VBAC - Public vs Private

Hi Everyone,

I just need to get this off my chest as I am feeling very confused.

So I am due with baby number two late December. My first birth ended in a section. I am desperately wanting a VBAC, but ultimately a healthy baby and better recovery then my first birth.

I have been to see a pro VBAC ob at a private hospital. I left feeling excited and supported in my choice and decided at the time I wouldn't bother going to see other obs or hospitals. It is expensive to go private even with hospital cover which is making me question my choice. We are a single income family after all, that really should be saving that money. The things bothering me.

- There is the chance that he may not be there when I labour. What if I get an ob that will not support me the same way? What am I paying for if I don't get his care? That is after all why I am choosing him!

- Should I go and make an appointment with the public hospital to see what their support would be like? But again it can differ per ob.

- If I go public I can afford a doula but with private care our funds will be exhausted already so no doula.

- Private hospital is an hour away. Public hospital is half hour.

- Is private care really any better then public? Besides the rooms.

- maybe I m just feeling like this because a VBAC is 'unknown'. Doubt has been planted and it's my personality to worry.

I am just feeling so confused. I believe my body will labour well, I do know I will be affected negatively without the proper support though. Which is why I need to make the best decision.

I am not sure what I plan to achieve with this post, hopefully just to make me feel better. If anyone has any advice please post.

(Please note I am happy to have a cannula and be monitored - but only with wireless monitoring otherwise they can stick it)

Have you considered midwifery care as an alternative? It might be an option to have a private midwife at the public hospital, with OB backup if required.

You can ask your private OB about his backup OBs and their attitudes, etc. And making an apt at the local hospital makes sense, too. It's a good idea to explore all your options so you can get a good feel for them all before making a decision.

I don't believe private care is better, no, except that you may have more choice in determining who actually cares for you. (And this is often very important.)

Thanks onthefly. Unfortunately I had left it too late with private midwife as they are all booked out for births and can only do shared care. So won't be at the birth. Unless I have missed some midwifery groups in my area, I will search and call again I think. Thank you for your advice :)

My ob is in a practise with another ob and between them one is always on call. They are reasonably like minded and you always have at least one appointment with the other in case you end up with them. I would be finding out what your obs back up plan is and how well that person works for you.

Statistically I think public has higher rates of successful VBACs, but I would also think that unless you are with a midwife practise you would be seeing different midwives and obs and get whoever was on the day you go in. I personally rate seeing the same person throughout very highly, so would go with an option that offered that, whether that be the VBAC supportive private ob or a VBAC supportive midwife program. I personally wouldn't pass up a supportive ob for a 'normal' public hospital care model.

Do you know what the VBAC rates are at your chosen hospital? I would ask your OB that, and their own rates of successful VBACs.

My understanding is that the public system has higher rates of VBACs.

If it were me in your situation and I couldnt go ahead with a homebirth (HBAC) I would continue to call around your midwifery groups and really try to get one on board and go the public option.

So, a two pronged approach: ask your OB and the hospital for the VBAC rates and call those midwives!

Best of luck!

Thanks ladies. Sarges - yes your right that's my thinking. I don't want luck of the draw on the day, continuity of care if what I'm after that's why I went with this ob. Thank you for your input. Cassius2 - HBAC is not an option for me, as it's not something I personally would feel comfortable with and neither would hubby. I would love to think I could do it, but I would stress too much. 70% success rates with this ob for VBAC.

I have an appointment soon so will jot some questions down to ask him.

It's the unknown that is worrying me. I remember when I left his office last time I really did feel supported and excited to birth. I think maybe I am thinking about everything too much. I know what I want, so I should just focus on relaxing.

