Dear Jo, Our KYM scheme was set up 10 years ago for low risk women. The increase in VBAC women has increased over recent years, so women strongly wanting a VBAC have been included in our inclusion criteria to KYM. So if women want an elective caesarean we are unable to offer care to them. Since 1999 to date 33 women have planned VBAC. 10 women required repeat emergency caesareans. 23 achieved their VBAC. 19 of those women had spontaneous vaginal births, while the other 4 had assisted vaginal births associated with epidural use or fetal distress. We have a 2nd KYM team that also has success with VBAC, but I am not aware of their statistics.
The KYM midwives in my team often refer VBAC women for appointments to see me. At the first visit we look at what happened last time to see the contributing factors that lead to the caesarean and focus on trying to avoid those happening again. The most common reason by far is the posterior position of the baby in labour. We look at the woman's chances of success depending on the contributing factors. The primary focus is on cephalic optimal position, so if the last baby was breech, I proivde appropriate information (Maggie Banks Breech Birth Woman Wise has a great chapter on how to encourage turning a breech baby) and encourage the woman to focus on the position of the baby. The focus on optimal fetal position is important for women who have had previous posterior baby antenatally and while in labour.It seems to me that women success rate of VBAC increase with the woman's determination, partners and midwifery support. The women receive a VBAC package with information regarding sucess rate for VBAC, how to improve their chances of VBAC, the chances of uterine rupture, hep lock, fetal monitoring, eating and drinking, post dates, natural and medical induction, active birthing, epidural use and VBAC (increases chances of another c/s or instrumental birth), moving on from anger, prelabour and labour signs, comfort strategies, posterior labour, what if I need another c/s and planning a dual birth plan. W e suggest women read books and provide appropriate websites (eg. birthrites). I ask women if they would like to met a woman who has achieved a VBAC, interestingly enough, most women have already met someone who has had a VBAC. We focus on issues as they arise for indivivdual women. I encourage that they inform support people of their plans. The women know that they can come make an appointment to chat to me as they need, but they also need to meet the other midwives of the team too. I hope this helps Jo. If you would like to know more just let me know. kathy ----- Original Message ----- From: "Jo & Dean Bainbridge" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Friday, May 30, 2003 6:37 PM Subject: [ozmidwifery] Reply to Kathy > Thanks for your reply Kathy, > I am VERY interested in the KYM VBAC care and would love for you to share > with me as many details about how it was set up; what you do and the > outcomes!!! We desperately need this sort of care up and happening > especially in the shadow of the ACTOBAC trial. > In regards to the woman with the vaginal wall tearing: she is not actually a > VBAC. She birth vaginally the first time and tore badly and has suffered > since and now she is pregnant again and is thinking a cs would be better > than making the damage worse. > Jo Bainbridge > founding member CARES SA > www.cares-sa.org.au > [EMAIL PROTECTED] > phone: 08 8388 6918 > birth with trust, faith & love... > . > > > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
