Homebirth VBAC

Jana Stump

Homebirth VBAC

Hi Henci,

I have read through several of your forums and noticed you do rec. waiting 15 months to conceive after a csection to allow for a better chance of vbac success... my question is I conceived 13 months post section but miscarried 1 month later on... I conceived again 15 and a half months post csection.  My question is did the miscarriage (natural) put extra stress on my uterine scar? And also since I did end up pregnant again after the 15th month mark, but only by a few weeks, am I in the low risk .5 percent chance of rupture or do I fall into the 1-3 percent... I am thinking of a homebirth and would rather be in the .5 percent category. I am also wondering if the miscarriage could up that risk with added stress of contractions during the miscarriage. I feel like homebirth is my only choice besides induction because with my first baby I did not go into labor until 42 weeks and 4 days (refused induction) and I know I would be under too much pressure to be induced this time. Do you feel it is reasonable to attempt a homebirth with this history or do you think the risk or meconium and rupture might be too high? There was meconium with my first birth... I hope this isn't asking too many questions.. Thankyou so much for your time.

Henci Goer

RE: Homebirth VBAC
(in response to Jana Stump)

I'm actually just reporting what the research has to say about the association between scar rupture in a subsequent pregnancy after cesarean and length of time between the cesarean and, depending on the study, the next conception or the next delivery. Unfortunately, that means I can't be of much help to you since I am not aware of any research on how an intervening miscarriage might affect matters. The best I can do is tell you that investigators theorize that the reason scar rupture rates go up with a short interval between the cesarean and the next labor is because the scar takes time to heal. I don't know that this gets you much further, though. 

One thing that might help you make your decision is to find the hospital-based care provider in your community who is the most supportive of VBAC and have a heart-to-heart with her or him about your concerns, including that since you seem to run long pregnancies, you are worried that you might be pressured to agree to a repeat cesarean. I say "repeat cesarean" because most clinicians are leery of inductions when a woman has a uterine scar. The research shows that nduction can increase the risk of scar rupture. (FYI: it doesn't necessarily, but that is a post for another time.) Then see what this person says.

~ Henci

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