I would check out public too, I went public and they were very pro VBAC, put on special info sessions and there was never a mention of anything but VBAC - I never felt I had to 'fight' for it at all. I felt all there midwives and OB's (I think I only had to see one once apart from actual emergency c-section were on the same page. Yes there was no continuity guaranteed but most of my appointments were with one midwife and I only had two during the labor and then c-section(went over shift change). Not all public hospitals are the same but is probably worth checking out if only to commit in your mind you want to spend the money. (Any monitoring I had was wireless, lots of movement, showers, etc etc was all supported)

Saw my ob. Again left feeling happy and supported, felt like this was the right decision, he said he will be there for the birth and can't see why he wouldn't. Then I went to the labour ward and met some midwives - one asked if I would like to see the VBAC policy. That flawed me as that has never been mentioned to me. I said 'no thanks I'm not interested in the policies'. That will be a question I ask the ob next time. Was feeling great then that seed of doubt was planted.

Wysiwyg - yes I think I better see the public hospital too! Did they have a 'policy'?

It might be helpful to see the policies, and definitely chat with your OB about them. Why not call right away rather than waiting?

In terms of the cost... If you end up with another c-sect (emergency or breech etc), will you be kicking yourself that you paid all this money and still had a caesarean?

I had a VBAC (public) and now for third have chosen an elective c section. My views have hugely changed as my kids have gotten older and I've realised that labour is but one day (or two if you're really unlucky), and that parenting is about so much more.

I'm absolutely not trying to diminish how important it is to you. I just have been interested to see the change in myself and I'm glad I didn't go to huge lengths to get a VBAC (the actual labour was a different story!). Although, I am very fortunate to have birthed in one of the best birth centres around.

I would prefer to have a planned section in a private hospital so my DH can stay a night or two with me. So would be happy to pay the extra money. If I VBAC the costs will be much less.

Your right surprised parenting isn't about that first meeting or entry into the world :) . I just want it for me and to hopefully better afterwards. That's awesome you got to birth in a wonderful birth centre. No birth centers around here that accept VBAC that I know of :(

I'd call back and grab the policy :D you will want to read it and go through it all at home in comfort so that you can start to really visualise the space and not be floored if something comes up during labour that you werent quite expecting in terms of care/monitoring etc. it shouldnt be too complicated to go through and if you have concerns then you can flag them and bring it up in the appt with the OB (I know that i *always* forget to ask the right questions at those appts hahahaha).

I am so excited for you though! I would reckon that 70% success rate is actually pretty good. On another note, have you thought about other birth prep stuff? I know that i needed to do some prep for my second birth (as first was horrendous) and i went and did a calmbirth course...it was fun to do and I know that it can have application in any birth setting (including c-sect). it might be a fun thing to do to help you get in the zone. i love planning for births...cant you tell :lol:

Ha ha Cassius2, nope couldn't tell ;) . Thanks for being excited for me. I am excited also but need to get all this outta the way. Settle on a place and stick to it. I have looked at calm birth classes briefly, before pregnancy. I really must look again. Hopefully it's something I can afford. If not I will be searching out some wonderful videos or books.

Don't forget, hospital policies aren't laws. You can say no to anything you don't like, or insist on things like labouring in water etc.

Good luck :)

This is true, but I would find it hard saying no while in labour. Don't know how hubby would go either. Plus I don't really want this to be a 'fight'. I want to work out what I can now (though we all nature will do it her own way) and then focus on relaxing about this VBAC.

Did you have a doula with your VBAC forshelby. Did you manage to get into a birth pool?

Just came from the pubic hospital. Did hospital tour and then pulled the midwife aside. She was very supportive of VBAC and said that the ob's were all pro VBAC. She also said 'we have policies but are happy for you to say no, it's your birth not ours. If you've done your research and are happy to make these decisions then you should' then she did a fist pump. The facilities are just as good, partner can stay the duration unless your in a shared room which they don't have many of. My mission for this week - ring all private midwifery practices again, book official appointment at public hospital to have a proper chat.

I can't comment on the private side of things, but I had my VBA2C through the public system. I joined a midwifery group practice so I had continuity of care with my midwife and I hired a doula. I saw the OBs at the high risk clinic. Throughout my pregnancy I saw every single OB at the clinic, except the one who was on call the night I went into labour - typical hey?!

