VBAC

[Joanna Davis]

To Bronni with the sister in NZ with 
a previous section,
 
There are certainly midwives in NZ 
who will support someone 100% who is planning a VBAC.  If you let me know 
the area she lives in, I can probably recommend someone.  
 
However, I very much doubt whether 
they would be willing to support her in a homebirth.  Basically, the 
evidence doesn't support this.   While I've had a homebirth myself and 
absolutely agree that it's a beautiful way to bring a life into this world, in 
some cases the homebirth needs to be more about approach and support, 
intentions, etc  and not about place of birth.    A midwife 
can support your sister to 'rent the space' in the hospital, do things her way, 
and optimise her chances of having the birth experience she seeks.  

 
As you probably know, NZ has a 
brilliant system, 100% government funded, whereby women can have the midwife of 
their choice follow them through from early pregnancy to 6 weeks 
post-partum.  If you choose the right midwife, I believe this is the best 
support you'll ever get for a VBAC, or natural birth in any case.
 
Am happy to come up with names if 
required, or to direct to someone who can.   
good luck to your 
sister,
Jo

VBAC

[Mary Murphy]

.    A midwife can 
support your sister to 'rent the space' in the hospital, do things her way, and 
optimise her chances of having the birth experience she seeks.  
I wish this were true here.  If a woman wants a VBAC and a midwife is 
willing to support her, if hospital is the only option, then it would be fine if 
we could "rent a space".  Unfortunately, the hospital environment is not 
conducive to privacy, one on one care, continuity of care, freedom of movement, 
freedom to use the bath (if there is a suitable one) freedom from continuous 
fetal monitoring.  Because of the restrictions, the woman's chance of a 
VBAC is reduced.  Access to the Birthing Centre would improve things 
enormously.  This is definitely not going to be available in the near 
future. So, what other option do women have? MM

VBAC

[Joanna Davis]

Dear Joy 
and others,
 
I was 
aware when I wrote that statement (that the evidence doesn't support VBAC at 
home) that it would meet with some contention!  My belief that VBAC is 
safer in hospital comes from reading research, largely in MIDIRS I admit, 
 and that this is due to the small but real chance of scar 
dehiscence, or uterine rupture, or other problems resulting from abnormal 
placentation.  Alas, I am slack and have no note of the 
references.  Perhaps I'm wrong or my information is out of date.  
Please advise if this is so.
 
 I 
agree with you that ideally, women should be given all the information 
and 'allowed' to choose for themselves where to birth.  But I also think 
that midwives have the right to say they are not comfortable supporting certain 
options.  Shoot me down for not being radical enough, but I also believe 
that a midwife is well within her rights to not support someone having a breech 
baby at home.    I wonder how other people feel about 
this?
 
Jo
 
 
I am 
interested in your attitude towards VBAC and homebirth.  What 
evidencedo you have that it's not a good idea?My attitude as a 
responsible midwife is that if* a well woman who comes into spontaneous 
labour at term with a well baby,and* progresses in labourshe should 
be free to decide herself whether she wants to stay at home orgo to 
hospital.  This is regardless of whether she has a previous cs 
ornot.

VBAC

[Lynne Staff]

Dear Jo - 
Lots of support and information for women who book 
into Nambour-Selangor. We have a group of professionals who are comfortable 
working with women who are planning vaginal birth after caesarean, and also 
classes (I hate that word) - information is better for those women looking for 
information and support. Most of the women who are planning this go ahead and do 
it! And hey! Have we seen some wonderful women doing wonderful 
things!  
Regards, Lynne

[ozmidwifery] vbac

[Jo & Dean Bainbridge]

hi 
everyone,I am wanting to know if anyone can help with a petition being 
conducted through CARES to maintain vbac is a safe and viable option in 
birth centres.  The word is that the new perinatal protocols will be 
calling for all vbacs to be monitored by ECG and thus will remove them from 
birth centre care.I have a hard copy petition and we are working on an 
online version but need to know if there is anyone out there that I can send 
the hard copy to get some signatures?  I am calling on the maternity 
coalition although I know everyone is busy with NMAP -I am too!!, and also 
others who are willing to keep vbac safe from induction, augmentation and 
the other wonderful types of care that can increase the rates of rupture and 
decrease the woman focused care.Please help as we need to move quickly 
on this!cheersJo Bainbridgefounding member CARES SAemail: 
[EMAIL PROTECTED]phone: 08 8388 6918birth with trust, faith & 
love...

[ozmidwifery] VBAC

[Jenny Balnaves]

Just a query...the hospital I work in has a fairly high caesarian section rate unfortunately. I admitted a woman for rest last week (at 37 weeks) who is expecting twins...second pregnancy...first was an elective luscs because of 'high head at term'- otherwise known as cephalo pelvic disproportion. 
This time, both twins are cephalic, first twin's presenting part is very low in the pelvis and is well and truly engaged. Is such a shame that this woman's obstetrician will not even discuss the concept of vaginal birth after caesarian don't you think?
I welcome any comments anyone would like to make please.
Regards,
Jenny 
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[ozmidwifery] VBAC

[Mary Murphy]

www.midwiferytoday.com/articles/dozen.asp A 
really great article by Nancy Wainer .  Called "A Butchers 
Dozen"

[ozmidwifery] VBAC

[Mary Murphy]

  
  
20040414-39 Uterine 
  rupture  associated with misoprostol labor induction in women 
  with previous cesarean delivery - European 
  Journal of Obstetrics and Gynecology and Reproductive 
  Biology , vol 113, no 1, March 2004, pp 45-48 Aslan H; Unlu 
  E; Agar M; et al - (2004)
  
 
OBJECTIVE: To review our experience with uterine 
  rupture in patients undergoing a trial of labor with a history of previous 
  cesarean delivery in which labor was induced with misoprostol. STUDY 
  DESIGN: A retrospective chart review was used to select patients who 
  underwent induction of labor with misoprostol during the period from 
  February 1999 to June 2002. Women with a history of cesarean delivery were 
  retrospectively compared with those without uterine scarring. RESULTS: 
  Uterine rupture occurred in 4 of 41 patients with previous cesarean 
  delivery who had labor induced with misoprostol. The rate of uterine 
  rupture (9.7%) was significantly higher in patients with a previous 
  cesarean delivery (P<0.001). No uterine rupture occurred in 50 patients 
  without uterine scarring. Women with a history of cesarean delivery were 
  more likely to have oxytocin augmentation than those without uterine 
  scarring (41% versus 20%; P=0.037). CONCLUSION: Misoprostol induction of 
  labor increases the risk of uterine rupture in women with a history of 
  cesarean delivery. (16 references) (Author) 
  


  Article Type: 
  Original research
  


  Standard Search: P107 L14 L21 
Yet VBAC  women are still being induced this way.  4 
out of 41 is pretty definite.  M

[ozmidwifery] vbac

[simsarch]

Could anyone point me in the right direction 
for any info I could pass on to a client.  She had an emerg c/s 10 
months ago for fetal distress and op position when fully dilated, and is 
passionate about having a vbac this time. However, she has been scared by many a 
friend and doctor, that as this only happened 10 months ago and she is now 12 
weeks pregnant, she shouldn't be attempting a vbac, due to risk of uterine 
rupture. She had her first baby in a private hospital and has now come to 
me - I work at the W&CH in Adealide in a caseload model. I have given her 
the Cares brochure, but english is her second language, and she seemed reluctant 
to ring or join them in any way.  I know I have plenty of opportunity 
to discuss these issues with her, but also want to give her lots of stuff to 
read.  I am also not sure myself if the risk of uterine rupture in her case 
is real as I remember reading somewhere it is ideal to wait 2 years before 
getting pregnant again after a c/s.
Thanks,
Kathy


 

[ozmidwifery] VBAC

[Mary Murphy]

Hi everyone, collective knowledge sought!  Does anyone have
any information that would enlighten a woman who has had 2 vaginal births, then
twins by C/S and now wants a VBAC.  Is she at increased risk because of the twin
C/S?  Thanks, MM

[ozmidwifery] vbac

[sharon]

i was looking after a woman the other night who had 
requested a vbac. the original c section was for faliure to progress after 
induction late in the afternoon (the ob at the time was her cousin). the ob 
looking after this woman this time however was happy for her to let nature take 
its course this time and as long as their were no problems with the baby or her 
it did. iam pleased to report that she had the baby NVD. she had a very concise 
birth plan which she was willing to change if necessary on things such as 
epidural and monitoring. She also had in attendance with her an independent 
midwife who assisted her to get through her labour in all it was a very 
satisfying time for both her and the stafff involved.

[ozmidwifery] VBAC

[Gail McKenzie]

Hi everybody,

For those of you who were at that wonderful homebirth conference in Geelong 
last month, you may recall Ina May warning us about women in the US whose 
uterus had been sutured in one single layer instead of two following 
caesareans and the problems this poses for future VBACs.  When I went onto 
PN ward, I told the staff about this & they laughed at me and were adamant 
that it would never happen here in Australia.  Our doctors are too well 
trained.  Guess what?  I've gone through the notes this week of caesars done 
last week & this.  Two of the women had their uteruses sutured in a single 
layer.  Can't happen here?   Just wanted to make you aware it certainly does 
and is.


Regards,  Gail


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KYM VBAC

[Dean & Jo Bainbridge]

Could some one tell me what KYM VBAC 
means?
cheers
Jo Bainbridgefounding member CARES SAemail: 
[EMAIL PROTECTED]phone: 
08 8365 7059birth with trust, faith & love...

vbac pain

[jireland]

yesterday about 9 women met to discuss, debrief, 
share, gossip [all healthy stuff] their c/s and or their VBACS or plans for 
VBACS .
What came out of the session was the total lack of 
communication between the  labouring woman and her care giver the lack of 
support from hospital midwives and the fear of birth shown by caregivers . Then 
the lack of sensitivity and support during the operation and particularly in the 
immediate post partum period ie the time that belongs exclusively to parents and 
babies .
The women very ill with PE could accept the C/S but 
could not accept the attitude of SCN     saying your job is to 
get well and ours is to care for your baby . Which by the way meant formula and 
not handling the baby as the midwife says that babies get very tired when 
handled by their parents. None of the others could accept their c/s but 
basically because of comments eg lets get this baby out through the sun roof,or 
lets bypass the vagina or to a chubby lady ho-ho you'll still be able to wear 
your bikini
thats enough except to say we health professionals 
have a long way to go --
love to all those trying Jan  

vbac clinics

[Dean & Jo Bainbridge]

I think Jo is on the right track suggesting VBAC 
clinics
 
Yeah, a perfect world.  I am wondering if it 
is something that is a viable option?  If David is out there, would that be 
what you were trying to achieve?  
Wouldnt it be great to have a vbac clinic that has 
vbac supportive doctors, midwives, birth support people and educators?  Ah! 
whilst we are dreaming, lets throw in a birth counselor into the equation.  
Continuity of information, care, attitudes and understanding of all a vbac 
facesbetcha the success rate would be through the roof  It would 
certainly decrease the number of repeat cs (49.9% -or 1102 cs -
of repeats were based on previous cs in1999...if we 
could even halved that, 550 may have been successful vbacs.  optomistically 
ofcourse.)
 
Is this type of thing that hospitals would have to 
embark on themselves?  Is it something that could be run as a government 
backed (ha ha!!) project like the community mw?  Any 
suggestions?    Anyone willing to suggest it to their own 
hospital?  If there are Adelaide mw out there who think we might have a 
chance (all beit slim) that one of our hospitals would do it...after all we do 
have the highest cs rate!!! - give me a bell.
 
I challenge 
you!
 
Jo Bainbridgefounding member CARES SAemail: 
[EMAIL PROTECTED]phone: 
08 8365 7059birth with trust, faith & love...

Re: VBAC

[Jackie Mawson]

> I need the percentage of VBACs amongst the vaginal births for the state.

Hi Jan,
Thankyou for getting involved in finding these stat's. May I suggest chasing
down the percentage of VBAC's attempted in total, and the percentage of
successful VBAC's from those who attempted. Also the percentages of
homebirth VBAC, public and private hospital VBAC's for these two categories?
(ie, attempted and succeeded in the 3 birth environments?) Then there are so
many other categories - ie, previous number of c/sections prior to VBAC
attempt, etc.

Birthing Beautifully,
Jackie Mawson.

Convenor of Birthrites: Healing After Caesarean Inc.
Visit our Website at: http://www.birthrites.org
Email: [EMAIL PROTECTED]

Please note I am not a Professional Healthcare Provider, and all opinions
given in this email are not to be taken as medical, or legal, advice. Please
seek such advice from the relevant professional service.

