HBAC: Home Birth After Caesarean

Your birth, your choices

Experienced, supportive care for your HBAC

If you are considering a home birth after a previous caesarean (HBAC), one of the most important parts of my care is making sure you feel informed, prepared and supported throughout your pregnancy, labour and birth.

HBAC is a higher-risk home birth, so careful antenatal planning, ongoing assessment and a clear plan for transfer to hospital are particularly important.

My role is to support your choices while continually assessing the wellbeing of both you and your baby, and to recognise when home is no longer the safest place for your care.

HBAC is at home, but hospital care is there if we need it

HBAC means planning to give birth at home following a previous caesarean birth.

If at any point during your labour I have concerns about you or your baby, I will recommend transfer to hospital for further assessment or care.

Planning an HBAC doesn't mean pretending that hospital transfer won't happen. For me, good home-birth care means discussing that possibility openly and thoroughly before labour even begins.

Planning for transfer during your pregnancy

Because an HBAC is a higher-risk home birth, we will discuss transfer to hospital in full detail during your antenatal care.

I don't want the first conversation we have about hospital transfer to be when you are in labour and emotions are already heightened.

During pregnancy, we'll talk about why I might recommend transfer, the signs I will be looking for, how a transfer would happen, what you can expect when we arrive at hospital and how I can continue to support you.

This means that when you make your birth plan, you are making it with an understanding of the circumstances in which I may recommend that we change that plan.

If I recommend transfer, I will explain what I am seeing, why I am concerned and why I believe hospital assessment or care is the safest option for you and/or your baby.

The possibility of transfer will already have been discussed as part of your informed decision-making and birth planning, so it should not come completely out of the blue.

Of course, an unexpected change of plan can still feel emotional. I could never promise that transferring to hospital won't feel difficult or upsetting. But being prepared, understanding why it may happen and knowing what to expect can make an enormous difference.

And importantly, I come with you.

Your planned home birth becoming a hospital birth doesn't mean my support suddenly disappears. I can accompany you during the transfer and continue supporting you as you move into hospital care, helping you understand what is happening and supporting you to communicate your wishes and preferences.

Transfer isn't a failure of your HBAC. It is part of having a safe HBAC plan.

You can also read the NICE guidance on caesarean birth for further information about care and birth options following a previous caesarean

Knowledge is power

I truly believe that knowledge is power.

The more knowledge and information I can give you during your pregnancy, the more confident and empowered you can become in making decisions about your birth and your care.

This is particularly important with an HBAC. I want you to understand the benefits and risks, what I am assessing, what may cause me concern, when I would recommend hospital assessment and why.

My role isn't simply to make decisions for you. I want to give you the information you need to be actively involved in making decisions which feel right for you.

If circumstances change during labour, you shouldn't be hearing about these possibilities for the very first time. We will already have talked through them during pregnancy, giving you time to ask questions, understand your options and think about what matters to you.

The more you know, the more powerful you become in your own decision-making and your own care.

How I assess your caesarean scar during pregnancy

My assessment begins well before labour.

At your antenatal appointments, I will always ask you how your caesarean scar feels and whether you have experienced pain, tenderness, discomfort or anything else that concerns you.

I also assess the scar physically. I gently place my fingers across the scar and roll the tissue beneath my fingers, checking whether this causes tenderness, discomfort or pain.

This is one part of my wider clinical assessment. An external scar assessment cannot tell us with certainty how the uterine scar will behave during labour, so I don't use it as a guarantee that everything will be uncomplicated.

Instead, I consider your scar alongside your history, how you are feeling, your observations and the overall clinical picture.

What am I watching for during your HBAC?

During your home birth, I am continually assessing both you and your baby.

I am trained and experienced in recognising changes that may indicate that you or your baby need further medical assessment or a higher level of care.

That includes watching for things such as:

New, persistent or concerning abdominal or scar pain
Scar tenderness that concerns me
Your pulse increasing or becoming concerning
Other observations that aren't in line with what I would expect or want to see
Difficulty or inability to pass urine
Unexpected or concerning bleeding
Changes in your baby's heart rate which suggest that your baby may not be coping well
Changes in how you are feeling or behaving that cause me clinical concern
Any combination of signs or symptoms that makes me concerned about either you or your baby

I don't look at one symptom in isolation. I look at the whole clinical picture, including whether anything is changing as your labour progresses.

Recognising concerns early

An important part of caring for you during an HBAC is recognising when something isn't quite right before it develops into an emergency.

If your observations aren't where I would want them to be, your pulse is increasing, you're experiencing concerning pain or bleeding, you're unable to pass urine, or your baby's heart rate is showing signs that your baby may not be coping well, these are all reasons why I may recommend going into hospital.

Some situations may require an urgent or emergency transfer, while others may allow us to transfer more calmly for further assessment.

I will explain what I am seeing, why it concerns me and what I recommend.

The purpose of transferring isn't to take control of your birth away from you. It is because the clinical picture has changed and I believe that you and/or your baby will be safer receiving hospital assessment or care.

If your HBAC becomes a hospital birth

If we do need to transfer, I can continue to support you.

The location of your birth may have changed, but your need to feel listened to, informed, respected and involved in decisions hasn't.

I can come with you and continue to support you as you navigate hospital care. I can help you understand what is happening, support communication with the hospital team and help you express your wishes and preferences wherever possible.

Having already discussed these possibilities during pregnancy also means that we have a shared understanding of what matters to you if circumstances change.

Preparing for the birth you want, and for the unexpected

Planning an HBAC isn't about assuming something will go wrong.

It's about supporting your choice to birth at home while being realistic about the additional considerations that come with giving birth after a previous caesarean.

We can hope and plan for the home birth you want while also having a clear, well-understood plan for what we will do if circumstances change.

Every previous caesarean, every pregnancy and every woman is different. During your antenatal care, we can explore your previous birth, your medical and obstetric history, your hopes and concerns for this birth, the benefits and risks of your options, and what an individualised transfer plan would look like for you.

I want you to have the opportunity to ask questions and really understand your choices.

Because ultimately, knowledge is power and the more knowledge I can give you during pregnancy, the more powerful you become in making informed decisions about your birth, your baby and your care.

For further independent information about your options for birth after a previous caesarean, you can read the RCOG guidance on birth after a previous caesarean

Your second midwife

For your HBAC, I will be supported by a second midwife, so you will have two experienced midwives caring for you during your birth.

I don't want the second midwife to be a stranger arriving on the day. You will have the opportunity to meet her at around 36 weeks of pregnancy, so you know who she is, understand her role and feel comfortable with the people who will be supporting you at home.

Feeling safe and comfortable with the people around you can help support your natural oxytocin during labour and birth.

I want you to have the birth of your dreams as much as you do. My role is to support that dream while always keeping the safety and wellbeing of you and your baby at the heart of every decision we make.

If you're considering an HBAC and would like to talk through your options, get in touch. I'd love to hear from you.

We can have an open, honest conversation about the birth you're hoping for and how I can support you to feel informed, prepared and confident every step of the way.