Friday, September 5, 2008


Due the absolute epidemic of C/S performed in the last decade I feel there are more & more women seeking VBAC and wanting to do it at home (for obvious reasons).

According to The Australian College of Midwives
Women with a scar on their uterus are not considered low risk & are therefore not within the scope of practice for a caseload/homebirth midwife. They are flagged 'C' for consultation or transfer of care!
However so are women who are grande multis, women with psych disorders & 'failure of head to engage at full term' yet I attend them at home.
Still.....................ACMI are our guiding body.

I'm really struggling with this right now. I am getting increasing requests for H/B VBACs.
I'm perfectly comfortable with the process of labour with a scar.
Good surgery should be sound when healed shouldn't it ?
I don't hear anyone telling athletes not to compete with their reconstructed knees/ankles/shoulders etc do you ?

What do you all think ?
Am I the only one struggling with this ?
I'd appreciate your viewpoints.

Brenda Manning


Lisa Barrett said...

HI, I'm wondering why you put this out there? It is clear cut to me either you birth with VBAC's at home or you don't. The college guidelines are just guidelines and don't reflect what is or isn't in the scope of a midwife's practice.
The risk of cord prolapse is 1 in 37 (2.7%), or nearly ten times more likely than that of rupture. Does this put you off birthing at home?
You're 6 times more likely to have a doctor who is an impostor than you are to suffer a rupture. Two percent of docs are phonies (1 in 50), now that would put me off birthing at the hospital.
You have a 2% chance of misdiagnosed fetal distress on a ctg.
You have a 1 in 140 chance of being murdered, twice as likely as a uterine rupture.
I suppose it's a decision only you can make.
Risk is in everything we do and we can't eliminate it all. It's all about the risk you feel most comfortable with.

Joy Johnston said...

You're right Lisa, risk is in everything.
I accept vbac women planning homebirth, and my rationale is that these women need someone who is competent in promoting normal birth, and working in harmony with the natural processes if they are to have any chance. The biggest hurdle is establishing spontaneous labour.
Women need to know the differences between the care an independent midwife will be offering, particularly in labour, and what would be done in hospital. They make a choice.
btw I have seen the draft of the reviewed ACM National Midwifery Guidelines, and the women who have had previous caesarean surgery are now coded 'B' - which is consultation. Every woman in my care has a consultation with a medical practitioner when she asks for routine blood work and informs the doctor that she is in the care of an independent midwife. I don't think the College Guidelines should be used to discourage women from planning homebirth.

Brenda M said...

I put this 'out there' to generate discussion (obviously).
Perhaps what is 'clear cut' to Lisa is not so 'clear cut' to the other midwives I'm interested in hearing from.
I'm not asking what I should do, I'm asking how others feel about the issue.
I have been making my own decisions for 30 years re Homebirth & shall continue to do so.
It doesn't stop me being interested in what other midwives think or feel.
Thank you for your stats & informative replies though !

Lisa Barrett said...
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