HBAC - Important Correction on statistics with Uterine Rupture

Just a quick post: I have been informed that my stats on Infant death in regards to Uterine Rupture at home are incorrect. Unfortunately they are worse than I had originally discovered.

The facts are that if you are attempting a HBAC and experience a uterine rupture then the survival rate is almost zero. On the very odd occasion where a baby has survived rupture during a HBAC there has been significant lasting brain damage, and/or the baby has passed away in the weeks following the birth. Once a mother ruptures there is only a 15 minute window to get the baby out. This isn't possible in a home birth environment, even if you are just around the corner from the hospital!

I will update my other posts accordingly, although it may not be done today as I have a very grumpy baby boy who has had his first set of vaccinations today, hence writing this very brief post to make people aware of just how unsafe a HBAC really is.

Bella xxx

HBAC - How I was almost led to believe the hype

After writing the first three follow up posts to my 'Why I am so against HBAC - DS2 birth experience' post I joined a group on facebook. The group is for women wanting a natural birth after caesarean, and for those who have attempted and want support. I thought it would be a good place to share my story, especially as the group supports VBAC, HBAC and Home Birth.

I initially asked if I could share my story prior to posting it and mentioned that I was anti HBAC but pro VBAC as long as it's in a facility equipped to deal with any eventuality. This much to my surprise went down like a ton of bricks!

When I did post my birth story (which I edited heavily) I was still targeted despite the fact that I am very much pro VBAC (which is one of the factors the group supports). I was given information and links to show that had I had my VBAC at home then the likelihood was that I would not have ruptured, and that I would not have needed intervention.

Here are some of the things I was told:

• If I had had a HBAC instead of a hospital VBAC the risk of rupture would have been much lower as I wouldn't have had all of the interventions.
• Ruptures have early signs - a trained home birth midwife would have picked up on the rupture in time to transfer me to hospital.
• Epidurals reduce the awareness of a rupture.
• Home birth midwives are more 'hands off' so tend to watch you rather than monitor, so they can detect a change in behaviour or appearance far better than a hospital midwife.
• Uterine Rupture is a rare occurrence and the chances increase with intervention.
• Having your waters broken for you can increase the risk of Placental Abruption.
• Epidurals are proven to lesson your chance of a successful VBAC
• I should have spoken to a Midwife who specialised in home birth and not my consultant obstetrician 

With the above being planted in my mind I actually started to question my thoughts in regards to HBAC! Would I have been better off at home? Would I have still ruptured?

I sent a message to Amy who runs 'The Skeptical OB' blog, I already knew the answer to my question, but I needed someone to snap me out of the doubts that were now forming in my mind.

Here is my message and her reply:

Hi,

Sorry to message you directly, I hope you don't find it unacceptable.

I've been writing about my birth story (failed VBAC/Uterine Rupture/Placental Abruption in hospital - outcome positive)

I joined a VBAC group who also support HBAC, on joining I was very anti HBAC. I felt it important to tell my story, that had I homebirthed, my baby (and potentially myself) would have died!

I couldn't understand how any mother would take the risk of a HBAC when there is a chance that if something were to go wrong they could lose their baby (to me their own life is irrelevant, that's their choice, but to risk the life of an unborn was beyond me)

Upon joining I posted my story, and I did mention that I was anti HBAC but also edited my story heavily so as not to offend anyone (although I did still manage to offend a lot of people)

I've been told and given links that apparently show that had I birthed at home I would probably not have suffered the complications, and that even if I had I would have been transferred in ample time as home midwives are trained to spot these things happening far better than hospital midwives....

I've been told that the epidural I had would have contributed to the rupture, and that having my waters broken could have caused the abruption. Combine these together and hey presto that's why I suffered my rupture.

I'm struggling with this in my head! My heart is saying that maybe had I been left alone I could have birthed naturally. But my head is still saying that there is a risk, and if there is any risk to an unborn then surely we should put that first, over and above what we view as our 'ideal' birth! Surely the outcome is all that matters. A healthy mother and baby!

I would really appreciate your input on this as I'm no going stir crazy and wondering if the epidural and waters being broken could have contributed to my rupture....

Also I've been advised by my consultant that I shouldn't have any further children now, as the risks are too high and I may not carry full term without rupturing. Again to me this made sense, and in all honesty I have never wanted more than two children. But I'm being told now that it is possible to birth after a rupture...

Please set my mind at rest and tell me I am not crazy. That my doctors are right and that my original opinion is the one I need to go with.

The women in the group are all wonderful women, and I can certainly relate to them in a lot of ways, but I am still struggling with the concept of HBAC ever being a safe option, and surely that's something I need to be spreading awareness of?

Many Thanks in advance.

