Sunday, January 13, 2008

More about VBAC. Your input wanted

Photo 'Birth' from Maria Mono's photostream on

For those interested in this topic there is an online site '' which has links to useful resources (most but not all of which will open in New Zealand). This is a good place to start looking for evidence on risks and benefits of VBAC . Women who have a previous scar do have some additional risks compared to women with no scar, however having had a previous vaginal birth reduces these risks significantly. The really important point about this whole issue is avoiding the first caesarean section. How can we, as midwives and women, impact on the sky rocketing caesarean section rates internationally? I would love to hear your thoughts on this important topic.


Sarah Stewart said...

Glad to see you back after your holiday. Did you have a nice time? I'm off camping next week in Central so am hoping for hot weather.

Hannah said...

Hi Carolyn,

"The really important point about this whole issue is avoiding the first caesarean section. How can we, as midwives and women, impact on the sky rocketing caesarean section rates internationally?"

As a CBE I'd say education, education and education. Also promoting / providing / supporting home birth for first timers (and multip's too).

I also wonder about doulas. I know a NZ doula who trained in USA, and is working towards offering doula training here. I've read / heard that doula presence reduces intervention rates etc. And, (getting off the subject of C/S and VBAC here) but I think that, for women, doulas may work better than the potential 'midwifery assistants'.

Hannah :)

Carolyn McIntosh said...

Thanks for your comment Hannah. I totally agree education is the key, and keeping women who are at low risk of complications away from secondary tertiary units as much as possible. To do this we need to inspire confidence in women of their ability to birth without the need for drugs etc and of benefits for themselves and their babies. Their is lots of research evidence which supports this perspective.

You raise an interesting point about Doulas as opposed to midwifery assistants. I used to be of the opinion that when women have one to one midwifery care their is no need for a doula service as well. I am no longer so certain of this however and I do see that there could be a benefit for some women. Although the midwife is 'with the woman' it is hard to fulfill the clinical roll and be the support for the woman as well. When women are well supported by a partner or close friend or family it makes the midwives role so much easier in many ways.

I am interested to see the final role description of a midwifery assistant. I hope that this does not just become a cheap second-class midwife doing the job the midwife should be doing. I admit to reservations about this and wonder who will want to do this type of work?

It is an interesting debate. I would be very interested in any other thoughts on this.

Hannah said...

Yes I agree.
I have more to say but will wait for that post!! ;)

Sitting in Silence said...

Hi Carolyn.

Great topic...

Something I have thought about is the OBGYN......I often wonder why some have such a high rate of C also seems to be standard for a breech birth to be a c section as well.

What do you think ?


Carolyn McIntosh said...

Hi Danielle,
I agree that the difference in intervention rates between different practitioners and between different maternity facilities is something that should concern us all. There is a great website in the UK, BirthchoiceUK [] which is run by volunteers and has good (though not always complete) statistical information on many aspects of birth [normal birth rates, induction, intervention rates and homebirth rates]. As a midwife I would suggest women look at this information when they are making decisions about where to birth.

For example I originally come from Dumfries in Scotland. While the normal birth rate in the local maternity facility there is 30.8% the normal birth rate just over the border in Carlisle is 50%. If I was still living there I might consider hopping over the border to birth, unless of course I was planning a homebirth which is around 2% of births in both regions.

From time to time the New Zealand government publish a report on the Maternity service in New Zealand which is available to download online []
here also there is an enormous difference from region to region and between facilities. The last report was in 2003 so the data is quite old now. Midwives and facilities are becoming more and more experienced at data gathering and it is time that we had regular accessible statistics available for all to see. We have all been submitting data for many years now.

In September I wrote in this blog on caesarean section rates []and quoted Mike Robson from Dublin who said we need reliable data about the care we give, in order to monitor the effects of care. I would suggest that the public should have access to the information about the care that is provided in public hospitals.

As the first step in making an informed choice about their own birth experience I think all women should ask their care giver about their intervention and normal birth rates.

Carolyn McIntosh said...

Can't seem to find your blog Danielle. I just get to your profile page. Can you give me the address please?

Lorraine said...

Hi Carolyn
Just found your blog site and your discussion on VBAC. I created a program called Birth Beyond Fear and have had some really good feedback from the women who participated in it. Many of them were midwives themselves and wanted to let go of their fears as they knew fear would influence how they birthed. I am hoping to do some research as the numbers of women who do the program increase, as I believe reducing fear will reduce caesarean section rates. I am ready to launch my website so I can reach many more women and as I now do the session over the phone or Skype I hope to reach women worldwide.

Carolyn McIntosh said...

Thanks for popping by and commenting Lorraine. Good luck with your research. I hope your idea for online support is successful and helps women overcome their fear of birth. I have commented with some of my thoughts on this in your blog.

I do believe that society as a whole is ever more fearful of birth. Increasing intervention rates feed fear and the result is a spiral of increasing intervention and fear. Grantly Dick Read (1959) recognised that this was an important aspect of how well women laboured and birthed back in the 1950s. He identified the fear pain cycle and believed that education was a key element in overcoming this fear.

I agree that fear is a contributer to rising caesarean section rates. This is not only the fear that women have but the fear of their care givers and support people as well. This is something we all need to find some way to overcome. Well done in your concept of 'birth beyond fear', I wish you every success with this project.

Sarah Stewart said...

Complete change of subject.

Here is the answer to your question onmy blogabout how to insert urls into 'comments'.

To make a link in a comment, you
should type: Here's a link to my blog
post about you

Carolyn McIntosh said...

One further point here. Dr Judith McAra-Couper (AUT) argues that the technification of society is the source of increasing intervention and use of technology in childbirth. She states that this affects not just the practice of obstetrics but also the practice of midwifery and it is for this reason that women choose medical intervention in birth. She states that this is something over which we have little power, it has been a process which has been evolving since the era of enlightenment in the 18th century. If you pop by here Judith could you add to this? What do others think of this argument? Is increasing medical intervention something we just have to accept?

Sitting in Silence said...

I have added my link.Hope it works.
I dont really have a theme so I hope it does not bore you. I dont really even write about nursing, to worried about being sued LOL..

Enjoy and let me know what you think.

Carolyn McIntosh said...

Finally got it Danielle, thanks. it is lovely blog. Nice get a glimpse of you.

Anonymous said...

Re the technification of society - nah I don't agree we just have to accept increasing medicalisation - on an individual level anyway. Fortunately we have the capacity to reason and decision make - we also have the power and autonomy to set our own priorities.
The landscape has become more cluttered with options for us to navigate and that takes energy I guess but ultimately we have choice. The mass of choices has impacted the role of the midwife now though as we have become obligated to engage with women as facilitators of information so women can retain control.

Carolyn McIntosh said...

Yes and there is so much information to share. It can be mind boggling for me never mind for the woman who needs to have this information. You can see why some women do not want to make decisions they just want to be told what is best. How do you handle this situation?

Anonymous said...

I genuinely don't think I know what is best for them or their baby. So I think I use time (in a continuity relationship there is usually time) and support to encourage them to work through the choice and find their decision. I try to express my faith in them to manage this - and add some perspective or balance if they are getting overwhelmed by the responsibility of what parenting demands - as we all do naturally enough as parents.
perhaps they need to talk it thru with others in their life who matter to them or who they lean on for guidance and perspective. Its time for them to consider whothey are and what their own priorities are. I think this is the core of midwifery in many ways. ideally I think we should aim not to take up too much space in their lives and not to encourage dependency.

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