HBAC: Having a Home Birth after Cesarean Section

Why are so many moms now opting for a home birth after having a cesarean (HBAC) in a hospital? The reasons are as diverse as there are new mothers. It really comes down to individual choice.

Some prefer the support of a birthing coach in the comfort of their own home after experiencing birth in a hospital setting. Others wonder about the widespread use of interventions in a hospital and want better control of the kind of environment in which they will give birth. Whatever their reasons, many women are recognizing the value of birthing the old-fashioned way—at home.

Rate of Home Births Rising

The home birth rate is on the rise in the United States and has actually reversed the trend of decline through the 1990s, according to a report released in January 2012 by U.S. Centers for Disease Control and Prevention. The report showed that home births in America occurring outside of a hospital environment grew 29 percent over a five-year period, and represented nearly 30,000 births.

What Are the Advantages of Home Births?

Comfort and Care – Some benefits of home birth are privacy, comfort and continuing care from someone with whom the pregnant woman feels a close relationship, such as a midwife or doula.

Becoming more mainstream – Home birth was seen as a counterculture move not long ago, but now it’s becoming more commonplace.

Flexibility – People understand they are not limited: “It’s a woman’s prerogative to change her mind.” She can take advantage of alternative birth coaching and still give birth in a hospital if she so chooses.

Preferable for certain women – Women who are healthy and have a history of low risk for themselves and their unborn child are realizing that the hospital equipment and staff may not be needed in their particular cases.

What Are Some Objections to Home Births?

Concerns about safety - The biggest objection to home birth has been about the risk to the mother and infant, should something go wrong with a woman who has had a prior c-section.

Increased risk to the baby –"Although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth," according to the American College of Obstetricians and Gynecologists.

Pre-existing indications – For those who have medical indications that could benefit from what the hospital offers, or who have had a previous complicated birth, they may be at a higher risk of developing complications during the next birth. In this case she would likely be advised to give birth in a hospital.

Accessibility issues – If something goes wrong during labor at home, the outcome for the woman and baby could be worse than it would be if they were in the obstetric unit of a hospital with access to specialized care. A prior cesarean delivery increases the risk of uterine rupture (0.2% risk of rupture) and other complications. Women wishing to attempt a vaginal birth after cesarean will have ready access to emergency care in a hospital.

What about VBACs in a Home Setting?

“Safe and appropriate” – For those who want a vaginal birth after cesarean (VBAC), it is considered a “safe and appropriate choice for most women” who have had one prior cesarean, according to the American College of Obstetrics and Gynecologists.

Freedom from pressure – Some women may choose not to go back to a hospital due to concern that they will be railroaded into another cesarean. Their obstetrician may be hesitant to condone a home birth after a prior cesarean, citing risk factors.

Who Assists with Home Births?

There are several choices of home birthing professionals. They range from a midwife to a doula (specially trained birth companion who provides labor support). Having a doula at the birth has its advantages, according to results of a 12-year study involving more than 2,250 women in 15 trials from N. America, Europe and Africa. The study found that women cared for in labor by a doula, compared to those receiving usual care were:

  • 26% less likely to give birth by cesarean section
  • 41% less likely to give birth with a vacuum extractor or forceps
  • 28% less likely to use any analgesia or anesthesia
  • 33% less likely to be dissatisfied or negatively rate their birth experience

Benefits for baby

  • The baby will likely be less groggy and more alert after birth.
  • The baby might have an easier time latching on and breastfeeding.
  • The will not have narcotics or other medications in his or her system.
  • The baby may have a lower risk of fetal distress during delivery.

Benefits for mom

  • Although the debate continues, having a natural childbirth may lower the chance of having a c-section.
  • The mom can walk around, go to the bathroom, and change positions during labor.
  • She doesn’t lose sensation in her lower body and probably will not require a catheter.
  • There may be less chance of experiencing nausea, vomiting, dizziness or other side- effects associated with pain medications.
  • Mom will feel empowered by having natural childbirth.

There is a myth in America that cesareans in a hospital are just as safe as, if not safer than, normal vaginal birth at home. The trend of more women giving birth at home in the U.S. seems to be debunking this belief.

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