I am 27 weeks pregnant and am trying to decide how I want to handle the birth of this baby (#4). My first two pregnancies were very healthy and normal and my second child was a water birth (which is what I'd like to do again).

However, my 3rd child I developed severe preeclampsia and HELLP syndrome. He was born at 31 weeks gestation via cesarean section.

My questions is, would I be foolish to transfer my care to a midwife and try and deliver this baby via a water birth? What is the likelihood of developing the same complications I had in my 3rd pregnancy?

Thank you for your time.

Sincerely,
Tracy

Since you did have complications during your last pregnancy, it could happen again. It's not a certainty. But, any doctor worth his/her salt will look at your past history, and that last pregnancy will raise concerns.

You must have an OBGYN, seeing that you're 27 weeks into this pregnancy. I would discuss this with him/her. If the baby is doing well, and you're doing well, then get the go ahead to try a water birth. But be prepared for these plans to change if something comes up. That's always a possibility with any pregnancy.

Does your hospital offer the option of a water birth? Many do now. Maybe you could check out hospitals in your area, see if any of them offer the option of a water birth in their facility. If you find one that does, then see if you can transfer to an OBGYN that works at that hospital. That may be your best bet. That way, if something goes wrong during delivery, you're already at the hospital, with the best possible care you and baby will need.

I wish you all the best. I hope that you get to do this your way.

As you previously had a cesarean section you will have to see an OB as you most likely will have to have another c-section. VBAC (vaginal birth after cesarean) is rarely done any longer due to the risk of uterine rupture. If that OB agrees to a VBAC a surgical suite will have to be prepared for an emergency section. In my years as an OB nurse, I have only participated in 2 VBACs. Most midwives will not take the risk of laboring a VBAC.

Are not getting prenatal care at this point in your pregnancy?

As you previously had a cesarean section you will have to see an OB as you most likely will have to have another c-section. VBAC (vaginal birth after cesarean) is rarely done any longer due to the risk of uterine rupture. If that OB agrees to a VBAC a surgical suite will have to be prepared for an emergency section. In my years as an OB nurse, I have only participated in 2 VBACs. Most midwives will not take the risk of laboring a VBAC.

Are not getting prenatal care at this point in your pregnancy?

Crap. I didn't even see the part about the C-section. Darnit.

My advice would have been very different had I actually read that part. Sorry.

Thank you for your input. I have been seeing an OB up to this point and he has advised me to do a VBAC over a c-section. He feels if there are no complications, it is better for both myself and the baby. I have also met with a midwife that is willing to take me on. She has delivered over 1200 babies and more than 100 of those have been VBAC. When I delivered before with my 2nd child, it was in a hospital that had a birthing pool. Unfortunately, the town we now live in, does not offer such. The midwife has a birth suite or will assist in a home birth if so choose. The birth suite is only about 4 blocks from the hospital. I just didn't know if anyone knew the likelihood of a recurrence of HELLP syndrome or preeclampsia. I feel like whenever I talk with the doctor or midwife, it's always a "you never know" kind of answer. I just want to be informed and make a educated plan.

The "you never know" part is very true with these conditions. What I advise my patients is that every pregnancy is different as is every labor.

According to the National Institute of Health there is approximately a 2.6-24% recurrence of HELLP and about a 14% risk with preeclampsia.

I am happy to hear that you have an OB and a midwife who are willing to risk a VBAC. The two that I assisted with were successful, just be informed that the risk of uterine rupture is real and poses the possibility of loss of life to you and/or your baby should a c/s not be performed immediately, and 4 blocks is too far to travel should that emergency occur.