Home Birth After C-Section: Deciding Between HBAC and Hospital Birth

Home births are becoming more common, especially home birth after Cesarean (HBAC). Laboring at home is common, but more and more parents plan to stay home for the delivery itself. 

In 2017, almost 1.4% of births in the U.S. happened at home or a birth center, up by 50% since 2004.

I suspect that home birth, especially VBAC at home, will prove to be even more common when the data for 2020 is released. COVID-19 precautions and hospital restrictions are leading more people to choose home birth during the pandemic. 

VBAC home birth faces a lot of scrutiny, mostly related to the risk of uterine rupture. So, how safe is home birth after C-section? What are the risks involved? Is it the right choice for your birth? 

In this article, we will get into all the details, so you can make an informed decision on where to have your VBAC.

Originally published January 29, 2019, this article was updated and republished on January 22, 2021.

How Safe is VBAC Home Birth?

A 2019 peer-reviewed, published, and registered meta-analysis of twenty years worth of studies on home birth containing roughly 500,000 parents showed:

Low-risk parents who have a hospital birth have no difference in the overall birth outcome than low-risk women who have a planned home birth. 

The analysis also showed that parents birthing at home have fewer medical interventions and fewer Cesareans. 

With that being said, there are no current, conclusive VBAC homebirth studies to date. There is not enough data to compile showing how those risks compare specifically for VBAC parents. 

It is important to note that having a prior Cesarean delivery does not put you in the high-risk category. However, the meta-analysis does not specify whether those attempting TOLAC were included in the findings or not. 

Overall, planned birth at home is at least as safe as a planned birth in a hospital, as long as the following four criteria are met:

• The woman has a low-risk pregnancy.
• Home birth is chosen, planned, and prepared for.
• The care provider involved is qualified and experienced in home birth.
• The home birth plan includes a backup transfer plan in case of emergency.

Risks of Home Birth After C-section

As with all things in birth, there are risks associated with choosing a VBAC home birth. One small study showed that those attempting HBAC had slightly higher instances of blood loss, infection, and NICU admissions compared to those without a prior Cesarean. However, the study is over ten years old and not large enough to provide conclusive data.

There is no peer-reviewed, scientific data to show whether HBAC carries more risk than home birth for those without a prior Cesarean.

Benefits of Home Birth After C-section

More recent studies have found that when compared with planned hospital births, planned home births are associated with:

• Fewer maternal interventions
• Fewer inductions
• Fewer instances of augmentation of labor 
• Reduced use of epidural analgesia
• Less chance of having an episiotomy 
• Fewer operative vaginal deliveries
• Fewer Cesarean deliveries. 

There are also many intangible benefits for those choosing home birth. Birthing in a comfortable and familiar location typically allows parents to feel more empowered during birth. At home, parents have more control of the things that happen to them. They have comfort and connection to the place they are giving birth in. 

Home birth is also associated with significantly lower medical costs. 

A common misunderstanding about home birth is that the attending midwives are not as trained and skilled as OBGYNs in a hospital. On the contrary, in the United States, Canada, Europe, and some other parts of the world, midwives have to participate in extensive training, schooling, and education on pregnancy and childbirth. 

The main difference between an OBYGN and a midwife is that OBGYNs are trained surgeons. 

Both types of providers are trained and able to safely and expertly deliver your baby. The exception is that midwives cannot perform a surgical delivery. Midwives know when hospital care is necessary, and they will facilitate a transfer of care to an OBGYN when you need it.

Midwives are required to attend hundreds of births, prenatal, and postpartum visits before they can practice independently. They are trained on how to handle obstetric emergencies. There is even a national standard of practice for midwives and hospital care providers to follow on transfer of care either during pregnancy or birth.

Choosing Between VBAC in Hospital or at Home

Choosing between a home birth or hospital birth for your VBAC is a very personal decision. What one person considers a pro may be a con for someone else. 

Below are some common reasons people decide on a home birth or hospital birth, but remember that these benefits have a lot to do with individual perception and personal experience. 

You might choose a hospital birth if you:

• Want to have immediate access to interventions
• Are at increased risk for certain complications
• Feel safer in a more medicalized environment
• Want to have an epidural
• Have a provider who fully supports you there
• Want to have continuous fetal monitoring
• Want to have immediate access to specialists or emergency care if needed
• Your health insurance only covers hospital birth
• Are high-risk

You might choose a home birth if you:

• Want to have complete autonomy in your care
• Had a traumatic experience at a hospital
• Desire a natural birth
• Do not want common medical interventions
• Want a water birth
• Want to have more freedom of movement during labor and pushing
• Want to give birth in a comfortable, familiar place 
• Have the desire to know and choose who will be at your birth
• Have a trusted provider who is skilled in homebirth
• Have a solid backup plan in case a transfer is necessary
• Have flexible health insurance or can afford the upfront cost
• Are a low-risk pregnancy
• Have religious or cultural preferences

Planning a safe and comfortable VBAC at home or hospital

Ultimately, the birth location choice should be based on what makes you feel safe and an environment where you can trust a confident provider.

You can do many things to make your birth space more cohesive with your needs, no matter where you give birth. Some suggestions include:

• Hanging up pictures or affirmations in your birth space
• Lighting candles (LED candles only for hospitals)
• Dimming the lights
• Wearing your own comfortable clothes
• Creating a quiet space or having your music or a custom birth playlist in the background
• Hire a doula to help with physical comfort and emotional support
• Create a home birth plan to share with your doula or midwife

Talk with your birth partner or doula to see what else you may want to implement for your birthing time. We also have lots of tips you can share and discuss with whoever you choose to take on the role of labor coaching.

How and where you give birth is YOUR decision, and you can find someone capable of supporting you no matter what your desires are.

Unassisted home birth after Cesarean

An unassisted delivery is when a mother gives birth to her baby without seeking help from a medical professional. There is not enough data on how many parents choose an unassisted birth or free birth. However, the number of parents choosing this option is growing due to a lack of support and restrictive hospital policies. 

Some parts of the country have VBAC bans, meaning if you want a VBAC vs. a repeat C-section, you can’t find a hospital that will support your choice. In some parts of the world, home VBAC is illegal. 

Restrictive policies and laws put parents in a challenging position. Some feel forced to choose autonomy over their care and give birth alone to avoid a situation they do not desire or feel safe in.

Sometimes unassisted births happen by accident. We love the story on episode 32 of our podcast about Erin, who was planning a hospital VBAC with her son’s birth.

Her episode will leave you on the edge of your seat as she walks you through the full story of how her sweet boy had a plan of his own and decided to come into this world not only at home but with only Erin present.

Her husband, cousin, and doula all handled things perfectly. Having an unassisted HBAC was not Erin’s plan, but we are so grateful that everything turned out so well.

VBAC Home Birth Stories to Get Inspired and Learn

We have a playlist of both home and hospital VBAC on our YouTube Channel, where you can watch videos of births in each location. Be sure to subscribe to get new content as soon as it gets released.

For more inspiring HBAC stories, head to our podcast page and search for the term HBAC in the podcast player. It will pull up a playlist of all our HBAC stories to listen to and get a feel for whether you want to go that route.

Want to learn everything there is to know about VBAC before your big day? Register today for our Ultimate VBAC Prep Course for Parents!