Email me your postal details for a FREE copy of our quarterly magazine, if
you live within Australia - Overseas postage costs are above budget, sorry!

Too many Gods;
so many creeds,
Too many paths
 that wind and
 wind,
When just the art
 of being kind
 Is all the sad
  world needs...
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Re: VBAC

[Jackie Mawson]

> Would you
> replace the word attempted with planned?

Oops! No problems, Lynne. And congratulations on such a fantastic VBAC
success rate within your birthing unit.

Birthing Beautifully,
Jackie Mawson.

Convenor of Birthrites: Healing After Caesarean Inc.
Visit our Website at: http://www.birthrites.org
Email: [EMAIL PROTECTED]

Please note I am not a Professional Healthcare Provider, and all opinions
given in this email are not to be taken as medical, or legal, advice. Please
seek such advice from the relevant professional service.

Email me your postal details for a FREE copy of our quarterly magazine, if
you live within Australia - Overseas postage costs are above budget, sorry!

Too many Gods;
so many creeds,
Too many paths
 that wind and
 wind,
When just the art
 of being kind
 Is all the sad
  world needs...
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Re: VBAC

[Ruth Cantrill]

Dear Lynn

I note your desire to turn the language of midwifery around. wonderful! I am
sure this is a very important work. i advocate that you include the
midwifery text books (if you have not already). since midwives learn some
from recommended texts it would seem reasonable that they will follow what
is in the texts. then another important place to break down barriers is with
the computer technology databases and the forms midwives work with. then as
well as all that there are the existing perceptions of the general public
and the women themselves.

for example the other day at work I heard a women  visitor greet one of the
midwives with "you delivered my baby..." there is a  perception by the
public that someone will 'deliver' the baby. try telling them that they will
give birth to the baby and they don't need anyone to 'deliver' the baby and
it is a bit like trying to convince them that their breast milk won't dry up
overnight and the day their breasts go  soft actually means the breasts know
how to respond to the baby's needs rather than not have any milk left as
they believed i could go ond on with comparisons. It is a tough world.

there are many such terminologies we need to change. But how to. In trying
to do so we also need to mind our tone. some people try to bring these
things to the attention of others but the tone of the way they go about it
creates antagonism and defensiveness. This requires self awareness on the
part of the instigators of change.


ruth



> From: "L & D Staff" <[EMAIL PROTECTED]>
> Date: Tue, 12 Feb 2002 07:43:36 +1000
> To: "Jackie Mawson" <[EMAIL PROTECTED]>
> Cc: <[EMAIL PROTECTED]>
> Subject: Re: VBAC
> 
> Hi Jackie - I want to give you a huge hug for all you do for women
> experiencing caesarean birth, but have one small favour to ask. Would you
> replace the word attempted with planned? I am looking more and more into the
> impact the language of maternity care  has on women, and believe it will
> help to reshape the culture of birth if we turn the terminology around to
> being positive instead of negative. A small step, but with growing momentum!
> Warm regards, Lynne
> - Original Message -
> From: "Jackie Mawson" <[EMAIL PROTECTED]>
> To: "Ozmidwifery List" <[EMAIL PROTECTED]>
> Sent: Monday, February 11, 2002 10:31 AM
> Subject: Re: VBAC
> 
> 
>>> I need the percentage of VBACs amongst the vaginal births for the state.
>> 
>> Hi Jan,
>> Thankyou for getting involved in finding these stat's. May I suggest
> chasing
>> down the percentage of VBAC's attempted in total, and the percentage of
>> successful VBAC's from those who attempted. Also the percentages of
>> homebirth VBAC, public and private hospital VBAC's for these two
> categories?
>> (ie, attempted and succeeded in the 3 birth environments?) Then there are
> so
>> many other categories - ie, previous number of c/sections prior to VBAC
>> attempt, etc.
>> 
>> Birthing Beautifully,
>> Jackie Mawson.
>> 
>> Convenor of Birthrites: Healing After Caesarean Inc.
>> Visit our Website at: http://www.birthrites.org
>> Email: [EMAIL PROTECTED]
>> 
>> Please note I am not a Professional Healthcare Provider, and all opinions
>> given in this email are not to be taken as medical, or legal, advice.
> Please
>> seek such advice from the relevant professional service.
>> 
>> Email me your postal details for a FREE copy of our quarterly magazine, if
>> you live within Australia - Overseas postage costs are above budget,
> sorry!
>> 
>> Too many Gods;
>> so many creeds,
>> Too many paths
>> that wind and
>> wind,
>> When just the art
>> of being kind
>> Is all the sad
>> world needs...
>> --
>> 
>> 
>> --
>> This mailing list is sponsored by ACE Graphics.
>> Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
> 
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> 

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RE: VBAC

[Johnston]

Hi Jo
I am interested in your attitude towards VBAC and homebirth.  What evidence 
do you have that it's not a good idea?
My attitude as a responsible midwife is that if
* a well woman who comes into spontaneous labour at term with a well baby, 
and
* progresses in labour
she should be free to decide herself whether she wants to stay at home or 
go to hospital.  This is regardless of whether she has a previous cs or 
not.

The comments you make about homebirth being a "beautiful way to bring a 
life into this world" make it sound as though a woman chooses homebirth 
mainly because she wants some sort of great experience.  That may be so, 
and she can choose for whatever reason she likes.  But the reason I as a 
midwife attend women for birth at home (primips, grand multis, vbacs and 
whatever else we might like to call them) is because I have no evidence to 
the contrary. In fact the intervention of moving from home to hospital may 
be the most significant intervention in many spontaneous labours, and may 
cause harm.

Please anyone else accept this as an encouragement to discuss the matter 
objectively via the list.  I used to have feelings about homebirth being 
just a bit risky, but I was uninformed at the time.  I began to look at the 
evidence, and changed my mind.

Joy Johnston
-Original Message-
From:   Joanna Davis [SMTP:[EMAIL PROTECTED]]
Sent:   Saturday, February 23, 2002 9:07 PM
To: OZ MIDWIFERY
Subject:VBAC

 << File: ATT5.htm >> To Bronni with the sister in NZ with a previous 
section,

There are certainly midwives in NZ who will support someone 100% who is 
planning a VBAC.  If you let me know the area she lives in, I can probably 
recommend someone.

However, I very much doubt whether they would be willing to support her in 
a homebirth.  Basically, the evidence doesn't support this.   While I've 
had a homebirth myself and absolutely agree that it's a beautiful way to 
bring a life into this world, in some cases the homebirth needs to be more 
about approach and support, intentions, etc  and not about place of birth. 
   A midwife can support your sister to 'rent the space' in the hospital, 
do things her way, and optimise her chances of having the birth experience 
she seeks.

As you probably know, NZ has a brilliant system, 100% government funded, 
whereby women can have the midwife of their choice follow them through from 
early pregnancy to 6 weeks post-partum.  If you choose the right midwife, I 
believe this is the best support you'll ever get for a VBAC, or natural 
birth in any case.

Am happy to come up with names if required, or to direct to someone who 
can.
good luck to your sister,
Jo

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Re: VBAC

[Julie Clarke]

Dear Joy,
I often reflect on the same issue:  that once upon a time I thought of
homebirth as a bit risky and a sigh of relief when things went ok. That was
years ago - since then I've had my second baby safely at home 3.5 weeks
"overdue".   There was no doubt in our minds the pregnancy was 43.5 weeks
but when he was born he was a normal weight still had vernix on him and
didn't peel - placenta normal. He didn't pass mec till he was out.
Working as a childbirth educator I am privy to lots of birth stories and
often when I listen to them my gut wrenches and I quietly think to myself
"Hospital is no Place to Have a Baby".
I don't say it out loud because of the bizarre attitude in Australia amongst
the community that birth is a dangerous and risky event.
I feel strongly that the book "What to expect ..." contributes very
significantly to this extreme fear.
Often when I get a strange question in class I'll check out what caused that
line of thinking and it's often that book.

---Original Message-
From: Johnston <[EMAIL PROTECTED]>
To: OZ MIDWIFERY <[EMAIL PROTECTED]>
Date: Monday, 25 February 2002 9:40
Subject: RE: VBAC


>Hi Jo
>I am interested in your attitude towards VBAC and homebirth.  What evidence
>do you have that it's not a good idea?
>My attitude as a responsible midwife is that if
>* a well woman who comes into spontaneous labour at term with a well baby,
>and
>* progresses in labour
>she should be free to decide herself whether she wants to stay at home or
>go to hospital.  This is regardless of whether she has a previous cs or
>not.
>
>The comments you make about homebirth being a "beautiful way to bring a
>life into this world" make it sound as though a woman chooses homebirth
>mainly because she wants some sort of great experience.  That may be so,
>and she can choose for whatever reason she likes.  But the reason I as a
>midwife attend women for birth at home (primips, grand multis, vbacs and
>whatever else we might like to call them) is because I have no evidence to
>the contrary. In fact the intervention of moving from home to hospital may
>be the most significant intervention in many spontaneous labours, and may
>cause harm.
>
>Please anyone else accept this as an encouragement to discuss the matter
>objectively via the list.  I used to have feelings about homebirth being
>just a bit risky, but I was uninformed at the time.  I began to look at the
>evidence, and changed my mind.
>
>Joy Johnston
>-Original Message-
>From: Joanna Davis [SMTP:[EMAIL PROTECTED]]
>Sent: Saturday, February 23, 2002 9:07 PM
>To: OZ MIDWIFERY
>Subject: VBAC
>
> << File: ATT5.htm >> To Bronni with the sister in NZ with a previous
>section,
>
>There are certainly midwives in NZ who will support someone 100% who is
>planning a VBAC.  If you let me know the area she lives in, I can probably
>recommend someone.
>
>However, I very much doubt whether they would be willing to support her in
>a homebirth.  Basically, the evidence doesn't support this.   While I've
>had a homebirth myself and absolutely agree that it's a beautiful way to
>bring a life into this world, in some cases the homebirth needs to be more
>about approach and support, intentions, etc  and not about place of birth.
>   A midwife can support your sister to 'rent the space' in the hospital,
>do things her way, and optimise her chances of having the birth experience
>she seeks.
>
>As you probably know, NZ has a brilliant system, 100% government funded,
>whereby women can have the midwife of their choice follow them through from
>early pregnancy to 6 weeks post-partum.  If you choose the right midwife, I
>believe this is the best support you'll ever get for a VBAC, or natural
>birth in any case.
>
>Am happy to come up with names if required, or to direct to someone who
>can.
>good luck to your sister,
>Jo
>
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>Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.

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RE: VBAC

[Meaghan Moon]

Joy,
I agree with you one hundred percent.  Until it is shown that outcomes from 
home labours and births after previous cesarean could be improved upon by 
hospitalization, women should be supported in making choices they feel will 
give them the healthiest outcome.  Monitoring the well being of mother, 
baby and progress of labour will increase the chance of a healthy outcome, 
not necessarily intervening by moving to hospital.

I think the reason the focus gets shifted to "birth experience" at home 
births is because birth is such an intense experience, and when women feel 
in control at home the experience is very positive (intensely so). If they 
feel out of control or other negative things happen (more likely to occur 
in an institution) the intensity is on the negative side, hence the 
feelings of violation etc.

  Which brings me to something I have been thinking about lately.Can 
any one think of someone they know who feels neutral about their birth 
experience? Neither here nor there?  It just was? I  wonder if there are 
many women out there that feel that way.  I can't think of anyone I know 
like this.

