HBAC The Sinister Truth and myths debunked - Follow up to my anti HBAC post Part 3 of 4

I've done a lot of reading the last few days in regards to HBACs and studies conducted which has helped me greatly in writing this post.

I don't want to sound like an extreme anti HBAC protester, but the facts and the truths are out there when you look for them. Unfortunately most women and blinded by their desire for a natural home birth that they don't read enough into it and find out all of the facts.

If you are considering a HBAC then please read all of this post, follow the links and read those as well, then you can at least make an informed decision on what you want to do. It's also worth remembering that with a HBAC you are three times more likely to lose your child than you are with a hospital VBAC.

HBAC Vs Hospital VBAC

Most of the HBAC advocates and site will often tell you that a HBAC birth is just as safe as a hospital birth. They will also tell you that you are less likely to suffer complications with a HBAC than you are in hospital.

Whilst it may be true that you will probably suffer less complications (its a known fact that women left to their own devices in a comfortable environment will labour easier than those being interferred with), you can also labour in a hospital with a Doula and no intervention (unless there are problems that may affect the life of your child or yourself).

It is NOT true that home birth is as safe as a hospital environment, and that's not just in regards to HBAC either.

You may have been told that plenty of studies have been performed to show that home birth is as safe as a hospital birth. However were you told which country these studies were performed in? You can't use facts unless they apply to your country. Bear in mind the UK and the USA have different training requirements for maternity staff and health care systems in place that other countries do not have. You can't compare these studies when you take into account the fantastic healthcare system we are fortunate enough to have access to.

In face there have been studies on home birth in the USA, and all of them show that with a home birth the risk of ending up with the death of a baby is tripled when compared with a hospital birth.

The latest study (from the Midwives Alliance of North America) was conducted in 2014 (yes it really is a recent study) has been brilliantly surmised in an article on babymed which was written to debunk a claim that homebirth was safer than a hospital birth. Have a read of it here: http://www.babymed.com/blogs/danielle-repp/press-release-wrongfully-claims-home-birth-safe

To quote from the article:

"A baby is 3 to 6 times more likely to die at a home birth than in a hospital"

How can anyone even consider a HBAC when you take this into account? This is not about a womans right to labour in her own environment, this is about the right of your unborn child! The right that child has to be born alive!

The Skeptical OB also sums it up wonderfully in her article below:
http://www.skepticalob.com/2014/01/homebirth-midwives-reveal-death-rate-450-higher-than-hospital-birth-announce-that-it-shows-homebirth-is-safe.html

To quote from the Skeptical OB:

"To summarize, the MANA statistics show that homebirth as practiced in the US has a death rate 450% higher than hospital birth"

Another article that I reccomend reading from the Skeptical OB is 'Another HBAC, Another Rupture, Another Baby Dies'

http://www.skepticalob.com/2011/06/another-hbac-another-rupture-another.html

"How many dead babies is it going to take before homebirth advocates realize that they have absolutely no idea what they are doing, and that precious babies are dying preventable deaths as a result of their arrogance and ignorance?"

There are so many articles out there that the advocates don't want you to read. If you have time (and I urge you please make time ) please read the following articles/stories:

Homebirths linked to a higher rate of infant deaths: http://www.livescience.com/43050-home-births-newborn-death.html

Home birth after Caesarean: http://www.babymed.com/blogs/danielle-repp/hbac-home-birth-after-cesarean

Critique of homebirth: https://www.sciencebasedmedicine.org/a-critique-of-the-leading-study-of-american-homebirth/

Apgars in relation to birth setting: http://www.ajog.org/article/S0002-9378(13)00641-8/abstract

Perinatal outcome in relation to homebirth: http://www.ajog.org/article/s0002-9378(13)00630-3/fulltext

NB: In regards to the studies used they were all based on planned Home births with a midwife present. Accidental home births were not included as this would have swayed the data.

But My Midwife Assured me that she/he carries everything they need to cope with an emergency...

I've seen this in a lot of HBAC forums, women are being misled in regards to the safety of their labour.

Yes a midwife will carry certain items which will help with some complications that may arise but they are not equipped for all eventualities.

