Considering an HBAC? Here’s what experts want you to know

The birthing process is such a deeply personal experience. And just like each child is unique, no birth experience is exactly the same. Sometimes labor follows similar patterns as previous pregnancies, but as many seasoned mamas will attest, it’s also possible to have two (or more) very different birth stories. These stories can be magical and profound, while others can leave you disappointed or even grieving if your birthing experience didn’t go as you’d hoped.

Mamas with unplanned (and even planned) C-sections may feel this sense of loss intensely, so many look for ways to reclaim their birth experience by having a vaginal birth after cesarean (or VBAC). Some take this even further and consider a home birth after a cesarean (HBAC). Trying for an HBAC can be incredibly empowering, but as with any birth story, there are essential things to consider for the safety of mama and baby.

We asked two experts to weigh in on the topic of HBACs—Marieme Mbaye, MD, FACOG, a board-certified OB-GYN and medical director at Noula Health, and Shiela VanDerveer, licensed midwife, writer and birth educator—to help you make an informed decision.

Why do people consider HBACs?

Trying for an HBAC can be a way for some women to reclaim control of their birth process. “Even when cesareans are clinically necessary, birthing people can still feel cut off from their power based on how their providers did or did not behave, the respect they did or did not receive, and the explicit and implicit messaging they received through it all,” shares VanDerveer.

Everyone has the freedom to make their own choices about giving birth—and it’s important to note that not everyone who has a C-section feels a sense of loss about it. Still, for those who do, an HBAC birth can be healing, especially if there’s any fear about returning to the hospital. “It is stating through one’s birth choices that your body, your birth, and your baby are yours and that you have the right to claim them,” says VanDerveer. 

Is an HBAC safe?

Risks for VBACs and HBACs are higher than a vaginal birth for both mama and baby, but they can still be safe when mamas receive quality care from knowledgeable providers. “There are, of course, risks with any type of delivery,” shares Dr. Mbaye. “Generally speaking, vaginal births after cesareans should only be done in places that can handle emergency cesarean delivery and under the supervision of someone who could perform a cesarean delivery.”

Safety considerations include many of the same concerns surrounding any VBAC, like an increased risk of uterine rupture, but the primary concern is that should any emergency arise, how quickly can the mama and baby get care? “Labor is unpredictable, and things can change in seconds,” says Dr. Mbaye.

However, VanDerveer shares that safety concerns can (and should) be addressed by understanding the potential risks and making sure you feel confident with your care team, “Like in any conscious birth environment, one prepares mindfully and with great care, which includes the experience of knowing when and how complications arise and how to respond to them.”

Dr. Mbaye shares the criteria that make someone a good candidate for HBAC include having a low transverse incision, no previous uterine rupture, and no complications like placental issues. “Additionally, I would add that having had one or more previous vaginal deliveries and having had your C-section at least two years before (meaning 24 months between deliveries) are also positive factors,” she says.

3 factors to explore if you’re considering an HBAC

1. Be familiar with any laws or local regulations that limit birthing at home

Laws about homebirth vary geographically, so you’ll want to ensure you live in an area where HBACs are legally allowed and that your provider is comfortable planning one. This also includes identifying a hospital for an emergency transfer. “Certain hospitals do not support them, so you need to know where to go in the case of a transfer,” says VanDerveer.

2. Think about what you need to feel safe and supported

Self-reflection can also help guide you in the right direction. “Questions for HBACs are similar to any questions one may have when planning a home birth. They start with self-inquiry, then extend out to the midwives and other birth workers you want to co-create your birth with.” She first suggests identifying  what helps you feel safe and supported (and any fears) to make it easier to communicate those needs with your provider.

3. Choose an experienced, supportive birth team

Dr. Mbaye agrees that feeling supported by your birth team is essential, no matter where or how you decide to give birth. “It’s so important to speak to your provider before making a final decision. It’s also fine to get a second opinion if you feel like you need it,” she says. “We’re not mind readers, but we can do our best to help you have the birthing experience you want.”

If you had a negative hospital experience during a previous birth, she suggests discussing it with your provider, “If you’re worried about not feeling in control during a hospital birth, let your doctor know that and see if they have ideas on how to make the situation better for you.” You can also discuss ways to optimize your experience, decrease the chances of complications, and make a hospital transfer plan.

VanDerveer also encourages mamas to really understand and explore how much experience their provider has regarding HBACs, “Know your midwives’ experience, scope of practice, and ability to co-regulate with you not just in the birth but all along the continuum of the journey,” she says. In other words, experience matters—make sure your team knows what they’re doing and are willing to work with you to achieve your birth goals.

Exploring all birth options can help you feel empowered and informed

Ultimately, you and your provider can decide the best choice for your birthing journey. You should always feel safe and supported throughout the process, whether trying for an HBAC or having a hospital birth. “Trust your gut!” VanDerveer says. “Use your intuition and your heart in choosing your birth team.”