Meaghan


At 03:26 PM 2/24/02 +1100, you wrote:
>Hi Jo
>I am interested in your attitude towards VBAC and homebirth.  What evidence
>do you have that it's not a good idea?
>My attitude as a responsible midwife is that if
>* a well woman who comes into spontaneous labour at term with a well baby,
>and
>* progresses in labour
>she should be free to decide herself whether she wants to stay at home or
>go to hospital.  This is regardless of whether she has a previous cs or
>not.
>
>The comments you make about homebirth being a "beautiful way to bring a
>life into this world" make it sound as though a woman chooses homebirth
>mainly because she wants some sort of great experience.  That may be so,
>and she can choose for whatever reason she likes.  But the reason I as a
>midwife attend women for birth at home (primips, grand multis, vbacs and
>whatever else we might like to call them) is because I have no evidence to
>the contrary. In fact the intervention of moving from home to hospital may
>be the most significant intervention in many spontaneous labours, and may
>cause harm.
>
>Please anyone else accept this as an encouragement to discuss the matter
>objectively via the list.  I used to have feelings about homebirth being
>just a bit risky, but I was uninformed at the time.  I began to look at the
>evidence, and changed my mind.
>
>Joy Johnston
>-Original Message-
>From:   Joanna Davis [SMTP:[EMAIL PROTECTED]]
>Sent:   Saturday, February 23, 2002 9:07 PM
>To: OZ MIDWIFERY
>Subject:VBAC
>
>  << File: ATT5.htm >> To Bronni with the sister in NZ with a previous
>section,
>
>There are certainly midwives in NZ who will support someone 100% who is
>planning a VBAC.  If you let me know the area she lives in, I can probably
>recommend someone.
>
>However, I very much doubt whether they would be willing to support her in
>a homebirth.  Basically, the evidence doesn't support this.   While I've
>had a homebirth myself and absolutely agree that it's a beautiful way to
>bring a life into this world, in some cases the homebirth needs to be more
>about approach and support, intentions, etc  and not about place of birth.
>A midwife can support your sister to 'rent the space' in the hospital,
>do things her way, and optimise her chances of having the birth experience
>she seeks.
>
>As you probably know, NZ has a brilliant system, 100% government funded,
>whereby women can have the midwife of their choice follow them through from
>early pregnancy to 6 weeks post-partum.  If you choose the right midwife, I
>believe this is the best support you'll ever get for a VBAC, or natural
>birth in any case.
>
>Am happy to come up with names if required, or to direct to someone who
>can.
>good luck to your sister,
>Jo
>
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Re: VBAC

[Steve & Bronni McGrath]

Am happy to come up with names if 
required, or to direct to someone who can.   
good luck to your 
sister,
Jo
 
Thanks for your reply Jo.  My sis has come up 
trumps in her area ( Raetihi ) and a local midwife Robyn has said she will 
support her if that is her choice.  I now am getting lots of info for her 
and her partner so they can choose with confidence.  Unfortunately because 
Raetihi is a tiny town in the "middle of nowhere" therefore attracts little 
funding etc, the midwife would be unable to go with her to a hospital of her 
choice ( too many clients not enough midwives )  That is one part of the 
decision process too, my sis will have to travel over pretty bad roads 2 hrs to 
reach a hospital.  in labour.  She's feeling a bit confused!  

if there are other midwives in the area we would 
love to know.
 
Big thanks 
Bronni

Re: VBAC

[maxine hardinge]

Hi Julie,
I am interested in why you choose to keep the thought that "hospital is no 
place to have a baby" when you hear gutwrenching stories, rather than use 
your own experience of homebirth as well as your role as a childbirth 
educator to generate discuss and help swing community attitude to a more 
balanced view of the (percieved, but as we know not always true) safety of 
hospital v risk of homebirth.
Maxine

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Re: VBAC

[maxine hardinge]

Hi Julie,
I am interested in why you choose to keep the thought to yourself that 
"hospital is no place to have a baby" when you hear gutwrenching stories, 
rather than use your own experience of homebirth as well as your role as a 
childbirth educator to generate discuss and help swing community attitude to 
a more balanced view of the (percieved, but as we know not always true) 
safety of hospital v risk of homebirth.
Maxine

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Re: VBAC

[Mary Murphy]

No controversy, just information!
Today a very determined woman gave birth at our local teaching hospital
after 3 previous caesareans, no labours, and LOTS of negative harrassment at
A/N.clinic.  She was supported by a homebirth midwife who was constrained by
protocols, to birth in the hospital and ended up with a VBAC vacuum with
episiotomy.   she feels TRIUMPHANT!  a girl after 3 boys and birthed an 8lbs
plus baby.  (sorry about the imperial weight) Congratulations to the
hospital midwives who supported her and the homebirth midwife who stepped in
just 5 days ago as a replacement midwife. The rules were: IV bung,
continuous fetal monitoring and one other rule that I have forgotten.(my
brain is in overload..I also had a 36 wk labour and birth in the same
hospital early today.. not easy but all was well in the end.  thanks
midwives of the labour ward, room 19). regards, MM
.
>

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Re: VBAC

[Kleimar]

Wonderful story Mary. Here is the reference of the previously mentioned 
article:
Lydon-Rochelle, M., Holt, V. L., Easterling, T. R., and Martin, D. P. 
"Risk of Uterine rupture during labor among women with a prior cesarean 
delivery". N Engl J Med 2001;345:3-8. 

Even though the authors' conclusion is specifically directed towards women 
with one prior c/s who have been induced, it seems to me that this paper has 
changed the way institutions and insurance companies have/ or are looking at 
VBAC. Here in Seattle ( where midwives can still buy insurance however, the 
insurers have just recently chosen to exclude homebirth VBAC as a procedure 
that would be covered). As was discussed previously on this list, this paper 
has many limitations but while we are discussing it academically, policies 
are being re written. The authors' conclusion: "For women with one prior 
cesarean delivery, the risk of uterine rupture is higher among those whose 
labor is induced than among those with repeated cesarean delivery without 
labor." seems reasonable enough, but it was their results that were 
provocative though I personally think it was because they were reported in 
incidence per thousand instead of as a %. I wont regurgitate the results 
unless someone wants me to.  Take care, marilyn
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Re: VBAC

[Kleimar]

Dear Listers: I am trying to find the author and title of the book about 
fistulas and the hospital in Ethiopia. I have just done a search on 
BarnesandNoble.com and only came up with what looked like a medical text book 
called : Obstetric Fistulas by Zaccharin, something tells me this is not the 
book people have been discussing on this list. Can anyoone help me? Thanks, 
marilyn
PS to Jan Robinson: I have been trying to send you an email and it keeps 
coming back to me saying your quota is full, hope this one gets through, love 
marilyn 
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Re: VBAC

[Leigh Evans]

Hi Joy. I would have to agree with you. Leigh
- Original Message -
From: "Johnston" <[EMAIL PROTECTED]>
To: "OZ MIDWIFERY" <[EMAIL PROTECTED]>
Sent: Sunday, February 24, 2002 2:26 PM
Subject: RE: VBAC


> Hi Jo
> I am interested in your attitude towards VBAC and homebirth.  What
evidence
> do you have that it's not a good idea?
> My attitude as a responsible midwife is that if
> * a well woman who comes into spontaneous labour at term with a well baby,
> and
> * progresses in labour
> she should be free to decide herself whether she wants to stay at home or
> go to hospital.  This is regardless of whether she has a previous cs or
> not.
>
> The comments you make about homebirth being a "beautiful way to bring a
> life into this world" make it sound as though a woman chooses homebirth
> mainly because she wants some sort of great experience.  That may be so,
> and she can choose for whatever reason she likes.  But the reason I as a
> midwife attend women for birth at home (primips, grand multis, vbacs and
> whatever else we might like to call them) is because I have no evidence to
> the contrary. In fact the intervention of moving from home to hospital may
> be the most significant intervention in many spontaneous labours, and may
> cause harm.
>
> Please anyone else accept this as an encouragement to discuss the matter
> objectively via the list.  I used to have feelings about homebirth being
> just a bit risky, but I was uninformed at the time.  I began to look at
the
> evidence, and changed my mind.
>
> Joy Johnston
> -Original Message-
> From: Joanna Davis [SMTP:[EMAIL PROTECTED]]
> Sent: Saturday, February 23, 2002 9:07 PM
> To: OZ MIDWIFERY
> Subject: VBAC
>
>  << File: ATT5.htm >> To Bronni with the sister in NZ with a previous
> section,
>
> There are certainly midwives in NZ who will support someone 100% who is
> planning a VBAC.  If you let me know the area she lives in, I can probably
> recommend someone.
>
> However, I very much doubt whether they would be willing to support her in
> a homebirth.  Basically, the evidence doesn't support this.   While I've
> had a homebirth myself and absolutely agree that it's a beautiful way to
> bring a life into this world, in some cases the homebirth needs to be more
> about approach and support, intentions, etc  and not about place of birth.
>A midwife can support your sister to 'rent the space' in the hospital,
> do things her way, and optimise her chances of having the birth experience
> she seeks.
>
> As you probably know, NZ has a brilliant system, 100% government funded,
> whereby women can have the midwife of their choice follow them through
from
> early pregnancy to 6 weeks post-partum.  If you choose the right midwife,
I
> believe this is the best support you'll ever get for a VBAC, or natural
> birth in any case.
>
> Am happy to come up with names if required, or to direct to someone who
> can.
> good luck to your sister,
> Jo
>
> --
> This mailing list is sponsored by ACE Graphics.
> Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
>

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Re: VBAC

[Cheryl LHK]

The book is 'The Hospital by the River'
authored by Dr Catherine Hamlin with John Little
(Macmillan) copyright 2001.

Got my copy in K-mart!

Cheryl


>From: [EMAIL PROTECTED]
>To: [EMAIL PROTECTED], [EMAIL PROTECTED], [EMAIL PROTECTED],  
>   [EMAIL PROTECTED]
>Subject: Re: VBAC
>Date: Mon, 25 Feb 2002 15:26:45 EST
>
>Dear Listers: I am trying to find the author and title of the book about
>fistulas and the hospital in Ethiopia. I have just done a search on
>BarnesandNoble.com and only came up with what looked like a medical text 
>book
>called : Obstetric Fistulas by Zaccharin, something tells me this is not 
>the
>book people have been discussing on this list. Can anyoone help me? Thanks,
>marilyn
>PS to Jan Robinson: I have been trying to send you an email and it keeps
>coming back to me saying your quota is full, hope this one gets through, 
>love
>marilyn
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RE: VBAC

[Johnston]

The whole idea of a list like this is to allow open discussion of pertinent 
issues - and VBAC is one of them.  I think this discussion helps all 
midwives to reflect critically on the way we practice, and the beliefs we 
hold. This discussion has been very helpful and I think many people will 
appreciate following it, even if they don't offer opinions.

The Birthrites www.birthrites.org booklet 'Caesarean Birth ... making 
informed choices' has an interesting chapter on VBAC, including references. 
 Also the Birth Matters (Maternity Coalition) journal Vol 5 No 2 June 2001 
on caesarean has good articles.  None of these deal specifically with the 
question of homebirth and vbac. The principles of continuity of care by a 
known midwife, protecting spontaneous onset and progress of labour, and the 
woman-centred partnership social philosophies of midwifery are significant 
in forming my professional opinion, and in being prepared to consider 
attending birth at home after a previous caesar.
I agree with you that
"midwives have the right to say they are not comfortable supporting certain 
options."
We all have out personal limits. BUT
Surely that's got nothing to do with being "radical enough"!
This isn't a perfect world, and decisions are made for many reasons.  I 
don't think that's being radical.  (I think of myself as being a plain 
midwife - no frills)

However Let's be as radical as we can when we see a system that does harm 
women and babies (eg unacceptably high rates of interventions, such as 
induction) because it ignores best practice, and take every opportunity we 
can to change it.
Joy Johnston



Original Message-
From:   Joanna Davis [SMTP:[EMAIL PROTECTED]]
Sent:   Tuesday, February 26, 2002 9:52 AM
To: OZ MIDWIFERY
Subject:VBAC

 << File: ATT4.htm >> Dear Joy and others,

I was aware when I wrote that statement (that the evidence doesn't support 
VBAC at home) that it would meet with some contention!  My belief that VBAC 
is safer in hospital comes from reading research, largely in MIDIRS I 
admit,  and that this is due to the small but real chance of scar 
dehiscence, or uterine rupture, or other problems resulting from abnormal 
placentation.  Alas, I am slack and have no note of the references. 
 Perhaps I'm wrong or my information is out of date.  Please advise if this 
is so.

 I agree with you that ideally, women should be given all the information 
and 'allowed' to choose for themselves where to birth.  But I also think 
that midwives have the right to say they are not comfortable supporting 
certain options.  Shoot me down for not being radical enough, but I also 
believe that a midwife is well within her rights to not support someone 
having a breech baby at home.    I wonder how other people feel about this?

Jo


I am interested in your attitude towards VBAC and homebirth.  What evidence
do you have that it's not a good idea?
My attitude as a responsible midwife is that if
* a well woman who comes into spontaneous labour at term with a well baby,
and
* progresses in labour
she should be free to decide herself whether she wants to stay at home or
go to hospital.  This is regardless of whether she has a previous cs or
not.



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Re: VBAC

[Sue Cookson]

Hi Joy and list members,

Radical of course means 'of the roots', and if that is not a good
description of the choice that we as women and midwives make when supporting
a philpsophy of normal birth rather than medicalised birth, then I don't
know a better one.

