or turning a ill-positioned baby. Get your medical records from the hospital and start researching VBAC. There are a lot of success stories out there!!! Good luck! glow
I don't know about narrow pelvic arches, but i do know several friends who had c-sections and later really questioned them and ended up having incredibly healing experiences by having homebirth VBAC's with midwives who were by their sides and present for their whole birth experience. If you haven't seen ''the business of being born,'' I highly recommend it. find a medical professional you trust to get another opinion about the narrow pelvic arch question. Better yet, if you are considering a home birth, meet with a midwife or two and ask what they think. they will only plan a homebirth if they think you are a good candidate, not a high-risk birth. Doctors get so freaked out by homebirths, but have rarely attended one. you are better equipped to know what is right for you than anyone, so do your research and then trust your gut on what is the safest birth environment that will help you feel most comfortable and supported. Happy birthing! Gillian
I was once present at a birth where a VBAC ended in uterine rupture, and despite the parents' initial strong feelings against another c-section it was necessary for the life of the mom and baby. Had that happened in a home birth the baby would unquestionably have died. Fortunately after a few days on maximal life support the baby improved and did quite well. I believe most hospitals and OB practices around here will work with you if you want to try for a VBAC. But if you've had a previous cesarean there is a small but real chance of needing to be in an OR within a few minutes. Most likely you won't, so you could take the gamble, but if you lose that gamble the consequences are far worse than an unwanted c-section. pro-home-birth/anti-HBAC pediatrician
It always amazes me how much animosity people feel toward the medical profession. Doctors put their patients' best interests first. They are not ''freaked out'' by home births; they've just seen a few too many ''bad outcomes'' to take that risk. They don't attend home births because their malpractice insurance prevents it.

Our first birth experience was not complicated at all, but our second child needed to be put on a respirator immediately. He was non-responsive, and needed to be in the NICU for over a week. Meanwhile, there were no signs of distress before labor began. Thank goodness we were at the hospital; I am sure he would have died if we had been at home.

You can have a wonderfully positive birth experience in any setting. The most important thing is to have a healthy baby, period.

not worth the risk


VBAC at home?

August 2005

Hi, Baby two is due March 2006 and it will be a VBAC. First baby was an attempted home birth. I am new in the East Bay (Piedmont) and still trying to find my way around. My question is: does anybody know of any midwives that have experience with home VBACs? Are there any birth centers around here, attended by midwives, that do VBACs (with or with out physician back-up)? I would prefer not to give birth in a hospital and am exploring home vs. birth center births. Thanks! Thanks. Iris


Your life and death question reminded me of the movies. '' ... you've got to ask yourself a question: Do I feel lucky? .... ''
It's never been clear to me what the advantages of a birth center are over giving birth at home. From what I can tell, midwives bring the exact same equipment to your house that they would have at a birth center, except if you're at a birth center, then you aren't at your house. Unless you're at a birth center that is connected with a hospital, that is. You could try calling Cindy Haag (510-704-8366) about this--she's a fabulous midwife, very knowledgeable, lots of good recommendations on UC Parents. I talked to her about VBACs and her take is that whether or not it is a good idea to have a VBAC homebirth depends on a variety of factors, such as the reason for the C-section and where the incision was made. Hope this helps
I recommend contacting any of the midwives associated with the Bay Area Home Birth Collective. Our particular midwife was Cindy Haag (first-time, at-home, vaginal birth), and I believe she has had VBAC experience. We loved working with her and are planning on calling her as soon as we start thinking about baby #2. Her number is 510-704-8366. She is based in Berkeley. kara
Good for you for considering your options! The OB world is much stricter now about VBACs. I hope you get just what you want. Just FYI, you can get a VBAC with the midwifery group at Marin Maternity Services in San Rafael (415-507-4030 don't let the poor phone service distract you from getting what you want). This is actually a county service with prenatal care and childbirth attended by midwives at Marin General Hospital. Stay empowered!
My understanding is that, given the current liability insurance situation, none of the birth centers in the Bay Area will accept VBAC patients (for that matter, there are very, very few nationwide who will accept any patient who's not extremely ''low- risk.'') That's what happens when too many docs and midwives get sued too many times (childbirth being, well, a dangerous business that doesn't always go well).

You may or may not be able to convince a midwife to attend you at home; there have been successful lawsuits against VBAC homebirth midwives in recent years, so this option is also closing. I am not aware (and this is after some research, believe me) of any Bay Area OBs who will provide homebirth backup for a VBAC. This means that if your home VBAC does not go well, for whatever reason, you are likely to be at the mercy of whatever OB you find on call at the emergency room that day. Given the enthusiasm most MDs seem to have for repeat Cs, I would not think your chances of getting out without getting cut are very good in that circumstance.

After giving all this some consideration, I've elected to plan a hospital VBAC for our next kid. Alta Bates is still accepting VBAC patients. Sara


I had to respond. It is a serious mistake to try a VBAC anywhere that does not have surgical facilities and a surgeon IMMEDIATELY availabe. I do understand the desire to have your baby at home, without intervention, but what you need to understand is the risks of VBAC. The risks are of a rupture to your uterus, which can happen at any time in labor (early or late) and happens usually with little or no warning. With a rupture, you will hemmorrage terribly and if the rupture is not surgically dealt with IMMMEDIATELY you or the baby or both will die from loss of blood. People who tell you otherwise are lying or really don't know the facts. There is not time to get to a hospital. The risks are enough that the recommendations are swinging away from VBACs at all, and hospitals that can't guarantee a dr. will be available IMMEDIATELY for surgery won't allow them. Lucky for you, you are in the Bay Area and hosptials here will help you try to have a VBAC, but I promise you, you want that surgeon right nearby. No VBAC homebirths!
I respect your choice but I had to write in and ask if you have seriously thought of the risks of having a VBAC not in a hospital. 1 in 100 VBACS end in a rupture. Those are not small odds. If your uterus ruptures, they have to get to the baby asap to prevent neurological damage or even death. There is no guarantee that even if a doctor is standing over you with a scalpel at the exact second you rupture that they will get to the baby in time. I say this after considering VBAC myself and rejecting the idea because of this risk. I recently had an acquaintance who ruptured during a VBAC and thank goodness the baby lived but we're still not sure about the neurological damage. I do not mean to be preachy, judgmental or scary - I just wouldn't have slept if I had any doubt that you had all the information to make your decision. Whatever you choose, I hope you have a wonderful birth experience and a happy and healthy baby! C-Section X 2
I highly recommend Amrit Khalsa, 510-235-4878, homebirth midwife. Had 2 kids with her with great success. Haven't done a VBAC with her, but she will work with you to help you figure out what the best approach for you is. Congratulations and good luck! Joanne
I had a beautiful and successful VBAC homebirth with Bea Haber and Jennifer Hess. They work either at a free standing birth center or at home. Both are very experienced midwives. They have a website http://midwifeinfo.com/find/show_inst.php3?id=359 If you would like to hear more about my experience feel free to send me an email. Mindy
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