VBAC/HBAC and TOLAC

VBAC (Vaginal Birth After Cesarean) and HBAC (Home Birth After Cesarean) are two acronyms I'm seeing/hearing with increasing frequency.  I'm also, unfortunately, hearing a new one - TOLAC (Trial Of Labor After Cesarean).

Increasingly, many hospitals are no longer offering women VBACs due to the American College of Obstetrics' recent recommendation that hospitals not offer VBACs without an anesthesiologist and surgeon on staff. Financially this inhibits many rural hospitals from serving women in this way even when they want to, as it opens them up to additional liability if they do. For this reason, I am getting lots of calls from women who are not willing to sign up for a repeat Ceasarean section and feel a HBAC is their only viable alternative.

Hospitals who do still offer VBACs no longer call them VBACs; instead they call them TOLACs which, in my mind, sets women up for failure as it doesn't positively reflect that they will succeed. This makes me angry. While I am always more than happy to offer homebirth as an alternative, not all women are suitable candidates, and this will leave them out in the cold.

What are your thoughts on this?

Benefits of Homebirth

Through my months of searching, I compiled this list of many of the benefits of a homebirth. I hope it proves useful to you.


A Comfortable Environment is a Safe Environment
In the comfort of your home, you are relaxed and at ease. The midwives attending you have spent much time getting to know all about you and what will support you through the birth process. You are intimately cared for and, in this setting, many of the interventions used in the hospital are not needed; simply because the stable, comfort of your home creates an environment where you feel safe and uninhibited and this allows the flow of labor to progress naturally.

Reduced risk of Cesarean Section
You have a one in four chance of having a c-section in the hospital, compared to 1-5% at home. Cesarean section carries a greater risk of death than do vaginal deliveries.

No episiotomies
Hospital episiotomy rate is about 70-80% in North America. Episiotomies are almost always unnecessary and take longer to heal than do tears, as they penetrate through many layers of tissue. They may cause you much discomfort after labor, making it more challenging to nurse your newborn.

No pitocin
Used to induce labor, this synthetic hormone can increase the pain of contractions, causing you to cry out in desperation for an epidural. When you're given pitocin, your body is unable to release the natural endorphins that help you cope with the sensations of labor. Without these natural pain relievers, bonding between you and your baby may not be optimal.

No epidurals
Epidurals come with many side affects. To start with, they rob you of the full birthing experience. You are less able to push and help the baby along, and when the baby does come, you are in a drugged state and not able to make that full connection with your newborn. Also, epidurals may leave you with headaches or prolonged numbness. They make your newborn sluggish and drowsy, making it more difficult to nurse. Without this pain killer, you'll find strength you never knew you had and be triumphant in this rite of passage.

Position Choices
In a hospital, you are generally asked to birth in a position that is most convenient for the doctor (usually on your back). At home, you are free to walk around and chose the positions that are most comfortable for you and most effective at getting your baby out.

A safe environment for your immune-suppressed newborn
The chance of your baby contracting an illness at home are far less than in a hospital.

The umbilical cord is cut only when it stops pulsing
Premature severance of the umbilical cord cuts the flow of oxygenated blood to the baby before the baby has established the lungs as the source of oxygen.

Baby is allowed to nurse immediately
Rather than having your baby taken from you moments after you deliver for routine examination and bathing, which are unnecessary procedures at this time, your newborn is immediately placed on your warm chest, next to your heart, where s(he) belongs! Bonding and breastfeeding begin naturally and without interruption.

You are the center of attention
Your midwife will not be watching the fetal monitor screen while you are laboring, she will be tending to you and doing all she can to make you comfortable and help you progress in labor.

You have the option of giving birth in water
Submersing yourself in warm water is an amazing way to ease the pain of contractions. It also gives you a greater sense of privacy and allows you to move with the contractions, helping your baby in his/her descent.

You create the mood
You can create a setting of low lights, calm peaceful music and choose who is in the room with you. You are in a familiar place with the people you love – just the way you want it.