First I would like to say thank you for writing such an informative piece of information, everything I have read of yours has been based on medical research and facts not tradition. I have a question about the risks associated with a VBAC. I've been told by 3 different care providers (a midwife, A CNM, and an OB/GYN) that I will be unable to labor and birth in a way that feels right for me. I'd like to be able to labor without constant EFM, walking around, and perhaps birth in the water if I'd like to. I've been told that I can't do this because my combination of a premature birth (he was born at 24 weeks due to infection) and a previous C section (due to my twins that were both breech at 36 weeks). I was told that I am majorly high risk, even though I've never had any other issues in pregnancy. I count both birth issues as isolated incidents, I feel like I do not have a chronic issue that would stop me from a VBAC. However, the birth of my first son was extremely traumatic to me, so much so that I've had to go through counseling to over come the effects of the emotional trauma (I was held down while a manual extraction was performed on me without my consent).

Well due to this situation I feel that my best option for my mental/emotional well being is a home birth. However, I would like to do this knowing that the risks are acceptable. I've read the post about the chances of rupture when a VBAC is performed 24 months after the C section without induction being 0.4% in recent studies. My question is how long it takes to bleed to death from a rupture. I am 11 miles away from the nearest hospital and I want to be sure that in the unlikely even of a rupture that I will have the possibility of surviving. Obviously, if the bleed out time on average is 4 minutes or something then this would be impossible for me to do. I also realize that the bleed out time is based on the size of the rupture and many other factors, I'm looking hopefully for resources and studies about this. I care the most for my child and want to do what is best for her while balancing my emotional needs.

Thank you for your time and help with this!!

I am not entirely clear on your history. I think that you are saying that you had a vaginal birth at 24 wk for infection followed by a cesarean at 36 wk for twins. If that is correct, then you are at very low risk of the scar giving way. If you are trying to do a risk calculation, though, it would help if you could verify the nature of the uterine scar and whether the incision was closed with single- or double-layer suturing. (Single-layer suturing increases the risk of scar rupture as do scars other than low transverse.) That information should be in the surgical notes. It might also be helpful to see if the most congenial of the clinicians you have spoken with can give you any further information on why you can't do things the way you would prefer. Is there something specific about you or is that just their standard practice for VBAC labors?

That being said, scar rupture in labor will require a repeat cesarean, probably fairly urgently, but only 6% result in the baby's death, according to a recent massive systematic review of VBAC, although, of course that percentage comes from pooled data from VBAC studies, most of which took place in university hospitals with 24/7 emergency cesarean capability. No woman died secondary to scar rupture in any of the studies included in that review, and, unfortunately, the same was not true of women having elective repeat cesareans. So this is to say that if you have a qualified home birth attendant, who follows the fetal heart rate (fetal distress being the most reliable symptom that something has gone wrong with the scar), and you and she were pay attention to other possible symptoms such as unusual pain or bleeding, then even with a scar rupture, in the vast majority of cases you and the baby would survive, and the baby would survive intact . There's no guarantee, though.

This brings me to your PTSD. Even if you plan a home birth, the reality is that you may end up needing to be in the hospital. I recommend going back to your therapist to come up with strategies for maximizing likelihood of a positive experience and minimizing likelihood of another traumatic one. You may find Solace for Mothers, an online peer support organization helpful as well.

~ Henci

Henci,

You are correct about my history. Also, I know I had a bilayer closure. It's good to know that my risk is very low. Thank you!