• Amanda Macdonald, LM, CPM

Is a homebirth VBAC safe?

Do you do VBACs (vaginal birth after cesarean)? Are VBACs at home safe?

Yes, I do attend VBACs at home in many circumstances.

A cornerstone of midwifery care is shared decision making. If you are interested in a VBAC, we will support that decision in many cases, based on the research, with true informed consent, based on your medical history, and if we are sure that you absolutely positively understand the risk of a VBAC at home.

Everyone’s definition of “safe” is subjective. The main risk associated with a VBAC is the scar opening up which can result in the death of the baby. ACOG recommends VBACs in the hospital with access to an OR in case of emergency. At home, we don’t have access to an OR and that *does* increase risk of a VBAC at home. This is not meant to scare you. It is simply the facts.

So why have a VBAC at home? Unfortunately, despite ACOG’s statement that VBACs are the overall better option (medically speaking) vs planned repeat cesarean, many hospital-based providers do not encourage them. We see providers presenting obviously biased information at the beginning of pregnancy swaying families to schedule a repeat cesarean. We see providers saying they are supportive at the beginning of pregnancy and then subsequently less supportive as the pregnancy goes on. We see providers “requiring” a cesarean once you hit 40 weeks. We see providers using unsupportive language like “let you try” or “allowing a TOLAC” or attempting to scare families into surgery.

It is important to choose your home birth provider carefully when opting for a VBAC. Do they know the warning signs of VBAC complications? What is their definition of a “good candidate”? What is their protocol for monitoring you and the baby during labor?

At Sage Springs, we will attend your VBAC at home if you have had 1 prior cesarean, no history of previous uterine rupture, a copy of your surgical report, with a known low transverse scar, and a known placental location. We monitor baby frequently: every 15-20 minutes during active labor. Knowing how baby is doing is paramount. If we have ANY question, we will transport to the hospital.

Research everything. Ask your provider all the questions. Expect a high level of care from your midwife. You owe it to yourself, your family, and your baby

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