On the whole, I appreciate Dorothy Wickens' article in the September issue of Minnesota Parent called "Give Birth Your Way." Ms. Wickens presents all the options: home birth, midwives, birth centers, hospital births, c-sections, and doulas. I was initially happy to see that home birth was first on the list as a legitimate choice for birthing women. However, I was unhappy to see this sentence in her discussion of who shouldn't choose a home birth: "Mothers with high blood pressure or diabetes or who have had a cesarean section or other uterine surgery are more likely to experience complications during labor and should not give birth at home" (emphasis mine). Previous c-section is, quite frankly, not a reason to exclude women from home birth.
The complication she refers to is no doubt uterine rupture. Although it's true that women who have had a c-section or other uterine surgery are at a higher risk for this, it is extremely rare - less than 1%. This is not to say that the risk should not be taken seriously, but good home birth midwives know how to recognize the signs, are often more closely monitoring the mother and baby's well-being than would be done at the hospital, avoid unnecessary interventions (such as pitocin augmentation) that have been linked to increased risk of rupture, and have plans in place for transfer to the hospital if need be. Every birthing woman faces risk - whether they have had a cesaren or not. Lots of things can go wrong during labor. To say that women attempting VBAC should unequivocally avoid birthing at home is misguided. Every woman who seeks to VBAC needs to make her own decision about where it is best to birth her baby, whether in the hospital or at home. Both home birth and VBAC are reasonable choices to make based on the evidence.*
In fact, an increasing number of women nationwide who desire VBAC are choosing to birth at home because they cannot find supportive providers, are unwilling to submit to unnecessary interventions required by hosptials and doctors in order to VBAC, or who prefer to stay away from the hospital given their previous experiences there. Even the American College of Obstetrics and Gyencology (ACOG) recognizes this trend in their August 2007 legislative update on "lay" midwives and home birth. ACOG notes, "The situation with hospitals declining to do VBAC deliveries has complicated our advocacy efforts on midwives. ACOG Fellows in California, Washington and other Western and Rocky Mountain states report that women are seeking out alternatives, including home birth with midwives, in their desire for a VBAC." Of course, being a trade organization for doctors, ACOG is none too happy about this trend, but that's a whole different post...
*See Best Evidence on the Safety of VBAC and The Medical Literature on the Safety of Home Birth.