Louise

------

Dear Louise,

There are many different factors that can affect the success of a VBAC and the risk of rupture. However, neither epidural or ruptured membranes are among those factors.

This issue has been looked at multiple times and there is NO evidence that VBAC is safe let alone safer than hospital VBAC. The risk of death of baby and/or mother is much higher at home.

Those who insist that what happened in the hospital would not have happened at home are trying to deal with their own cognitive dissonance. It is extremely important for them to believe that homebirth is safe as hospital birth and when they are presented with evidence that shows they are wrong, they will do almost anything to discount it so they can preserve their beliefs.

The important thing to understand about the women offering you false information is that it has nothing to do with you and nothing to do with the truth. If's all about them and their need  to justify their own dangerous choices.

As regards your consultant's advice, it's difficult for me to evaluate it without studying your medical records. The odds of a future rupture are higher than before, but it is possible to have a successful pregnancy and an early C-section (before labor ever begins) to reduce the risk somewhat.

I hope this information is helpful.

Sincerely,
Amy

I know that there will be many HBACers who will read this and think to themselves, oh she spoke to Dr Amy and then dismiss any common sense they may have gained from reading this blog! This is the sad reality of these groups. Dr Amy is a well know medical professional, she gave up her career to have her family and now blogs on various subjects including home birth and HBACs.

A lot of the HBAC community don't like her, she is labelled as a troll and a fear-mongerer! The reason behind this hatred is purely because Dr Amy tells it how it is! She doesn't beat around the bush trying to be nice when the facts are simple. HBAC mums are risking their children's lives in order to have the birth they choose! They blind themselves with the success stories and when someone comes along with a negative it is either swept under the carpet, dismissed or removed.

They lead the way for others to follow, armed with rose tinted glasses and ready to attack anyone who may have a different point of view.

SO after much thought on the matter I've revisited the comments that were raised in regards to my story:

• If I had had a HBAC instead of a hospital VBAC the risk of rupture would have been much lower as I wouldn't have had all of the interventions - Interventions do not increase the chance of rupture. If you are going to rupture you will, be that at home, in the car or in a hospital. The main difference is that if you rupture during a HBAC your child is three times more likely to die than if you had VBAC'd in a hospital
• Ruptures have early signs - a trained home birth midwife would have picked up on the rupture in time to transfer me to hospital - Every rupture is different, I felt my pain through my epidural. When it happened it happened fast and I was bleeding out straight away. There would not have been enough time for anyone to have got me to hospital. My baby and potentially myself would have died.
• Epidurals reduce the awareness of a rupture - I can't vouch for everyone, and I'm not a doctor, but I can assure you my epidural did not mask the pain of my rupture! It is a pain I never want to experience again, and I would not wish it on anyone.
• Home birth midwives are more 'hands off' so tend to watch you rather than monitor, so they can detect a change in behaviour or appearance far better than a hospital midwife - I was quite happy the minutes leading up to my rupture. Although babies heart rate had started to drop. This is something that a hands off midwife would not have picked up on!
• Uterine Rupture is a rare occurrence and the chances increase with intervention - When you think of rare what figures pop into your head? 1 in a million? 1 in ten thousand maybe?? What about 1 in 200! Does that still sound rare? Because to me thats a pretty real figure, and an accurate one at that 0.5% of women attempting a VBAC WILL rupture. Don't think it will be you? Well I didn't think it would be me either and it was! Now if you played a lottery where the odds were in your favour at 1 in 200 how many extra tickets would you buy? Because those are pretty good odds. But turn them against you and they are rare? Come on wake up and smell the coffee. Uterine Rupture is not a rare occurrence, its a common one, and thats why your doctor, your consultant, your friends, family and most other people are asking you to please go into hospital for your VBAC! They are not scare mongering you! The statistics are there. Please look at them, read the stories of the women who lost their children to HBAC and Uterine Rupture. It's very real and it happens more often than anyone cares to think about. How many babies need to die before this is taken more seriously!
• Having your waters broken for you can increase the risk of Placental Abruption - I can't comment on this as I've not seen the statistics. I would imagine if your placenta was already starting to come away then having your waters break in general could cause an abruption.
• Epidurals are proven to lesson your chance of a successful VBAC - Rubbish! 
• I should have spoken to a Midwife who specialised in home birth and not my consultant obstetrician - So I should trust a nurse over a Consultant OB who has spent 15 years of schooling and training to get to consultant status and has over 30 years experience under her belt? (talking in reference to my consultant). Consultants are not their to make our life hard, they don't want us to end up with a repeat section! Mine was fully VBAC supportive, stressing that if you can do it its much better for mum and baby. She also explained the risks to me, and I was fully aware of what could happen when I tried. Hence trying in a facility that was equipped to cope when my uterus ruptured.