RADICAL RADICAL RADICAL

The more we say it, accept that that is what we are, the stronger those
roots will grow.

I have always fully supported VBAC women, accepting that they need as much
special care as any women birthing vaginally possibly for the first time,
and to date all my VBAC woman have birthed vaginally, without assistance.

The figures from the HBA statistics 1985-1990 show 131 planned VBACs with
109 or 89.3% births occurring at home with 8 more born in hospital (4
assisted). So 14 women had repeat c/sections (10.7%)
This surely is clear that VBAC women have the same rights, the same chance,
even the same sort of transfer rates as the non VBAC women.

And speaking of VBACs - attended a lovely 23 year old on Sunday who had a 30
hour labour, with 8 hours caught at 7-8cms. So took her in to a local
hospital where they immediately decided to transfer her to a large hospital
solely because she was a VBAC. The GP didn't want to attempt anything (like
breaking her waters or lifting the cervix or even forceps if that became
necessary - they do forcep/vacuum assists there, but not for a VBAC woman>)

So with a few tricks from me - like a gentle 'lift' of the baby's shoulders
to reposition the baby, membranes appeared at the vagina and were broken,
cervix then lifted at first attempt, and 9lb6oz baby born after a 30 minute
second stage. This is all with the ambulance guy outside waiting to transfer
to larger hospital!

Go those strong radical women!!

See you at the conference,
 Sue Cookson
 

> The whole idea of a list like this is to allow open discussion of pertinent
> issues - and VBAC is one of them.  I think this discussion helps all
> midwives to reflect critically on the way we practice, and the beliefs we
> hold. This discussion has been very helpful and I think many people will
> appreciate following it, even if they don't offer opinions.
> 
> The Birthrites www.birthrites.org booklet 'Caesarean Birth ... making
> informed choices' has an interesting chapter on VBAC, including references.
> Also the Birth Matters (Maternity Coalition) journal Vol 5 No 2 June 2001
> on caesarean has good articles.  None of these deal specifically with the
> question of homebirth and vbac. The principles of continuity of care by a
> known midwife, protecting spontaneous onset and progress of labour, and the
> woman-centred partnership social philosophies of midwifery are significant
> in forming my professional opinion, and in being prepared to consider
> attending birth at home after a previous caesar.
> I agree with you that
> "midwives have the right to say they are not comfortable supporting certain
> options."
> We all have out personal limits. BUT
> Surely that's got nothing to do with being "radical enough"!
> This isn't a perfect world, and decisions are made for many reasons.  I
> don't think that's being radical.  (I think of myself as being a plain
> midwife - no frills)
> 
> However Let's be as radical as we can when we see a system that does harm
> women and babies (eg unacceptably high rates of interventions, such as
> induction) because it ignores best practice, and take every opportunity we
> can to change it.
> Joy Johnston
> 
> 
> 
> Original Message-
> From:Joanna Davis [SMTP:[EMAIL PROTECTED]]
> Sent:Tuesday, February 26, 2002 9:52 AM
> To:OZ MIDWIFERY
> Subject:VBAC
> 
> << File: ATT4.htm >> Dear Joy and others,
> 
> I was aware when I wrote that statement (that the evidence doesn't support
> VBAC at home) that it would meet with some contention!  My belief that VBAC
> is safer in hospital comes from reading research, largely in MIDIRS I
> admit,  and that this is due to the small but real chance of scar
> dehiscence, or uterine rupture, or other problems resulting from abnormal
> placentation.  Alas, I am slack and have no note of the references.
> Perhaps I'm wrong or my information is out of date.  Please advise if this
> is so.
> 
> I agree with you that ideally, women should be given all the information
> and 'allowed' to choose for themselves where to birth.  But I also think
> that midwives have the right to say they are not comfortable supporting
> certain options.  Shoot me down for not being radical enough, but I also
> believe that a midwife is well within her rights to not support someone
> having a breech baby at home.I wonder how other people feel about this?
> 
> Jo
> 
> 
> I a

VBAC help

[Tom, Tania and Sam Smallwood]

Hi everyone,
 
Found this on a site I browse and lurk on, I know everyone's 
really busy, but I thought i'd post it here and see if anyone had any 
suggestions for this enterprising (and gutsy!) young woman...
 
 
I am currently trying to get into the 
Brisbane Birth Centre at RWH for the birth of my 3rd child who will be my 2nd 
natural delivery (my first child was a csec). I am currently being denied on 
the basis of a policy which will not allow any woman with a uterine scar 
(regardless of cause or subsequent obstetric history) access to the birth centre 
because of the risk of uterine rupture. This means that there are a group of 
women who have a risk of uterine rupture that varies between 0.2% (1 in 500) and 
6% (6 in 100) who do not have access to the birth centre. The risk of uterine 
rupture is directly related to the cause of the uterine scarring, the location 
of the scar and subsequent obstetric history. For women such as myself who had a 
lower segment ceasarean and a vaginal birth since the risk is only 0.2% which is 
actually less than the risk of fetal distress, cord prolapse and placental 
abruption; all conditions that could happen to any woman in labour in the birth 
centre regardless of history and all of which require similar emergency action 
to uterine rupture. 
I have used this information and the fact that this 
policy contradicts two other policies to which RWH are signatory to develop my 
arguement for allowing me to the birth centre. The midwives at the birth centre 
have indicated they would be happy to take me (and women like me). I am yet to 
receive an answer from RWH. 
The primary reason I am writing is two fold. Firstly to 
find out if there are any women out there who had a VBAC (vaginal birth after 
caesarean) delivery in the Birth Centre (as the midwives have told me they have 
done some of these in the past but arn't allowed to give me names because of 
medical in confidence) 
Also to find other women who have recently been turned 
away from the Birth Centre because of this policy. I am aware that there has 
been at least one other in the past couple of weeks with a similar history to me 
but do not know her name. 
If there are also women out there who have had VBAC 
deliveries in other public Birth Centres in Australia I would appreciate your 
stories. 
I can be contacted at [EMAIL PROTECTED] or on this 
board. 
 
The link is at http://www.essentialbaby.com.au/ubb/ubbhtml/Forum12/HTML/000355.html 

 
Thanks in advance
 
Tania

VBAC question

[Sue Cudlipp]

Dear midwives
I have been back 'listening' on the list again 
for a few weeks now after a long pause.  
Today I was looking after a lady who was having 
a 'trial of scar' She ended up having a lovely VBAC and was very happy.  
The obstetrician came in just after the birth and proceeded to don gloves in 
order to check the uterine scar!
 
I was a little shocked and said that I had never 
known of any such thing before, that I had never seen any other doctor do this, 
and that I had had 2 vbac's myself and would have kicked any doctor had he tried 
to do such a thing to me!  Said obs insisted that it was routine procedure, 
that it was well documented that the uterine scar should be checked to see that 
it had not dehisced during the birth, and proceeded to do just 
that.
 
So, to all of you out there, has anyone heard of 
this before, and does anyone know of any documentation to support such a 
barbaric act?  In 25 years of high and low- tech midwifery practise I have 
never met this before.
 
On a happier note, the birth was wonderful and 
the woman was so very pleased with herself (rightly so). I have been blessed 
with 5 lovely births in my last 5 shifts, we are BUSY again which is great after 
our enforced closure to birthing women during January.
 
Regards
Susan Cudlipp
Swan District Hospital 
WA

VBAC question

[Julia Monaghan]

Am I missing 
  something here but this sounds like assault. Did the woman consent to 
  this? She only has to say no and we should tell them that they do not 
  have to be subjected to this barbaric treatment. Julia 
M. 

VBAC feedback

[Sue Cudlipp]

Dear list 
A couple of weeks ago I asked if any of you had 
seen or heard of manual checking of scars following VBAC.
I collated your responses, copied the relevant 
passage from "Effective Guide...".
and wrote a letter to go with it all, and posted 
the lot to the doctor involved.
He telephoned me at home a few days later, 
actually on the weekend,  and we had a very lengthy conversation.  He 
was a bit taken aback at the force of some of your comments!
On balance, I feel the conversation was 
productive and was not acrimonious.  I respected the fact that he phoned me 
at home rather than make a verbal assault in the workplace, and it gave us both 
the opportunity to express our opinions in a neutral zone. 
I have worked with this doctor (among others) 
for the past 11 years, and we have had one or two disagreements in that time, 
without it ever becoming nasty, so I was happy that this was the 
same.
He did say that he would no longer manually 
check scars - so I guess you could say that the result was a positive one!  
And I said that I respected his decision to change his practice in light of 
evidence etc..
It was an interesting exercise for me, as even 
after all this time (23 years) as a midwife, I still found it took a great deal 
of courage to actually confront the power of the medical profession.  
(Why???)
Anyway, thank you for all your feedback - none 
of my colleagues had heard of this procedure either - though in all fairness, my 
research has shown me that it was indeed considered normal practice once!  

Happy IMD to you all.  I shall be 
celebrating with a long-overdue, childfree weekend alone with my 
husband!
 
Sue C

VBAC Support

[Carolyn Donaghey]

Dear Ozmidders
This is my first foray into the ozmid list. I am Carolyn 
Donaghey-Harris, Jo Bainbridge's  buddy from CARES SA :-P .
We have had a query from a lady in N Z who is seeking vbac support. 
 Does anyone know of any groups or midwifery support services for vbac 
in NZ?
Thanks
Carolyn

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[ozmidwifery] vbac

[Jo & Dean Bainbridge]

Hi guys!  
Just a quick question for all you wonderful people 
out there:
is there any evidence or incidence of a uterine 
rupture in a vbac being managed in a birth centre anywhere or any 
time?
Jo Bainbridgefounding member CARES SAemail: 
[EMAIL PROTECTED]phone: 
08 8388 6918birth with trust, faith & love...

Re: [ozmidwifery] vbac

[Lynne Staff]

We don't use continuous EFM for women planning 
vaginal birth following caesarean, and they use the tub too. Yes, it IS a safe 
and 'viable' option for women, and the percentage of women giving birth 
vaginally (since numerical values seem to have more street cred than the 
experience, as far as you-know-who is concerned) at our unit has consistently 
been in the high 80's to 90's.
 
Passion of mine!!!

  - Original Message - 
  From: 
  Jo 
  & Dean Bainbridge 
  To: [EMAIL PROTECTED] 
  
  Sent: Monday, September 23, 2002 3:57 
  PM
  Subject: [ozmidwifery] vbac
  
  hi 
  everyone,I am wanting to know if anyone can help with a petition being 
  conducted through CARES to maintain vbac is a safe and viable option in 
  birth centres.  The word is that the new perinatal protocols will be 
  calling for all vbacs to be monitored by ECG and thus will remove them 
  from birth centre care.I have a hard copy petition and we are working 
  on an online version but need to know if there is anyone out there that I 
  can send the hard copy to get some signatures?  I am calling on the 
  maternity coalition although I know everyone is busy with NMAP -I am 
  too!!, and also others who are willing to keep vbac safe from induction, 
  augmentation and the other wonderful types of care that can increase the 
  rates of rupture and decrease the woman focused care.Please help as we 
  need to move quickly on this!cheersJo Bainbridgefounding member 
  CARES SAemail: [EMAIL PROTECTED]phone: 08 8388 6918birth with trust, faith 
  & love...

Re: [ozmidwifery] vbac

[Jo & Dean Bainbridge]

Dear Lynne
It is good to hear that you don't use ECG for 
vbac.  Could you send me some policies regarding this (I hate policies but 
they seem to be the 'in thing' at the moment and we need those who LOVE policies 
to start to listen.)  Where do you work?
We would also like some stats to back the success 
of vbac without  ECG.
Could I send you a petition for your (obviously 
intelligent, well run, women focused) place of employment to sign.  Our 
RANZCOG state committee are trying their DARNDEST to get vbac out of the realm 
of normal and back into the good old High Risk category.  
 
Jo Bainbridgefounding member CARES SAemail: [EMAIL PROTECTED]phone: 08 
8388 6918birth with trust, faith & love...

  - Original Message - 
  From: 
  Lynne 
  Staff 
  To: [EMAIL PROTECTED] 
  
  Sent: Monday, September 23, 2002 7:09 
  PM
  Subject: Re: [ozmidwifery] vbac
  
  We don't use continuous EFM for women 
  planning vaginal birth following caesarean, and they use the tub too. Yes, it 
  IS a safe and 'viable' option for women, and the percentage of women giving 
  birth vaginally (since numerical values seem to have more street cred 
  than the experience, as far as you-know-who is concerned) at our unit has 
  consistently been in the high 80's to 90's.
   
  Passion of mine!!!
  
