Homebirth after Cesarean: The Myth and the Reality

“Homebirth after cesarean” is a phrase that garners mixed reactions—most of them negative. “Why?” or “Are you insane?” they ask. The people who make these comments, however, usually have no idea about the realities of birth in the US. My phone rang one afternoon. It was a woman looking for a care provider to attend the birth of her next child at home. I offered to send her the midwives list. “I won’t go back to a hospital unless I am unconscious,” she told me. I gave her the name of the one midwife in the area who attends women who have vaginal births after cesarean (VBAC) at home, wondering why the caller was so adamant about avoiding a hospital. The next day a friend called and asked me to do a presentation at the next International Cesarean Awareness Network (ICAN) conference on homebirth after cesarean (HBAC). “Sure,” I said. “No problem.” After I hung up and realized that I knew little about the issue, I thought what a coincidence it was that these two calls came in a day apart. But was it? Why is this issue controversial? We used to think that women who have cesareans should continue to have them. Then, in part because of the women who wanted better births, VBAC became a reality in the 1980s after research showed that the risks for birthing vaginally were not as high as previously assumed. Under this backdrop, ICAN was formed. More recently, flawed research reset the protocols and VBAC once again became rare. In the midst of this confusion women are seeking to have not just VBACs, but HBACs. What’s going on? Has the world gone insane? On the contrary, women are simply learning late in the game to demand the type of birth they should have had in the first place. They are also learning that their chances of a successful VBAC in a hospital are slim. So is it reasonable to have a homebirth after cesarean, or is the risk just too great?