Yes a midwife will call for transfer to hospital in an emergency - but often this can be time consuming and if you suffer a rupture or haemorrhage then you need to be in theatre within 18 minutes to save the life of your child. Bear in mind it will take at least 5 - 10 minutes to get you out of the door and into some form of transport, then take into account journey time, getting out at the other end and the other factors that come into play when transferring. Unfortunately even for those living close to a hospital the transfer time is too long to save the life of the baby in a lot of cases.

What happens if your baby is born with breathing difficulties?  Can your midwife ventilate and intubate your baby? Unfortunately they can't do this, and a transfer is required. Again often transfers for this complication are not fast enough and you risk the life of your child or serious brain damage due to lack of oxygen.

There are hundreds of situations that can occur, and whilst your midwife is prepped for some he/she is not prepped for all of them.

Many Thanks to 'Doula Dani' for the following lists and exert that I took from her blog.

"Home birth midwives carry with them certain items to use in case of an emergency - b/c no matter how low risk a mom might be, emergencies can and do happen in childbirth and as such, they need to be prepared. I've heard or read many, many times from mothers/fathers/couples that have chosen home birth (or freestanding birth center) that “their midwife carries with them all the necessary equipment in case an emergency arises.” So I want to present a clear cut list for each setting of the equipment available in case of an emergency.

There is a slew of equipment needed and provided in both situations that I am not going to get into - such as gauze pads, chux pads, sterile gloves, etc. What I'm focusing on is the equipment used either to detect issues or for life saving measures."

Here's what a (typical) certified home birth midwife will bring with her to a home birth:

• Fetoscope or Doppler (or both) - to detect the heart rate of the baby
• One oxygen tank
• Infant mask (used with oxygen tank)
• Adult mask (used with oxygen tank)
• Blood pressure cuff
• Suturing items - to stitch tears for the mother
• Thermometer - to check for fever for mother, which can indicate uterine infection
• Lidocaine - to numb mom locally while she is being stitched up
• Pitocin - in case of postpartum hemorrhage
• Methergine - in case of postpartum hemorrhage
• Bulb syringe - to clear airways of the baby, especially in case resuscitation is needed
• IV equipment - if mom needs antibiotics in case of GBS or prolonged rupture of membranes
• Pegnancy and labor records and charting, including blood type - in case of transfer, to ensure accuracy and increase speed
• A midwife may or may not have an assistant with her
• Midwife should be current in the following skills:
• Neonatal Resuscitation (chest compressions and mouth-to-mouth)
• Basic Life Support (some may have Advanced Life Support training)

"I would ask your midwife ahead of time to make sure she carries (at least) these above items and has (at least) those certifications. The items should be in good working order, drugs should not be expired and midwife should be very familiar with exactly how to use each of these items and medications. Be your own advocate! Don't be afraid to ask questions ahead of time.

Now keep in mind, if the midwife is not certified she will not have access to things like Pitocin (or any medications), Oxygen, an IV, etc or any item that could get her in trouble with the law for practicing medicine without a license (at least, she will not have legal access to such items).

Ambulance:

A Paramedic will have the knowledge, skill and certain equipment to be able to help in the case of an emergency. However, while a Paramedic can certainly provide life saving support, they should not be considered a fool proof back-up plan. Quoting a Paramedic: “We can do neonate intubations but we do them SO seldom that it’s not a skill all medics are up to par on. This goes for babies & pregnancy in general. In an emergency childbirth scenario where minutes can make the difference in life and death, NOTHING in an ambulance can save a baby; it can only be a very temporary bandaid while we drive as fast as we can to the closest hospital.”

Response Time:
In a non-emergent transfer, travel time or response time will likely not be an issue. However, being "5 minutes from the hospital" may not be close enough when minutes can make the difference between a perfectly healthy life and death or neurological damage or injury or blood loss resulting in a transfusion or hysterectomy. Regardless of the scenario, emergency or not, a home birth transfer will take much longer than 5 minutes to get a laboring woman in her home (or birth center) to a hospital, in the right hands at the hospital, admitted, monitored and ready for a doctor to deliver a baby.

