Midwife, researcher, mother (who has experienced a VBAC) and all round amazing woman Hazel Keedle, has spent years researching VBAC and has some great insights. We were fortunate enough to have a conversation with her this week about her work.
Hazel has published several papers as part of her PhD research that have examined different aspects of having a VBAC in Australia. Through her work she has found that 4 key factors have an impact on women’s journeys when planning a VBAC. They are: Control, Confidence, Relationship with Health Care Provider and Active Labour.
Her latest research looks at the impact of Continuity of Care on women’s experience of having a VBAC. She compared three models of care: Continuity of Care with a Doctor (Obstetrician, GP or other), Continuity of Care with a Midwife (public or private) and Fragmented Care (Care in hospital seeing multiple midwives and doctors).
Her research showed that Continuity of Care models (seeing the same Health Care Provider throughout pregnancy, labour and birth) had a significantly beneficial effect on how women planning a VBAC perceive their overall experience, when measured across the four factors.
In particular, Continuity of Care with a Midwife (seeing the same midwife throughout your pregnancy, labour and birth) had the best overall results for women planning a VBAC.
After years of working with women planning a VBAC, it is wonderful to now have research which proves what we know to be true… Which is that women who feel supported, safe and prepared for the reality of Vaginal Birth after Caesarean Section are more likely to be in control of their labour and birth and have a positive experience.
We appreciate that throughout Australia, many women still don’t have access to continuity of care, which needs to improve! This is one of the key reasons we have developed our online program for women planning a VBAC. We wanted to be able to provide women from all over the country and in all models of care with a toolkit to empower them to have a successful VBAC and a positive birth experience.
Care in labour when you have had a previous Caesarean is different. Because of the increased risk due to the scar, there are specific interventions that will be recommended. Our program will teach women what might be different and show them how to prepare. We will help women have meaningful conversations with their Health Care Providers by giving examples of the questions they need to ask. Regardless of the model of care during pregnancy, we encourage women to build a partnership with their Health Care Providers while ensuring their hopes and wishes are at the forefront of the conversations and will be respected on during labour.
It can be tricky to navigate the Health Care system and sometimes women can feel like their preferences wont be respected or listened to, especially if they fall outside of what is normally recommended. Women should not have to go into combat when it comes to their birth choices.
Clearly Hazel’s research shows that with a continuous relationship throughout pregnancy, labour and birth, where a woman feels understood and where negotiation is welcome, there is a better outcome for women planning a VBAC. Her conclusion states:
Women found VBAC less traumatic than their previous caesarean and those who had CoC with a midwife were more likely to feel in control of the decision-making, feel that their midwife was confident in their ability to have a VBAC and to receive positive support. Women who had CoC with a midwife were also more likely to have been active in labour, experience water immersion and have an upright birthing position. There needs to be a focus on increasing shared belief and confidence in VBAC across professions and an expansion of midwifery led continuity of care models for women seeking a VBAC.Hazel Keedle, “Women’s experiences of planning a vaginal birth after caesarean in different models of maternity care in Australia”
Until then, we will continue to support women planning a VBAC in all models of care across Australia.
As always, we wish you all the best.