So there we have it! I almost believed the hype that is HBAC! I'm leaving the group now as I can't stay there and read stories of mums going into labour! I don't want to be privy to the next death by HBAC! It's too heartbreaking to even contemplate.

Bella xxx

PS: My main blog site is now: http://www.lifehathchanged.co.uk 

Follow up to my anti HBAC post Part 2 of 4 - Why I chose to try a VBAC (Vaginal Birth after Caesarean)

When I found out I was pregnant with DS2, I knew I wanted to try and have a normal vaginal delivery so I started to look into my options, I read into both VBAC  and HBAC. This post covers planned VBAC in hospital, why I chose to attempt one and the benefits and risks. I'll cover HBAC and Caesarean in my next two posts.

I had already had one caesarean and knew the recovery time would be much longer if I opted for an elective. However I must stress my last section was an emergency and elective sections are typically much easier to recover from as your body hasn't been through the stress of labour prior to the operation.

For me the main reasons for wanting a successful VBAC were as follows:

1. I wanted to experience giving birth 'normally'
2. Vaginal births are much better and less stressful for baby
3. Vaginal Births are much better and less stressful for mum
4. Recovery time is much faster
5. No limit on when you can drive (6 week driving ban after a section)

There are risks involved in trying for a VBAC, but to me the benefits outweighed the risks and considering that the risks involved in a vaginal delivery are lower than that of a section I came to the conclusion that as long as I laboured in hospital it would be a safe option. 

I wouldn't advocate trying for a VBAC in any facility that isn't equipped to handle a Caesarean just in case there is an emergency, especially as there is a 1 in 200 chance of Uterine Rupture! If you have been following my blog you will already know that I was that 1 in 200 and had I not have been in hospital or a facility equipped to cope with such an event then I would have lost my baby and potentially my own life too.

VBAC is also a preferred option for women who are planning more children. Whilst the risk between VBAC and a second Caesarean is minimal, the risks in a third or fourth Caesarean start to rise dramatically. So VBAC is a much better option for those wanting more children. For me it wasn't one of my reasons behind opting for VBAC as I don't plan on having more children, but if you are it is something to consider.

There are two main risks involved with a VBAC. The first is you may need to end up with another Caesarean, this is most likely if the reason for your first was failure to progress. For me this wasn't an issue as my first was due to malpositioning and I had managed to fully dilate and start pushing prior to my first section when DS1 decided to move and then get himself into distress. 25% of VBACs will end in a repeat section, the chance of a repeat section lowers to 10% if you like me did manage to progress to full dilation prior to the section.

The other risk involved with a VBAC is far more serious and is the Uterine Rupture. 1 in 200 VBACs will end up this way (0.5%) This is when the previous scar breaks open internally and baby breaks through the wall of the uterus into the abdominal cavity. This unfortunately is what happened to me.

If this does happen to you then like me you will need an immediate emergency Caesarean to prevent complications such as haemorrhage, brain damage to the baby or infant death. You may also need a hysterectomy if they can't fix your uterus after the rupture. Thankfully for me they managed to save my baby and my uterus and thus save me a life of hormone replacement.

Whilst the prospect of a Uterine Rupture is extremely scary, as long as you are in a facility that is ready to deal with it then the chances of perinatal death are greatly reduced. You will have staff on hand to immediately deal with the situation.

It is worth considering that 6.2% of uterine ruptures are associated with perinatal death and that 33% of women with uterine rupture will require an emergency caesarean. Whilst these statistics seem scary, bear in mind that rupture only occurs in 0.5% of VBAC's so the risk of perinatal death from attempting a VBAC stands at less than 0.005% (I can't vouch for the accuracy of this figure, but it is low)

It is also worth considering that for VBACs in a hospital environment or a facility equipped for an emergency section that the maternal mortality rate due to uterine rupture is 0%.

So whilst there are risks associated with a VBAC they are minimal, especially if you ensure that you labour in an environment equipped for an emergency.

I feel blessed that I was in a great hospital with fantastic staff on hand when mine ruptured, my outcome could have been so different had I laboured at home.

Overall I am pleased I tried, and I don't regret it at all. Yes I got unlucky, but as with anything you never know unless you try, and I felt secure in the knowledge that I was safe if/when the worst happened. It's always good to remember that 75 - 90% of VBACs are successful, so the odds are in your favour :) 

Bella xxx

Why I am so against HBAC - DS2 Birth Experience

Before I explain why I am so against HBAC (Home Birth After Caesarean) I must say that I am not against home births in general, if a woman can safely birth in a comfortable environment without intervention then that could be a truly wonderful experience, and I wouldn't want to interfere with their choice. For me I am glad I didn't go with a home birth for my first son as it did end up in disaster and an emergency section. So had I opted for a home birth neither of us would be here today.