I can't recommend doulas enough!! Mine was amazing! Totally worth every cent.. whichever way you decide to go, I would def see if funds would stretch far enough for a doula (some may offer payment plans?). What was your first birth like? Why did it end in a c-section?

And just think - all that money you will save can buy you a nice family holiday down the track! :)

Glad to hear you've got some really good options either way.

Peekaboo - always the way! Congrats on your VBAC! We do need a doula, I hear nothing but good things. My first birth in a nut shell - PROM, long establishment to active, 12+hours active and no further dilation after the hospital interfered and scared my cervix into closing. I almost got to fully dilated. I can do it! Was your births all very different?

Thanks surprised!

I didn't have a doula, no. I took on a student midwife though and she was an amazing support for my antenatal appointments and she was there for the birth also.

Unfortunately for me, I ended up with a necessary cs for fetal distress. But I am glad about the decisions I made. I waited till labour started naturally at 42 weeks- the labour itself was awesome and I was supported and respected in my wishes. Definitely take the time to write a solid birth plan. Decide what is absolutely not negotiable (continuous monitoring, cannula on arrival etc were on my list of NOs).

I did get in the birth pool for a little while. Be prepared to remind people what your plans are. I was told 'no you can't use the bath, we don't recommend it for vbacs'. I laughed and told the mw to get the tub filling because it'll take a while. Lol. She did as I asked her. Ultimately, you are in charge.

I know you don't want to fight against policies etc but it's very important to know what you don't want to do and why. Eg- how x y or z will affect your chances of vbac. Research, know your enemy, and do everything you can to maximize your chances.

I found the most effective way to avoid arguments in labour was to keep it simple. They offered a VE. I said 'no. I like it in the bath.' They offered again. I said 'not now. I'll tell you when I'm ready. ' Be assertive NOW, before you're in labour. People are far less inclined to question you if you're pro-active about demonstrating your stance on their rules and regulations well ahead of time.

The best advice I have for you is to research evidence based care (not standard practice) make clear decisions, draw up a birth plan, assemble a (strong) support team, and leave the rest to nature. Trust in yourself, your body, and baby. Align the odds in your favour, and know that you did the best you could to achieve your vbac. And if not- you can still be proud that you advocated for yourself, and got the best possible outcome because of your determination and courage.

Xoxo

After reading the reason for your primary cs...... you can totally vbac! Perhaps add "Keep your hands and other instruments out of my vagina" to your birth plan though... hehe.

:)

Thank you for your reply forshelby and for your confidence in me. I think I can do it also :) ! I'm sorry your baby went into distress but I am so happy to hear your are happy with the decisions you made. That's fantastic you had an awesome labour. How did you find the birth pool?

It's not that I don't want to fight against policies. I just don't want the tension of feeling like I am fighting while I am labour, I want to get MY plan in action before and then hopefully have someone to advocate for me if need be.

Thank you for your advice. I do appreciate everyone's input.

Oh and I will be telling them to keep their hands out this time. I had a ridiculous amount of VE's last time. The first led to PROM. I was naive, but I am wiser now!

The pool (or rather gigantic bath) was amazing. I wish I stayed in there longer.

And I know exactly what you mean. Fighting in labour is impossible.

Hi ladies. Just thought I would pop in and update the thread incase anyone else ever wants to read it on their quest for a VBAC. I had a successful VBAC with a private midwife in public hospital. Can't recommend a private midwife enough. I don't doubt that without her support and advocating for me my birth story would be different. So glad I didn't go with the private OB.

H Rosie, I'm not stalking you, this came up in my sidebar :)

Didn't realise you had a VBAC. Well done you!

Have you written your birth story?

Ha ha turtledove :)

Thank you. It was everything I'd hoped it would be. I have written a birth story though I'm unsure wether I will post it online.