Saturday, December 4, 2010

How can I plan vbac?

The following letter (copied with permission) has been received from a woman who would dearly love to give birth spontaneously to her child next July.

I am 'just' pregnant, about 8 weeks. I had an 'emergency' caesarean with my first child after going with midwife led care through at XX Hospital.

I had a really hard time coming to terms with having has a caesarean and now seem to have anxiety when going in to the hospital.

We are a 1 income family and on a health care card, so although I would love to have a homebirth it is not going to be possible. I have contacted [a MIPP] and was hoping I could get medicare covered antenatal care and possible birth support in hospital, but after reading from your blog and midwives Victoria website this looks like it also won't be possible.

I am typing to you with tears in my eyes because I am unable to have the birth I want because I don't have enough money. Is there anything I can do?

I wrote many letters to the government during the health services review and am just so angry that we are not treated normally, respectfully and responsibly. Someone else's decision for me to have a caesarean means my choices are so limited now and that frightens me.

Every reader will probably see something different in this brief note.
The risk of attempting vbac is often mis-understood and overstated, leading to risk management protocols in hospital that are likely to lead to repeat caesarean surgery.  Click here for more detail on risk.

The obstetricians' College Statement sets out advice on TOL (trial of labour), including:
  • admission to hospital relatively early in labour
  • intensive maternal and fetal surveillance intrapartum, including continuous electronic fetal monitoring.

Midwives advising women who are intending to give birth physiologically will encourage minimal interference as labour establishes and progresses. If their plan is to go to hospital for the birth, the transfer will usually occur after the labour has established. Key features of midwife care for planned vbac include:
  • trust: the woman and midwife establish a partnership based on reciprocity and trust
  • the woman calls the midwife to be with her at her home when her labour has established
  • the midwife carries out basic assessments of fetal and maternal wellbeing, and progress, in an unobtrusive way
  • the woman is able to proceed to home birth vbac, or to make an informed decision to go to hospital when and if needed

Clearly there is a huge difference in the way independent midwives and obstetricians approach vbac. There is no evidence of poor or worse outcomes when women plan vbac at home. Some go to hospital; some proceed to vaginal births in hospital and some proceed to another caesarean birth.
The woman who, like the writer of the note inserted in this post, is unable to afford the 'luxury' of a private midwife, may feel abandoned by a maternity care system that does not provide optimal care for her.


The only way ANY woman can have a vbac is if she gives birth under her own power, in harmony with her body’s natural processes in birth. It’s not about place, or even care providers.

It’s about being well at Term, coming into spontaneous labour, and progressing well. That all happens at home. If you can do that you can give birth in the hospital without too much trouble, and no one can stop you.

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