However the risks are very low and it is all down to a matter of choice. I would only advise if you did choose a home birth for your first child that you are within a short distance to the hospital just in case things do go wrong. I am however also aware that home births often have less complications so most of the time do not pose an issue.

With a HBAC the ball game changes completely. There is a 0.5% chance of Uterine Rupture. This seems relatively low until you consider that it is in fact 1 in 200! All of a sudden the chances are higher than you imagine.

When I fell pregnant with my second son I knew that I wanted to attempt a natural delivery and decided to try for a VBAC (Vaginal Birth after Caesarean)

It wasn't something that I had my absolute heart set on, but something that would have been nice to achieve if at all possible. I learned with DS1 that making too many plans for the birth  is pointless, you can't predict what will happen until the time comes.

My choice for a VBAC was for several reasons. Mainly I wanted if possible to experience a natural delivery, and with a 4 year old to run after I was hoping to be back on my feet as soon as possible. With DS1 I suffered an infection and it was 3 months before I was back on my feet. I weighed up the pros and cons of a VBAC versus an Elective Caesarean and decided that the benefits of a VBAC outweighed the risks.

My due date was 6th March 2015, although due to my size and the size of DS2 my consultant thought I may deliver a couple of weeks before this, so from 38 weeks we were on high alert and waiting for those first pangs of labour to start.

After what seemed like an eternity and 41 weeks down the line my contractions started (On the evening of Friday 13th of all days) We called DHs mum to come over and watch DS1 for us, and within an hour we were at the hospital.

My labour with DS2 was totally different to DS1, my waters never broke and the contractions were thick, fast and excruciating from the onset. We arrived at the hospital a little after 11pm and went through to triage where I was just 2cm dilated. Because of my previous section and the intensity of the contractions they kept me in to monitor me and by 4am I was 4cm dilated and moved to the delivery suite.

I felt like I had reached a huge milestone and that everything was going to work out as planned, I was very positive about achieving a natural birth. I did choose to have an epidural at the earliest opportunity. I'm a great believer that if there is something to assist with the pain then why suffer (and labour is very painful)

The anaesthetist arrived at around 5am, and by 6am I had my epidural in place and fully topped up (It took longer than expected as my body was fighting the tube going in). I was told to keep self administering every ten minutes to ensure that it was topped up to the maximum (my intention was to use and abuse it for the worst of the pain and then slow down once I got to 7-8cm so that I could let it ease off and feel when to push with the contractions)

I was examined again by my midwife at around ten past 6, my waters had still not broken and I was sat at 5cm dilated. At around 7.30am the midwife broke my waters to help speed things up a little. Once my waters had broken the contractions were back thick and fast (but pain free) and again I felt positive that all would be ok and that I could do this. I was examined again at around 8am and still no progression with dilation.

My contractions were starting to get a little more painful so I was topping up my epidural every ten minutes to try and counteract them. Then at around 8.30 I was hit with the most excruciating pain I have ever felt (and never wish to feel again) It was like one long contraction that never ended, combined with someone tearing my insides apart with red hot knives. The midwife immediately pressed the emergency button and examined me.

I looked down and had never seen so much blood in my life, I started to panic, all I cared about was my son being born alive. The consultant was in the room in less than 30 seconds, and before I could say anything I was being whisked into theatre.

My uterus had ruptured and taken out my placenta at the same time!

I can remember being told they would have to give me a general anaesthetic as they needed to act fast to save us both, I can also remember screaming at them to save my son. I didn't care what happened to me. Then it went black.

My son was born at 8.34am with an Apgar of 9, which is incredible considering the circumstances he was born in, and testimony to the speed and efficiency of the doctors. I didn't get to meet him until several hours later as they had to continue working on me once he was out.

Had I been at home, or even in a birthing unit without immediate access to a hospital then we would both had died. Once the uterus ruptures medical staff have just a few precious minutes to save the life of your unborn child, and then limited time after that to save you!

With a 1 in 200 chance of this happening I can not understand how anyone would want to take the risk and have a HBAC. I know that people have done it successfully and they continue to campaign for more women to try. But really? You may as well take a 200 shot revolver with two bullets (one for your child and one for yourself) and then play Russian Roulette.

It's simple math! More and more mothers and babies will die if the HBAC campaign continues, I've read the stories of mothers who have lost their babies due to Uterine Rupture and its heartbreaking!

I'm one of the lucky ones, and as I look at both of my boys I count my lucky stars that we are all here today!

So HBAC? Would you really want to take that chance with your childs life? I know I wouldn't!

Bella xxx