- Original Message - 
From: 
Jo 
& Dean Bainbridge 
To: [EMAIL PROTECTED] 

Sent: Monday, September 23, 2002 3:57 
PM
Subject: [ozmidwifery] vbac

hi 
everyone,I am wanting to know if anyone can help with a petition being 
conducted through CARES to maintain vbac is a safe and viable option in 
birth centres.  The word is that the new perinatal protocols will 
be calling for all vbacs to be monitored by ECG and thus will remove 
them from birth centre care.I have a hard copy petition and we are 
working on an online version but need to know if there is anyone out 
there that I can send the hard copy to get some signatures?  I am 
calling on the maternity coalition although I know everyone is busy with 
NMAP -I am too!!, and also others who are willing to keep vbac safe from 
induction, augmentation and the other wonderful types of care that can 
increase the rates of rupture and decrease the woman focused 
care.Please help as we need to move quickly on this!cheersJo 
Bainbridgefounding member CARES SAemail: [EMAIL PROTECTED]phone: 08 8388 6918birth with trust, faith & 
love...

Re: [ozmidwifery] vbac

[Lynne Staff]

Jo can you email me privately?

  - Original Message - 
  From: 
  Jo 
  & Dean Bainbridge 
  To: [EMAIL PROTECTED] 
  
  Sent: Monday, September 23, 2002 8:36 
  PM
  Subject: Re: [ozmidwifery] vbac
  
  Dear Lynne
  It is good to hear that you don't use ECG for 
  vbac.  Could you send me some policies regarding this (I hate policies 
  but they seem to be the 'in thing' at the moment and we need those who LOVE 
  policies to start to listen.)  Where do you work?
  We would also like some stats to back the success 
  of vbac without  ECG.
  Could I send you a petition for your (obviously 
  intelligent, well run, women focused) place of employment to sign.  Our 
  RANZCOG state committee are trying their DARNDEST to get vbac out of the realm 
  of normal and back into the good old High Risk category.  
   
  Jo Bainbridgefounding member CARES SAemail: [EMAIL PROTECTED]phone: 08 
  8388 6918birth with trust, faith & love...
  
- Original Message - 
From: 
Lynne 
Staff 
To: [EMAIL PROTECTED] 

Sent: Monday, September 23, 2002 7:09 
PM
Subject: Re: [ozmidwifery] vbac

We don't use continuous EFM for women 
planning vaginal birth following caesarean, and they use the tub too. Yes, 
it IS a safe and 'viable' option for women, and the percentage of women 
giving birth vaginally (since numerical values seem to have more street 
cred than the experience, as far as you-know-who is concerned) at our unit 
has consistently been in the high 80's to 90's.
 
Passion of mine!!!

  - Original Message - 
  From: 
  Jo 
  & Dean Bainbridge 
  To: [EMAIL PROTECTED] 
  
  Sent: Monday, September 23, 2002 3:57 
  PM
  Subject: [ozmidwifery] vbac
  
  hi 
  everyone,I am wanting to know if anyone can help with a petition being 
  conducted through CARES to maintain vbac is a safe and viable option 
  in birth centres.  The word is that the new perinatal protocols 
  will be calling for all vbacs to be monitored by ECG and thus will 
  remove them from birth centre care.I have a hard copy petition and 
  we are working on an online version but need to know if there is 
  anyone out there that I can send the hard copy to get some 
  signatures?  I am calling on the maternity coalition although I 
  know everyone is busy with NMAP -I am too!!, and also others who are 
  willing to keep vbac safe from induction, augmentation and the other 
  wonderful types of care that can increase the rates of rupture and 
  decrease the woman focused care.Please help as we need to move 
  quickly on this!cheersJo Bainbridgefounding member CARES 
  SAemail: [EMAIL PROTECTED]phone: 08 8388 6918birth with trust, 
  faith & 
love...

Re: [ozmidwifery] vbac

[Veronica Herbert]

Dear all,
 
Once again I had to "explain" and defend the use of the word 
VBAC.  The response I got today was "Well I'm not going to change what I 
say!" When I said the term had been around since the late 70's (somebody said 
that on here so I hope it's right lol) they said they had never heard of it. 
Well they have now!!! I went home on my tea break and printed off copies of the 
paper that Carolyn (hope you don't mind Carolyn) wrote and I placed a copy 
in the postnatal ward, labour ward, special care nursery, and the tea room. 

Another thing, we had a woman who was trying to have a VBAC 
today and the Registrar that was on said she was only allowed to push for 20 
minutes and then she was to have a vaccuum extraction, if she hadn't pushed it 
out.  Now I'm no expert on VBAC's but I thought that that was a little 
unfair, since in her last labour she had only got to 4cm dilated, and she 
had never been through second stage. Any thoughts?/? By the way, she got to 
about 5cms and was in good established labour managing well, had a V.E (was 
quite disappointed that she was "Half way"), had pethidine, contractions eased 
off and she went for a C/S!
 
from Veronica Herbert
(Midwifery Student, University of Ballarat)

  - Original Message - 
  From: 
  Jo 
  & Dean Bainbridge 
  To: [EMAIL PROTECTED] 
  
  Sent: Monday, September 23, 2002 8:36 
  PM
  Subject: Re: [ozmidwifery] vbac
  
  Dear Lynne
  It is good to hear that you don't use ECG for 
  vbac.  Could you send me some policies regarding this (I hate policies 
  but they seem to be the 'in thing' at the moment and we need those who LOVE 
  policies to start to listen.)  Where do you work?
  We would also like some stats to back the success 
  of vbac without  ECG.
  Could I send you a petition for your (obviously 
  intelligent, well run, women focused) place of employment to sign.  Our 
  RANZCOG state committee are trying their DARNDEST to get vbac out of the realm 
  of normal and back into the good old High Risk category.  
   
  Jo Bainbridgefounding member CARES SAemail: [EMAIL PROTECTED]phone: 08 
  8388 6918birth with trust, faith & love...
  
- Original Message - 
From: 
Lynne 
Staff 
To: [EMAIL PROTECTED] 
    
Sent: Monday, September 23, 2002 7:09 
PM
Subject: Re: [ozmidwifery] vbac

We don't use continuous EFM for women 
planning vaginal birth following caesarean, and they use the tub too. Yes, 
it IS a safe and 'viable' option for women, and the percentage of women 
giving birth vaginally (since numerical values seem to have more street 
cred than the experience, as far as you-know-who is concerned) at our unit 
has consistently been in the high 80's to 90's.
 
Passion of mine!!!

  - Original Message - 
  From: 
  Jo 
  & Dean Bainbridge 
  To: [EMAIL PROTECTED] 
  
  Sent: Monday, September 23, 2002 3:57 
  PM
  Subject: [ozmidwifery] vbac
  
  hi 
      everyone,I am wanting to know if anyone can help with a petition being 
  conducted through CARES to maintain vbac is a safe and viable option 
  in birth centres.  The word is that the new perinatal protocols 
  will be calling for all vbacs to be monitored by ECG and thus will 
  remove them from birth centre care.I have a hard copy petition and 
  we are working on an online version but need to know if there is 
  anyone out there that I can send the hard copy to get some 
  signatures?  I am calling on the maternity coalition although I 
  know everyone is busy with NMAP -I am too!!, and also others who are 
  willing to keep vbac safe from induction, augmentation and the other 
  wonderful types of care that can increase the rates of rupture and 
  decrease the woman focused care.Please help as we need to move 
  quickly on this!cheersJo Bainbridgefounding member CARES 
  SAemail: [EMAIL PROTECTED]phone: 08 8388 6918birth with trust, 
  faith & 
love...

RE: [ozmidwifery] vbac

[Heartlogic]

Good on you 
Veronica! And I don't mind at all, I'm delighted that you find it useful. 
Whatever will help people become more informed! I reckon it is so great that you 
are prepared to stand in the truth and walk the talk :-)  the path of 
courage.

   
  Once again I had to "explain" and defend the use of the word 
  VBAC.  The response I got today was "Well I'm not going to change what I 
  say!" When I said the term had been around since the late 70's (somebody said 
  that on here so I hope it's right lol) they said they had never heard of it. 
  Well they have now!!! I went home on my tea break and printed off copies of 
  the paper that Carolyn (hope you don't mind Carolyn) wrote and I placed a 
  copy in the postnatal ward, labour ward, special care nursery, and the tea 
  room.  
   
  I found 
  this story very interesting.
   
  Another thing, we had a woman who was trying to have a VBAC 
  today and the Registrar that was on said she was only allowed to push for 20 
  minutes and then she was to have a vaccuum extraction, if she hadn't pushed it 
  out.  Now I'm no expert on VBAC's but I thought that that was a little 
  unfair, since in her last labour she had only got to 4cm dilated, and she 
  had never been through second stage. Any thoughts?/? By the way, she got to 
  about 5cms and was in good established labour managing well, had a V.E (was 
  quite disappointed that she was "Half way"), had pethidine, contractions eased 
  off and she went for a C/S!
   
  from Veronica Herbert
  (Midwifery Student, University of Ballarat) 
   
  Unfair 
  alright!  Pressure like this on a woman, whether she is anxious or 
  not to start with (and women having a VBAC are already anxious), is VERY 
  counterproductive. It's downright abusive. Anxiety pours those stress 
  hormones out in bucket loads. And what happens when women are stressed like 
  that? Oxytocin turns off, or is interrupted and the body can't work properly 
  and the cervix can't dilate efficiently or effectively very easily.  It 
  is amazing she was in such good labour, even with the negative pressure. 
  The chemical and electrical output with feelings of disappointment do 
  similar turn offs to the hormonal cascade of the labouring body. 
   Most women have to feel safe and supported 
  for their bodies to work well.  And the VE is interesting. How the 'f 
  indings' from VE's are presented are so influential to a woman's state of 
  being and her subsequent labour progress
   
  Saying "you're only five centimetres" or "you're 
  half way"with any inflection of pity, disappointment or other negative 
  inference is a downer, many women immediately respond in a 'not good enough' 
  way and feel inadequate, which again, turns off  or interrups the labour 
  cascade.  We really set people up don't we?  Self fulfilling 
  prophecy it's called.  Give people these impossible hoops to jump 
  through, turn the lights off so they can't see, put blindfolds on then say 
  "you'll never do it".  It's very like the psychological trick called 
  'gaslighting'. The term comes from a 1950's (or thereabouts) movie of the same 
  name. The husband in the movie sends his wife mad by altering her sense of 
  reality. He kept turning down the gaslight and when she said the light was 
  changing, he would deny it and tell her she was mad.  When we tell 
  someone something enough, it becomes true. 'Truth' no matter how suspect, 
  coming from someone in a position of power has authority. What if the 
  information was presented as "wow, you are five centimeters already! Aren't 
  you fantastic! You are doing so well, you are a natural at thisand 
  look how well you are coping" and then, turning to her support person/partner 
  "isn't she fantastic?  I bet you are proud of herand she is SO 
  in control". Language is so powerful.   We can 
  pull the rug from under someone in a heartbeat.  Or/and we can provide 
  them with a mirror of strength and 
  courage.  
   
  It's 
  wonderful to see you being so observant and analytical Veronica.  Wonder 
  what it could be like if the registrar could see with your eyes?  Doesn't 
  our future look bright with these students around? Makes my ol' heart very 
  glad. warmly, Carolyn 
Hastie

Re: [ozmidwifery] vbac

[leanne wynne]

Hi All,
I thought it might be time for a positive story about VBAC. I am a midwife 
working in an Aboriginal Community Health Centre. One of my women had 
previously had an emergency C/S in late 2nd trimester for PROM, followed by 
neonatal death at 12 hours of age. Needless to say she had alot of issues to 
deal with during this pregnancy. I cared for her throughout her pregnancy 
and she didnt see a doctor at all as she was perfectly normal and healthy 
(despite being labelled as 'high risk' due to her history and the fact that 
she is Aboriginal). She laboured so quickly the midwives at the hospital 
didnt even think to call me in. After less than 2 hours she gave birth to a 
perfectly healthy son. A week later she is still talking about how fulfilled 
she feels and how she will definitely "do it again".
Dont give up. Leanne.


