Second Step to Having a Successful VBAC in the Australian Health Care System: Informed Decision Making & Consent

As we mentioned in our previous 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. In our second of three in the series, we focus on Informed Decision Making and Consent.

Consent

Ultimately you are in charge. If you don’t consent, then no one can force you to do anything. Midwives and doctors are skilled health professionals and they come to work each day because they care and they truly want women to have healthy babies and a positive experience.

It can be distressing for everyone involved when a women doesn’t want to be cared for in the way that the midwife or doctor truly believes is the safest way forward for that woman and her baby.

No-one wants to get to a point where a woman is flat out refusing care. If you feel that you really cannot work with the hospital that you are planning to birth with and you reach a point where you feel you need to deny consent then it may be useful to look elsewhere.

However, there are some strategies to help you work constructively with your Health Care Providers to plan the birth you want in a collaborative way.

Informed and Collaborative Decision Making

For women planning a VBAC, there is a common list of interventions and monitoring that may be recommended. They are important for you to discuss with your health care providers prior to labour and birth. They include:

• • IV cannula
  • Continuous Electronic Fetal Monitoring
  • Increased frequency of Vaginal examinations
  • Active 3^rd stage of labour (the syntocinon injection to help the placenta come faster and reduces the risk of PPH)
  • What if you go overdue?

When a woman has Continuity of Care, it provides an environment where these things are discussed, decisions are made and documented and it shouldn’t need to be rediscussed.

However, when she has more Fragmented Care, this sometimes leads to the doctors or midwives either not discussing things (as there is an assumption someone else will) or rehashing the conversation over and over as each individual tries to cover all the bases.

Try these things first

If the above points have not been discussed with you, bring them up as soon as possible and get the conversation started. The following tips will help avoid too much repetition.

• Understand what your health care provider/hospital policy recommends you do with each of the interventions above.
• Ask yourself if you are comfortable with this. Do the benefits outweigh the negative impact you feel it might have on the day, i.e. will you feel more stressed, will it impact your freedom of movement or ability to labour how you would like to?
• Is there room for compromise instead of straight up refusal?  In my experience the negativity associated with refusing everything is very stressful for both the women and the staff and creates a negative space for birth to take place in. It is the role of the midwives and obstetric medical officers to advocate for the women and work with her wishes.  The solution is communication, communication, communication.  
• If you feel you really do not want to go ahead with a certain recommendation the following steps are helpful to maintain a positive, light and warm birth environment for yourself and your baby on the day:
  • Explore the alternatives – is there a compromise to be had? This is a great way for staff to build rapport with women and it is how collaborative relationships are built. 
  • Under what circumstances would you change your mind? An example of how to frame this is “If my contractions are continuing to get longer, stronger and closer together, the labour is progressing well and my baby’s heart rate is normal then I do not wish to……however, if things change then I will be happy to discuss……with a senior doctor" or "In an emergency I am happy for the medical and midwifery staff to care for me and my baby by…….."
• Ask for your preferences to be documented in your file/medical record and for them to be communicated to whomever is the most senior person in the unit that is able to ensure that you will not have to REDISCUSS the point on the day. This may be the Midwifery Unit manager, the Head of Obstetrics, the senior staff specialist or a Clinical director. The aim of this exercise is to ensure that when you arrive in labour, staff will see you preference, see that it has been discussed at length already and that the right people know about it. You do not want to be re-counselled all over again when you arrive at the birth unit in labour.

Ultimately, a woman will have a more positive birth experience if she feels safe, prepared and well cared for by her Health Care Providers. Even when she doesn't have Continuity of Care, she can influence her experience in a positive way through having a good understanding of the interventions planned and focusing on open communication.

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.