In our recent blog post, we reviewed the latest research by Hazel Keedle VBAC Researcher. It showed that women were more likely to have a successful VBAC if they had Continuity of Care (meaning the same midwife, doctor or obstetrician) throughout their pregnancy, labour and birth.
But what if you don’t have access to this type of care and are planning a VBAC? How can you navigate the Health Care system to give yourself the best chance of a successful VBAC?
Our three part series will show you how. This week we focus on the importance of communication and having effective conversations.
Having Effective Conversations
Sometimes women come to their next birth after a Caesarean Section feeling disenchanted with the health system.
They might have had a difficult experience last time and there’s a feeling they need to be somewhat combative in order to achieve the type of experience they would like this time.
However, feeling like you have to fight the system is counter-productive in terms of creating the optimal mindset for labour and birth. The hormones responsible for the flow of labour are blocked by stress hormones. We talk a lot about the interplay between feeling safe, a positive birth experience and a successful VBAC in our online program Preparing for a VBAC.
Women who can work positively and collaboratively with their Health Care Providers are more likely to have a positive experience that is more calm and conducive to normal birth.
Understand how the Maternity Service Works and Prepare Accordingly
Your first appointment will most likely be with a midwife to ‘book in’. You might remember that this appointment is all about your medical history, previous birth experience and planning the appropriate model of care for this pregnancy.
Some hospitals will have a Midwifery Group Practice (MGP) that can care for women planning a VBAC, but if not then we recommend you take the following steps:
1. Ask the following questions at that first appointment (or as early as possible):
- How does the service work, who will I see and what roles they will play?
- How do I make sure the outcomes of the conversations I have during my pregnancy are known to the people who will be caring for me on the day?
- If I request something that is outside of care recommendations (this means, if what you want and what the hospital recommends are different), how will that be managed and who needs to know?
2. For each appointment, prepare your questions
Do your research and write your questions down beforehand. This will allow you to get the most out of your conversation with your Health Care Provider and will make sure that your concerns are covered.
Don’t be afraid to ask more questions to understand why things are being recommended. Ask things like: ‘What is the procedure at this hospital for …?’ or, ‘What does the research recommend for someone in my situation for …?” Our course teaches you a decision making tool that helps you work through the benefits and risks for any recommendation.
3. Document your conversations
Some people find it helpful to take notes during the appointment, and others find it easier to write it down as soon as they leave. Either way, be sure to document what was agreed to in each appointment. This will mean you have a history of what was discussed, which makes it easier for you to remember where things were up to last time.
This is especially important if you are seeing different people for each visit. With this in mind, it is helpful to make sure the midwife has documented the same thing in your notes so you don’t have to re-explain yourself and start the conversation from the beginning next time.
4. Make sure the ‘right’ people know your preferences
If the midwife sitting with you in your appointment isn’t the decision maker regarding a particular aspect of care (it might be the hospital obstetrician, or a midwifery manager for example), then ask if you need to speak with the more senior person and if you should make an appointment to see them.
What is Helpful
As we mentioned earlier, working with your Health Care Providers in a positive, collaborative way is more conducive to normal birth. Midwives and doctors really care and want women to have a positive birth experience. As shown in some of Hazel’s earlier research, when women have confidence in themselves and their Health Care Providers and feel supported by them, it can result in feelings of resolution, regardless of mode of birth. This means, that when women felt well cared for in pregnancy, labour and birth their overall experience was positive, even if they didn't achieve a VBAC.
It might be useful to know that while doctors and midwives are bound by Health policies which are based on research that has shown the best outcomes for the most people, it is possible to choose care outside of the recommendations without conflict. We strongly advise that you seek to understand the background for each recommendation prior to making a decision.
It helps to frame your preferences positively, even if you would like to make choices that sit outside recommendations. There are two aspects to this. One is tone and the other is clarity. In terms of tone, it is more helpful to say something along the lines of: ‘I know this is not the usual choice for someone in my situation, but I have done my research and I would like ... to happen in my labour’. Framing your preferences in terms of what you DO want, rather than a list of the things you don’t want, gives clarity and makes it much easier for those caring for you. For example, ‘I would like to move around as much as possible’ rather than “I don’t want to be on the bed’… or ‘I would like to have a quiet, dark room to birth in’ rather than ‘I don’t want people coming in unnecessarily’.
We recognise that for some women their previous birth experience may have been traumatic*, or even just unsatisfactory. This can lead to a feeling of distrust and nervousness about the next birth and the people working in that system. Our experience shows that communicating these feelings and working through your previous experience with either a professional counsellor or the people caring for you this time, can help you to regain trust. This increases your chances of building a collaborative relationship and having a positive experience.
Next week, we will explore decision making and consent in more detail and then we will round up the series in week three by discussing how to write a VBAC birth plan that your Health Care providers can actually use.
As always we wish you all the best.
*If you have experienced a previous traumatic birth, you may find these resources helpful.