>From: "Jo & Dean Bainbridge" <[EMAIL PROTECTED]>
>Reply-To: [EMAIL PROTECTED]
>To: <[EMAIL PROTECTED]>
>Subject: [ozmidwifery] vbac and second stage
>Date: Mon, 23 Sep 2002 22:25:00 +0930
>
>I would like to generate discussion on the list about typical vbac labours 
>if I may?
>
>As a great number of vbacs are women whom have had a 'drama' in a previous 
>birth which resulted in a cs, there is a valid belief that the woman would 
>probably bring a number of 'issues' into the vbac.  These issues are 
>usually fear based "please don't let what happen last time happen again" 
>and coupled with the fact that for most second stage is a mystery; I would 
>like to propose that vbac labours should be given more support and less 
>restrictions.  I understand that if a woman labours for a long time the obs 
>and drs may begin to worry about the stress on the scar and possible 
>rupture; but I strongly believe that a woman's body will go at the right 
>pace for her.  Second stage is often  longer with vbacs.  Can anyone 
>support this anecdotally?
>I think we (they!) put too many pressures on vbacs and don't see them for 
>what they are...not high risk, but require high support and understanding.
>any thoughts?
>Jo Bainbridge
>founding member CARES SA
>email: [EMAIL PROTECTED]
>phone: 08 8388 6918
>birth with trust, faith & love

_
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Re: [ozmidwifery] vbac

[Carolyn Donaghey]

Hi Veronica
Wow, you seem to have your work cut out for you.  I will give you some good
information to back up the validity and the antiquity of the term VBAC.

Refer to the book Silent Knife: Cesarean Prevention and Vaginal Birth after
Cesarean (1983) Nancy Wainer Cohen & Lois J Estner New York.  This book
is a must in the library of any midwife supporting vbac women.
"In the 1970s, more studies substaintiated the safety of VBAC; yet women
were still being sectioned more than 99percent of the time.  Still, the winds
of change were blowing.  In 1974, Nancy coined the term "VBAC" and by 1975
she was hearing the acronym being used all over the country and was seeing
it in medical articles as well. "  page 94 Silent Knife

The book is getting quite old now, but most of what is written still holds
true today, and it is a confronting and challenging book to give food for
thought.

Congratulations Veronica on being informed and up-to-date with the last 3
plus decades ;-) .
Carolyn
PS I was under the impression that a woman who had never experienced pushing
stage, would indeed push just like a first time mother.  Certainly was the
case for my vbac, took me ages to work out that oh this was pushing not more
posterior labour DERR!
Veronica Herbert wrote:
004701c262fc$55ed7060$9245d0cb@pbncomputer">
  
  
  Dear all,
   
  Once again I had to "explain" and defend the use of
the word  VBAC.  The response I got today was "Well I'm not going to change
what I  say!" When I said the term had been around since the late 70's (somebody
said  that on here so I hope it's right lol) they said they had never heard
of it.  Well they have now!!! I went home on my tea break and printed off
copies of the  paper that Carolyn (hope you don't mind Carolyn) wrote and
I placed a copy  in the postnatal ward, labour ward, special care nursery,
and the tea room.  
  Another thing, we had a woman who was trying to have
a VBAC  today and the Registrar that was on said she was only allowed to
push for 20  minutes and then she was to have a vaccuum extraction, if she
hadn't pushed it  out.  Now I'm no expert on VBAC's but I thought that that
was a little  unfair, since in her last labour she had only got to 4cm dilated, and
she  had never been through second stage. Any thoughts?/? By the way, she
got to  about 5cms and was in good established labour managing well, had
a V.E (was  quite disappointed that she was "Half way"), had pethidine, contractions
eased  off and she went for a C/S!
   
  from Veronica Herbert
  (Midwifery Student, University of Ballarat)
  

- Original Message - 

From:
Jo& Dean Bainbridge


To:
[EMAIL PROTECTED]


Sent: Monday, September 23, 2002 8:36PM

Subject: Re: [ozmidwifery] vbac


Dear Lynne
It is good to hear that you don't use
ECG forvbac.  Could you send me some policies regarding this (I hate
policiesbut they seem to be the 'in thing' at the moment and we need
those who LOVE    policies to start to listen.)  Where do you work?
We would also like some stats to back
the successof vbac without  ECG.
Could I send you a petition for your
(obviouslyintelligent, well run, women focused) place of employment to
sign.  OurRANZCOG state committee are trying their DARNDEST to get vbac
out of the realmof normal and back into the good old High Risk category. 
    
Jo Bainbridge
founding member CARES SA
email: [EMAIL PROTECTED]

phone: 088388 6918
birth with trust, faith & love...

  
- Original Message - 
  
From:
Lynne  Staff
  
      
To:
[EMAIL PROTECTED]
  
  
Sent: Monday, September 23, 2002 7:09  PM
  
Subject: Re: [ozmidwifery] vbac
  
  
  We don't use continuous EFM for women
 planning vaginal birth following caesarean, and they use the tub too.
Yes,  it IS a safe and 'viable' option for women, and the percentage
of women  giving birth vaginally (since numerical values seem to have
more street  cred than the experience, as far as you-know-who is concerned)
at our unit  has consistently been in the high 80's to 90's.
   
  Passion of mine!!!
  

- Original Message - 

From:
Jo& Dean Bainbridge


To:
[EMAIL PROTECTED]


Sent: Monday, September 23, 2002 3:57PM

Subject: [ozmidwifery] vbac

    

hieveryone,
I am wanting to know if anyone can help with a petition beingconducted

through CARES to maintain vbac is a safe and viable optionin birth

centres.  The word is that the new perinatal protocolswill be calling

for all vbacs to be monitored by ECG and thus willremove them from

birth centre care.
I have a 

Re: [ozmidwifery] vbac

[Veronica Herbert]

Thanks Carolyn I will track down that book! I defiantly 
believe in the power of words and will continue to use "woman friendly" language 
even though it often generates lively discussions. At least it is informing 
people and making people think about what they are using. 
Veronica

  - Original Message - 
  From: 
  Carolyn Donaghey 
  To: [EMAIL PROTECTED] 
  
  Sent: Tuesday, September 24, 2002 9:32 
  PM
  Subject: Re: [ozmidwifery] vbac
  Hi VeronicaWow, you seem to have your work cut out for 
  you.  I will give you some good information to back up the validity and 
  the antiquity of the term VBAC.Refer to the book Silent Knife: 
  Cesarean Prevention and Vaginal Birth after Cesarean (1983) Nancy Wainer Cohen 
  & Lois J Estner New York.  This book is a must in the library of any 
  midwife supporting vbac women."In the 1970s, more studies substaintiated 
  the safety of VBAC; yet women were still being sectioned more than 99percent 
  of the time.  Still, the winds of change were blowing.  In 1974, 
  Nancy coined the term "VBAC" and by 1975 she was hearing the acronym being 
  used all over the country and was seeing it in medical articles as well. " 
   page 94 Silent KnifeThe book is getting quite old now, 
  but most of what is written still holds true today, and it is a confronting 
  and challenging book to give food for thought.Congratulations Veronica 
  on being informed and up-to-date with the last 3 plus decades ;-) .CarolynPS I was under the 
  impression that a woman who had never experienced pushing stage, would indeed 
  push just like a first time mother.  Certainly was the case for my vbac, 
  took me ages to work out that oh this was pushing not more posterior labour 
  DERR!Veronica Herbert wrote:
  004701c262fc$55ed7060$9245d0cb@pbncomputer type="cite">



Dear all,
 
Once again I had to "explain" and defend the use of the 
word VBAC.  The response I got today was "Well I'm not going to change 
what I say!" When I said the term had been around since the late 70's 
(somebody said that on here so I hope it's right lol) they said they had 
never heard of it. Well they have now!!! I went home on my tea break and 
printed off copies of the paper that Carolyn (hope you don't mind 
Carolyn) wrote and I placed a copy in the postnatal ward, labour ward, 
special care nursery, and the tea room. 
Another thing, we had a woman who was trying to have a 
VBAC today and the Registrar that was on said she was only allowed to push 
for 20 minutes and then she was to have a vaccuum extraction, if she hadn't 
pushed it out.  Now I'm no expert on VBAC's but I thought that that was 
a little unfair, since in her last labour she had only got to 4cm 
dilated, and she had never been through second stage. Any thoughts?/? 
By the way, she got to about 5cms and was in good established labour 
managing well, had a V.E (was quite disappointed that she was "Half way"), 
had pethidine, contractions eased off and she went for a C/S!
 
from Veronica Herbert
(Midwifery Student, University of Ballarat)

  - 
  Original Message - 
  From: Jo 
  & Dean Bainbridge 
  To: 
      [EMAIL PROTECTED] 
  Sent: 
  Monday, September 23, 2002 8:36 PM
  Subject: 
  Re: [ozmidwifery] vbac
  
  Dear Lynne
  It is good to hear that you don't use ECG for 
  vbac.  Could you send me some policies regarding this (I hate 
  policies but they seem to be the 'in thing' at the moment and we need 
  those who LOVE policies to start to listen.)  Where do you 
  work?
  We would also like some stats to back the 
  success of vbac without  ECG.
  Could I send you a petition for your 
  (obviously intelligent, well run, women focused) place of employment to 
  sign.  Our RANZCOG state committee are trying their DARNDEST to get 
  vbac out of the realm of normal and back into the good old High Risk 
  category.   
  Jo Bainbridgefounding member CARES SAemail: [EMAIL PROTECTED] 
  phone: 08 8388 6918birth with trust, faith & love...
  
- 
Original Message - 
From: Lynne 
Staff 
    To: 
[EMAIL PROTECTED] 
Sent: 
Monday, September 23, 2002 7:09 PM
Subject: 
Re: [ozmidwifery] vbac

We don't use continuous EFM for women 
planning vaginal birth following caesarean, and they use the tub too. 
Yes, it IS a safe and 'viable' option for women, and the percentage of 
women giving birth vaginally (since numerical values seem to have 
more street cred than the experience, as far as you-know-who is 
concerned) at our unit has consistently b

Re: [ozmidwifery] vbac

[Mary Murphy]

" Nancy coined the term "VBAC" and by 1975 she was hearing the 
acronym being used all over the country and was seeing it in medical articles as 
well. "  
 
I spent some time with Nancy in Boston in 1997, a wonderful woman. She is 
now a midwife in private practice.  Recently in an email she was 
griping about how she was ignored by the obstetricians at a conference, they 
wouldn't let her speak,  and that "they" were using the term as tho it was 
their own invention.  Wouldn't believe she had coined it. Does that sound 
like a familiar story? 
 

RE: [ozmidwifery] vbac

[Vicki Chan]

Title: Message



Open Seaon her book she 
wrote 10 or so years later is well worth reading...I would just break down and 
cry reading the stories...
Vicki

  
  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]] On Behalf Of Veronica 
  HerbertSent: Wednesday, September 25, 2002 5:35 AMTo: 
  [EMAIL PROTECTED]Subject: Re: [ozmidwifery] 
  vbac
  Thanks Carolyn I will track down that book! I defiantly 
  believe in the power of words and will continue to use "woman friendly" 
  language even though it often generates lively discussions. At least it is 
  informing people and making people think about what they are 
  using. 
  Veronica
  
- Original Message - 
From: 
Carolyn Donaghey 
To: [EMAIL PROTECTED] 

Sent: Tuesday, September 24, 2002 9:32 
PM
Subject: Re: [ozmidwifery] vbac
Hi VeronicaWow, you seem to have your work cut out 
for you.  I will give you some good information to back up the validity 
and the antiquity of the term VBAC.Refer to the book Silent Knife: 
Cesarean Prevention and Vaginal Birth after Cesarean (1983) Nancy Wainer 
Cohen & Lois J Estner New York.  This book is a must in the library 
of any midwife supporting vbac women."In the 1970s, more studies 
substaintiated the safety of VBAC; yet women were still being sectioned more 
than 99percent of the time.  Still, the winds of change were blowing. 
 In 1974, Nancy coined the term "VBAC" and by 1975 she was hearing the 
acronym being used all over the country and was seeing it in medical 
articles as well. "  page 94 Silent KnifeThe book is 
getting quite old now, but most of what is written still holds true today, 
and it is a confronting and challenging book to give food for 
thought.Congratulations Veronica on being informed and up-to-date 
with the last 3 plus decades ;-) 
.CarolynPS I was under the impression that a woman who 
had never experienced pushing stage, would indeed push just like a first 
time mother.  Certainly was the case for my vbac, took me ages to work 
out that oh this was pushing not more posterior labour DERR!Veronica 
Herbert wrote:
004701c262fc$55ed7060$9245d0cb@pbncomputer 
  type="cite">
  

  Dear all,
   
  Once again I had to "explain" and defend the use of the 
  word VBAC.  The response I got today was "Well I'm not going to 
  change what I say!" When I said the term had been around since the late 
  70's (somebody said that on here so I hope it's right lol) they said they 
  had never heard of it. Well they have now!!! I went home on my tea break 
  and printed off copies of the paper that Carolyn (hope you don't mind 
  Carolyn) wrote and I placed a copy in the postnatal ward, labour 
  ward, special care nursery, and the tea room. 
  Another thing, we had a woman who was trying to have a 
  VBAC today and the Registrar that was on said she was only allowed to push 
  for 20 minutes and then she was to have a vaccuum extraction, if she 
  hadn't pushed it out.  Now I'm no expert on VBAC's but I thought that 
  that was a little unfair, since in her last labour she had only got to 4cm 
  dilated, and she had never been through second stage. Any thoughts?/? 
  By the way, she got to about 5cms and was in good established labour 
  managing well, had a V.E (was quite disappointed that she was "Half way"), 
  had pethidine, contractions eased off and she went for a C/S!
   
  from Veronica Herbert
  (Midwifery Student, University of Ballarat)
  
- 
Original Message - 
From: Jo 
& Dean Bainbridge 
To: 
[EMAIL PROTECTED] 
Sent: 
Monday, September 23, 2002 8:36 PM
Subject: 
    Re: [ozmidwifery] vbac

Dear Lynne
It is good to hear that you don't use ECG 
for vbac.  Could you send me some policies regarding this (I hate 
policies but they seem to be the 'in thing' at the moment and we need 
those who LOVE policies to start to listen.)  Where do you 
work?
We would also like some stats to back the 
success of vbac without  ECG.
Could I send you a petition for your 
(obviously intelligent, well run, women focused) place of employment to 
sign.  Our RANZCOG state committee are trying their DARNDEST to get 
vbac out of the realm of normal and back into the good old High Risk 
category.   
Jo Bainbridgefounding member CARES SAemail: [EMAIL PROTECTED] 
phone: 08 8388 6918birth with trust, faith & love...