Hospital:

• All of the above listed home birth equipment and medications, plus…
• Electronic Fetal Monitor (EFM) - this detects the baby’s heart rate and the contractions. EFM vs Doppler gives nurses a much clearer picture of the baby's heart rate to make sure baby is getting all the oxygen baby needs. Heart rate variability is normal for the baby but it's important to know when changes to the heart rate occur in relation to when contractions happen. A heart rate of 155 BPM might sound healthy and wonderful when checked every 10 minutes or so but with decels at the end of a contraction, it can be a serious sign of distress. The decels may be so slight that unless you are looking at a print out (the EFM strip), you would not know they are happening.
• An endless supply of oxygen
• Cytotec - for postpartum hemorrhage
• Vacuum and/or forceps (though forceps are not common anymore) - if the baby’s health depends on immediate delivery, a vacuum can be used to help guide the baby through the birth canal while the mother pushes
• Blood Bank - for postpartum hemorrhage requiring a blood transfusion
• Operating Room and all personnel needed for an emergency c-section or for postpartum hemorrhage treatment/surgery (see Sara's birth of her son - an emergency surgical repair saved Sara's life after she suffered a cervical laceration; see Amber's experience as a doulaand Becky's birth of her second child - immediate emergency c-sections saved the lives of those two babies)
• Ventilator - a machine that facilitates breathing (see Christine's Birth Story of Baby Penelope and how a ventilator saved her daughter's life when she was born)
• Specialized diagnostic equipment and staff
• A skilled team of nurses and doctors that are current in the following skills (these skills are frequently used either on the job or through hospital drills):
• Neonatal Resuscitation
• Advanced Life Support
• Intubation (and obviously the equipment for such) – provides a much more effective way to oxygenate a person (of any age) compared to resuscitation

Also keep in mind, to be trained in Neonatal Resuscitation or Life Support every few years and practicing only on a dummy is very different than using those skills on-the-job in a true emergency, on a real mother or baby. In a hospital, you have other sets of eyes and hands to help, to shout direction or take over in case someone freezes or forgets under pressure, you have a back-up for your back-up for your back-up. They will be able to tend to baby AND mother at the same time, if needed.

From a nurse midwife student: "Not only is there a team full of certified, competent people, but in a hospital, they are running dystocia drills or practicing for other obstetric emergencies. These are people who have practiced working together, who have assigned roles, and in addition to all the drills, have seen their share of real emergencies. They not only have a pediatric and adult code teams, but depending on size and type of hospital, they may also have OB rapid response and code teams as well,as they do in my hospital. It's a well oiled machine."

Nurses will keep a watchful eye on mother/baby in the hospital not just during the immediate postpartum period but for the length of their stay, checking vitals and looking for signs of infection, breathing complications, arrhythmia, postpartum hemorrhage, seizure, undetected birth defects, etc.

It is true that an Operating Room may or may not be available immediately when an emergency c-section is needed. In some cases, a doctor can have a baby born via cesarean in less than 5 minutes, including travel time from the Labor and Delivery Room to the Operating Room. In other cases, it may take longer depending on the availability of the Operating Room, anesthesiologist and obstetrician. However, the added commute from a home or birth center will certainly not help facilitate a c-section any quicker – in addition to travel time, the hospital must do its due diligence to admit the mother and monitor the baby and mother before performing any emergency surgery. "

I stand by my opinion that HBACs carry a much greater risk than a VBAC in a hospital environment. There are so many factors that need to be taken into account. 

Yes it is your body, and yes you should trust it. But you should also plan for any eventuality. I can not imagine the pain that a mother would go through from losing a child, and I wan't to do as much as I can to prevent that from happening.

So please before you decide to go ahead with your HBAC, think about the risks, and take a moment to think about your unborn child and what would happen if you hit a serious complication. I've read so many heartbreaking stories in regards to women who have lost their babies via HBAC and VBAC in a birthing centre rather than a hospital. 

Annas Story (will bring you to tears) She lost her precious baby due to Uterine Rupture: http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2014/4/7/annas-uterine-rupture-story.html

I know I can't change the minds of some people in regards to HBAC, I'm just a mum afterall who had a failed VBAC and thanks her lucky stars every day that the outcome was positive. But if I can save just one life then that's all that matters.

I also want to add that I don't blame any of the mums who lost their babys through failed HBACS. They are innocent in a world of advocates brainwashing women that this practice is safe. I am 100% sure that if these mums knew all of the risks that they wouldn't have gambled their childs life. It's not something we do as mums. I blame the advocates and the fact that this has yet to be outlawed.

If you are a mum who has lost their baby - please don't blame yourself, instead focus on educating other mums on the dangers of HBAC. Lets work together to save lives so that your precious angels can look down knowing they have done what they came here to do. 

Much Love

Bella xxx

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