  - 
  Original Message - 
  From: 
  Lynne Staff 
   

Re: [ozmidwifery] vbac

[Debby M]

When I was doing my reseach to get into the birth centre at RWH Brisbane I found the VBAC policy document from the Canadian College of OBs and Gynes.  Their policy is the most comprehensive one produced by any of the Colleges including the American one.  Interestingly the Australian College have not produced one at all - I rang them up and asked them!!
Anyway on monitoring it states:
"One of the most consistent early signs of scah dehiscence and/or rupture is an abnormal fetal heart rate pattern.  Thus in cases of induction and/or augmentation, continuous electronic fetal heart rate monitoring is advised.  Intermittent fetal heart monitoring is to be reserved for cases in which neither induction nor augmentation with oxytocin is performed"
Therefore if you follow this guide it is not necessary to use ECG on the majority of VBAC women as the majority are not induced.  Therefore they should remain candidates for Birth Centres.  Interestingly here in Brisbane is a "normal" woman is induced with oxytocin she is also transferred out of the Birth Centre for monitoring - therefore there should be no difference between VBAC and non VBAC women in their management.  To see the full policy to to:
http://www.rcp.gov.bc.ca/Guidelines/Obstetrics/Master%5B1%5D.OB8.VBAC.May2000.pdf
Debby
 
 

>From: Carolyn Donaghey <[EMAIL PROTECTED]>
>Reply-To: [EMAIL PROTECTED] 
>To: [EMAIL PROTECTED] 
>Subject: Re: [ozmidwifery] vbac 
>Date: Tue, 24 Sep 2002 21:02:38 +0930 
> 
> 
>Hi Veronica 
>Wow, you seem to have your work cut out for you. I will give you 
>some good information to back up the validity and the antiquity of 
>the term VBAC. 
> 
>Refer to the book Silent Knife: Cesarean Prevention and Vaginal 
>Birth after Cesarean (1983) Nancy Wainer Cohen & Lois J Estner New 
>York. This book is a must in the library of any midwife supporting 
>vbac women. 
>"In the 1970s, more studies substaintiated the safety of VBAC; yet 
>women were still being sectioned more than 99percent of the time. 
>Still, the winds of change were blowing. In 1974, Nancy coined the 
>term "VBAC" and by 1975 she was hearing the acronym being used all 
>over the country and was seeing it in medical articles as well. " 
>page 94 Silent Knife 
> 
>The book is getting quite old now, but most of what is written still 
>holds true today, and it is a confronting and challenging book to 
>give food for thought. 
> 
>Congratulations Veronica on being informed and up-to-date with the 
>last 3 plus decades ;-) . 
>Carolyn 
>PS I was under the impression that a woman who had never experienced 
>pushing stage, would indeed push just like a first time mother. 
>Certainly was the case for my vbac, took me ages to work out that oh 
>this was pushing not more posterior labour DERR! 
>Veronica Herbert wrote: 
> 
>>Dear all, 
>> 
>> 
>> 
>>Once again I had to "explain" and defend the use of the word VBAC. 
>>The response I got today was "Well I'm not going to change what I 
>>say!" When I said the term had been around since the late 70's 
>>(somebody said that on here so I hope it's right lol) they said 
>>they had never heard of it. Well they have now!!! I went home on my 
>>tea break and printed off copies of the paper that Carolyn (hope 
>>you don't mind Carolyn) wrote and I placed a copy in the postnatal 
>>ward, labour ward, special care nursery, and the tea room. 
>> 
>>Another thing, we had a woman who was trying to have a VBAC today 
>>and the Registrar that was on said she was only allowed to push for 
>>20 minutes and then she was to have a vaccuum extraction, if she 
>>hadn't pushed it out. Now I'm no expert on VBAC's but I thought 
>>that that was a little unfair, since in her last labour she had 
>>only got to 4cm dilated, and she had never been through second 
>>stage. Any thoughts?/? By the way, she got to about 5cms and was in 
>>good established labour managing well, had a V.E (was quite 
>>disappointed that she was "Half way"), had pethidine, contractions 
>>eased off and she went for a C/S! 
>> 
>> 
>> 
>>from Veronica Herbert 
>> 
>>(Midwifery Student, University of Ballarat) 
>> 
>> - Original Message - 
>> 
>> From: Jo & Dean Bainbridge 
>> 
>> To: [EMAIL PROTECTED] 
>> 
>> 
>> Sent: Monday, September 23, 2002 8:36 PM 
>> 
>> Subject: Re: [ozmidwifery] vbac 
>> 
>> 
>> Dear Lynne 
>> 
>> It is good to hear that you don't use ECG for vbac. Could you 
>> send me some policies regarding this (I hate policies but they 
>> seem to be the 

Re: [ozmidwifery] vbac

[Denise Hynd]

Dear All
Can I please suggest we  do not create new 
patterns and labels for women inn labour to fit.
Vbac is like a primip??The more you go where 
women and their bodies and babies want to  go the more you will come to 
realise that individuality is every where 
 
There are and wil always be 
Primip have quick ("preciptate") labours
Grandmultips who have slow ("delayed" fail to 
progress") labours
Because they may share their aprity with other 
women but little else and so much can influence a woman, her body and baby in 
laour and the art of midwfeery is about being with the woman with all her 
complexities trying to understand and work with them, no some 
preconceptions!Denise

  - Original Message - 
  From: 
  Carolyn Donaghey 
  To: [EMAIL PROTECTED] 
  Sent: Tuesday, September 24, 2002 9:32 
  PM
  Subject: Re: [ozmidwifery] vbac
  Hi VeronicaWow, you seem to have your work cut out for 
  you.  I will give you some good information to back up the validity and 
  the antiquity of the term VBAC.Refer to the book Silent Knife: 
  Cesarean Prevention and Vaginal Birth after Cesarean (1983) Nancy Wainer Cohen 
  & Lois J Estner New York.  This book is a must in the library of any 
  midwife supporting vbac women."In the 1970s, more studies substaintiated 
  the safety of VBAC; yet women were still being sectioned more than 99percent 
  of the time.  Still, the winds of change were blowing.  In 1974, 
  Nancy coined the term "VBAC" and by 1975 she was hearing the acronym being 
  used all over the country and was seeing it in medical articles as well. " 
   page 94 Silent KnifeThe book is getting quite old now, 
  but most of what is written still holds true today, and it is a confronting 
  and challenging book to give food for thought.Congratulations Veronica 
  on being informed and up-to-date with the last 3 plus decades ;-) .CarolynPS I was under the 
  impression that a woman who had never experienced pushing stage, would indeed 
  push just like a first time mother.  Certainly was the case for my vbac, 
  took me ages to work out that oh this was pushing not more posterior labour 
  DERR!Veronica Herbert wrote:
  004701c262fc$55ed7060$9245d0cb@pbncomputer" 
type="cite">


Dear all,
 
    Once again I had to "explain" and defend the use of the 
word VBAC.  The response I got today was "Well I'm not going to change 
what I say!" When I said the term had been around since the late 70's 
(somebody said that on here so I hope it's right lol) they said they had 
never heard of it. Well they have now!!! I went home on my tea break and 
printed off copies of the paper that Carolyn (hope you don't mind 
Carolyn) wrote and I placed a copy in the postnatal ward, labour ward, 
    special care nursery, and the tea room. 
Another thing, we had a woman who was trying to have a 
VBAC today and the Registrar that was on said she was only allowed to push 
for 20 minutes and then she was to have a vaccuum extraction, if she hadn't 
pushed it out.  Now I'm no expert on VBAC's but I thought that that was 
a little unfair, since in her last labour she had only got to 4cm 
dilated, and she had never been through second stage. Any thoughts?/? 
By the way, she got to about 5cms and was in good established labour 
managing well, had a V.E (was quite disappointed that she was "Half way"), 
had pethidine, contractions eased off and she went for a C/S!
 
from Veronica Herbert
(Midwifery Student, University of Ballarat)

  - 
  Original Message - 
  From: Jo 
  & Dean Bainbridge 
  To: [EMAIL PROTECTED] 
  
  Sent: 
  Monday, September 23, 2002 8:36 PM
  Subject: 
  Re: [ozmidwifery] vbac
  
  Dear Lynne
  It is good to hear that you don't use ECG for 
  vbac.  Could you send me some policies regarding this (I hate 
  policies but they seem to be the 'in thing' at the moment and we need 
  those who LOVE policies to start to listen.)  Where do you 
  work?
  We would also like some stats to back the 
  success of vbac without  ECG.
  Could I send you a petition for your 
  (obviously intelligent, well run, women focused) place of employment to 
  sign.  Our RANZCOG state committee are trying their DARNDEST to get 
  vbac out of the realm of normal and back into the good old High Risk 
  category.   
  Jo Bainbridgefounding member CARES SAemail: [EMAIL PROTECTED] 
  phone: 08 8388 6918birth with trust, faith & love...
  
- 
Original Message - 
From: Lynne 
    Staff 
To: [EMAIL PROTECTED] 

Sent: 
Monday, September 23, 2002 7:09 PM
Subject: 
Re: [ozmidwifery] vbac

Re: [ozmidwifery] vbac

[Lynne Staff]

Hear Hear Denise! 

  - Original Message - 
  From: 
  Denise Hynd 
  To: [EMAIL PROTECTED] 
  
  Sent: Wednesday, September 25, 2002 12:07 
  PM
  Subject: Re: [ozmidwifery] vbac
  
  Dear All
  Can I please suggest we  do not create new 
  patterns and labels for women inn labour to fit.
  Vbac is like a primip??The more you go where 
  women and their bodies and babies want to  go the more you will come to 
  realise that individuality is every where 
   
  There are and wil always be 
  Primip have quick ("preciptate") labours
  Grandmultips who have slow ("delayed" fail to 
  progress") labours
  Because they may share their aprity with other 
  women but little else and so much can influence a woman, her body and baby in 
  laour and the art of midwfeery is about being with the woman with all her 
  complexities trying to understand and work with them, no some 
  preconceptions!Denise
  
- Original Message - 
From: 
Carolyn Donaghey 
To: [EMAIL PROTECTED] 

Sent: Tuesday, September 24, 2002 9:32 
PM
Subject: Re: [ozmidwifery] vbac
Hi VeronicaWow, you seem to have your work cut out 
for you.  I will give you some good information to back up the validity 
and the antiquity of the term VBAC.Refer to the book Silent Knife: 
Cesarean Prevention and Vaginal Birth after Cesarean (1983) Nancy Wainer 
Cohen & Lois J Estner New York.  This book is a must in the library 
    of any midwife supporting vbac women."In the 1970s, more studies 
    substaintiated the safety of VBAC; yet women were still being sectioned more 
than 99percent of the time.  Still, the winds of change were blowing. 
     In 1974, Nancy coined the term "VBAC" and by 1975 she was hearing the 
acronym being used all over the country and was seeing it in medical 
articles as well. "  page 94 Silent KnifeThe book is 
getting quite old now, but most of what is written still holds true today, 
and it is a confronting and challenging book to give food for 
thought.Congratulations Veronica on being informed and up-to-date 
with the last 3 plus decades ;-) 
.CarolynPS I was under the impression that a woman who 
had never experienced pushing stage, would indeed push just like a first 
    time mother.  Certainly was the case for my vbac, took me ages to work 
out that oh this was pushing not more posterior labour DERR!Veronica 
Herbert wrote:
004701c262fc$55ed7060$9245d0cb@pbncomputer 
  type="cite">
  

  Dear all,
   
  Once again I had to "explain" and defend the use of the 
  word VBAC.  The response I got today was "Well I'm not going to 
  change what I say!" When I said the term had been around since the late 
  70's (somebody said that on here so I hope it's right lol) they said they 
  had never heard of it. Well they have now!!! I went home on my tea break 
  and printed off copies of the paper that Carolyn (hope you don't mind 
  Carolyn) wrote and I placed a copy in the postnatal ward, labour 
  ward, special care nursery, and the tea room. 
  Another thing, we had a woman who was trying to have a 
  VBAC today and the Registrar that was on said she was only allowed to push 
  for 20 minutes and then she was to have a vaccuum extraction, if she 
  hadn't pushed it out.  Now I'm no expert on VBAC's but I thought that 
  that was a little unfair, since in her last labour she had only got to 4cm 
  dilated, and she had never been through second stage. Any thoughts?/? 
  By the way, she got to about 5cms and was in good established labour 
  managing well, had a V.E (was quite disappointed that she was "Half way"), 
  had pethidine, contractions eased off and she went for a C/S!
   
  from Veronica Herbert
  (Midwifery Student, University of Ballarat)
  
- 
Original Message - 
From: Jo 
& Dean Bainbridge 
To: 
    [EMAIL PROTECTED] 
Sent: 
Monday, September 23, 2002 8:36 PM
Subject: 
Re: [ozmidwifery] vbac

Dear Lynne
It is good to hear that you don't use ECG 
for vbac.  Could you send me some policies regarding this (I hate 
policies but they seem to be the 'in thing' at the moment and we need 
    those who LOVE policies to start to listen.)  Where do you 
work?
We would also like some stats to back the 
success of vbac without  ECG.
Could I send you a petition for your 
(obviously intelligent, well run, women focused) place of employment to 
sign.  Our RANZCOG state committee are trying their DARNDEST to get 
vbac out of the realm of normal and back into the good old High Risk 
   

Re: [ozmidwifery] vbac

[Jan Robinson]

Title: Re: [ozmidwifery] vbac



On 23/9/02 3:57 PM, "Jo & Dean Bainbridge" <[EMAIL PROTECTED]> wrote:

hi everyone,
I am wanting to know if anyone can help with a petition being conducted 
through CARES to maintain vbac is a safe and viable option in birth 
centres.  The word is that the new perinatal protocols will be calling 
for all vbacs to be monitored by ECG and thus will remove them from 
birth centre care.
I have a hard copy petition and we are working on an online version but 
need to know if there is anyone out there that I can send the hard copy 
to get some signatures?  I am calling on the maternity coalition 
although I know everyone is busy with NMAP -I am too!!, and also others 
who are willing to keep vbac safe from induction, augmentation and the 
other wonderful types of care that can increase the rates of rupture and 
decrease the woman focused care.
Please help as we need to move quickly on this!
cheers
Jo Bainbridge
founding member CARES SA
email: [EMAIL PROTECTED]
phone: 08 8388 6918
birth with trust, faith & love...


Dear Jo
Send me your online version as an attachment and I’ll download it and get a few signatures for you.

Have you looked at what “A Guide to Effective Care in Pregnancy and Childbirth” Third Ed. (Enkin et al) says about management?
The last paragraph of the author’s conclusions on page 370 is quoted here

“The care of a woman in labor after a previous lower segment cesarean section should be little different from that of any woman in labor. Oxytocin induction or stimulation, and epidural analgesia, may be used for the usual indications. Careful monitoring of the condition of the mother and fetus is required, as for all pregnancies. The hospital facilities required do not differ from those that should be available for all women giving birth, irrespective of their previous history.”

You should be able to argue that the monitoring is far more efficient with one-to-one care in a birth centre.  With constant care from the one attendant there is more likely hood that impending scar rupture or fetal distress will be picked up earlier. The midwives know the woman and her history very well as they have helped her construct her birth plans during her pregnancy..  There is more risk of potential problems NOT being picked up quickly when attendants are viewing monitors at a nursing station and not in constant attendance with the woman. 

As you no doubt know, there have been quite a few successful VBACS at home during the last decade.

I have now attended three successful VBACS at home and am due to attend another next week (with obstetric backup organised if we need to transfer to hospital for another C/S)  The obstetrician is totally supportive of my client’s plans and is looking forward to my call to tell her the baby has been born at home.

You may be able to get the SA figures related to VBACS at home from your DofH Perinatal Stats. Branch. (Midwives Data Collection)

Good luck with your efforts to increase the choices for women.

Jan Robinson

 

[ozmidwifery] VBAC Petition

[Debby M]

Jan and Jo (and anyone else who wants to raise petitions eg. in support of NMAP),
Don't know if you have seen this site but you can easily raise online petitions here at no cost.
http://www.petitionpetition.com/literature/freepetitions/index.html
Debby
 Send and receive Hotmail on your mobile device: Click Here
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Re: [ozmidwifery] VBAC

[Lynne Staff]

Hi Jenny - How does this woman feel about the 
decision to have another caesarean? Does she know that she is entitled to a 
second (and third...) opinion? Or will she be jumping out of the frying pan and 
into the fire with the other opinions she seeks (if all of the obs are 
like-minded)? And not just obs either. I remember many years ago at a homebirth 
meeting, a woman approached me who had had three caesareans and asked me whether 
I thought she could labour and give birth vaginally, and I said "No, it is 
unlikely". In my ignorance and naievety, and working within a system where no 
woman was encouraged, nor mostly "allowed" to have a "trial of scar" 
(ugh...), I did not know, nor had the experience to support a woman through this 
experience. I had therefore never seen what women could do, 
except for those who were dripped and monitored continually and told if they 
hadn't dilated x centimeters by x time they would 'need' a caesarean. Talk 
about setting them up for one!
 
Anyway, years have gone by when I have 
been able to be with women choosing this option and yes, it was at home. I 
got to know women who had done amazing things to get their babies born, and I 
remember telling ab ob I know about these experiences, and others I had heard 
about. He asked me why he had never heard of women achieving these incredible births after one and more caesareans. I can 
remember just looking at him, and asking back "Would you or colleagues of 
yours have listened to them had they requested support for this?" He could 
not answer me. 
 
I was at two amazing births a fortnight ago where 
the woman had had previous caesareans - I am fortunate enough to work in a 
hospital now with people who support the concept of vaginal birth following 
caesarean, and our "stats" are exceptional. But what is far more important 
than stats is how the woman planning to give birth vaginally feels about 
it, whether she gives birth vaginally or by caesarean (or as a friend of mine 
and I hear "from above, or from below" - WHAT mesages does that 
give!!!).
 
She is the 'liver' of the experience - the giver of 
birth, and what she feels as she moves through it and into the rest of her 
life may be cruicial to how she sees herself, her relationship with 
the infant, with her partner, and with her other children. And incidentally - I 
have learned more than you could know, or I could have possibly 
believed from these women - many go through agony before they get to 
the point of actually giving birth, and the agony begins long before the 
labour...and often doesn't include the labour either.
 
Some women go a long way, both emotionally and 
distance wise to find that support, but it is a fact that most have no or little 
support from family or friends for their decision, and less from the medical 
profession on the whole. A well know ob in Bris is often quoted as 
saying "you will never get sued for doing a caesarean but you will if you 
don't". I happen to disagree, and the really unfortunate thing about this is 
that either a woman or a baby, or both, will have to die or be badly 
injured during the course of an uneccessary caesarean for this to 
occur. 
 
My tuppence worth
 
 
 
- Original Message - 

  From: 
  Jenny Balnaves 
  To: [EMAIL PROTECTED] 
  
  Sent: Wednesday, November 06, 2002 8:22 
  AM
  Subject: [ozmidwifery] VBAC
  
  
  
  
  Just a query...the hospital I work in 
  has a fairly high caesarian section rate unfortunately. I admitted a woman for 
  rest last week (at 37 weeks) who is expecting twins...second pregnancy...first 
  was an elective luscs because of 'high head at term'- otherwise known as 
  cephalo pelvic disproportion. 
  This time, both twins are cephalic, first twin's presenting part is very 
  low in the pelvis and is well and truly engaged. Is such a shame 
  that this woman's obstetrician will not even discuss the concept of 
  vaginal birth after caesarian don't you think?
  I welcome any comments anyone would like to make please.
  Regards,
  Jenny 
  
  
  Surf the Web without missing calls! Get MSN Broadband. Click Here -- This mailing list is 
  sponsored by ACE Graphics. Visit to subscribe or 
  unsubscribe.

Re: [ozmidwifery] VBAC

[Jenny Balnaves]

Thank you for your reply Lynne. Unfortunately, the model of care where I 
practice is 95% medical, so consequently, options are rather limited. All 
obstetricians here would veto the choice of VBAC...litigation being foremost 
in their minds. One GP incorporates Team Midwifery into his practice, but 
even there we are still "under his banner" so to speak.

A midwifery model of care has been bandied about for many years here. This 
has been met with great resistance from the obstetricians who view the model 
as being one where they get to clean up the mess as one so delicatly put 
it.(We should wish!)

This particular woman has been advised that the only option was caesarian 
section. She has seen her obstetrician privately throughout her pregnancy 
and as a consequence, our only 'access' to her is when she was admitted as I 
said at 36 weeks gestation, although the cry..."Its never too late" could be 
used in this instance.
She is certainly aware of her options though, being advised by the midwives 
who have met her since her admission.

Unfortunately, because she would have to change hospitals (none of the other 
obstetricians would take on her care at this stage, in support of the other 
obstetrician), it is all too much of a bother to have to address the issues 
of booking else where etc etc apparently, and woe betide the midwife who is 
found culpable of directing this woman to an alternative hospital, let alone 
another doctor!

Hope this is not too long winded.
Regards,

Jenny http://graphics.hotmail.com/emrose.gif"; width=12>



From: "Lynne Staff" <[EMAIL PROTECTED]>
Reply-To: [EMAIL PROTECTED]
To: <[EMAIL PROTECTED]>
Subject: Re: [ozmidwifery] VBAC
Date: Wed, 6 Nov 2002 10:03:48 +1000

Hi Jenny - How does this woman feel about the decision to have another 
caesarean? Does she know that she is entitled to a second (and third...) 
opinion? Or will she be jumping out of the frying pan and into the fire 
with the other opinions she seeks (if all of the obs are like-minded)? And 
not just obs either. I remember many years ago at a homebirth meeting, a 
woman approached me who had had three caesareans and asked me whether I 
thought she could labour and give birth vaginally, and I said "No, it is 
unlikely". In my ignorance and naievety, and working within a system where 
no woman was encouraged, nor mostly "allowed" to have a "trial of scar" 
(ugh...), I did not know, nor had the experience to support a woman through 
this experience. I had therefore never seen what women could do, except for 
those who were dripped and monitored continually and told if they hadn't 
dilated x centimeters by x time they would 'need' a caesarean. Talk about 
setting them up for one!

Anyway, years have gone by when I have been able to be with women choosing 
this option and yes, it was at home. I got to know women who had done 
amazing things to get their babies born, and I remember telling ab ob I 
know about these experiences, and others I had heard about. He asked me why 
he had never heard of women achieving these incredible births after one and 
more caesareans. I can remember just looking at him, and asking back "Would 
you or colleagues of yours have listened to them had they requested support 
for this?" He could not answer me.

I was at two amazing births a fortnight ago where the woman had had 
previous caesareans - I am fortunate enough to work in a hospital now with 
people who support the concept of vaginal birth following caesarean, and 
our "stats" are exceptional. But what is far more important than stats is 
how the woman planning to give birth vaginally feels about it, whether she 
gives birth vaginally or by caesarean (or as a friend of mine and I hear 
"from above, or from below" - WHAT mesages does that give!!!).

She is the 'liver' of the experience - the giver of birth, and what she 
feels as she moves through it and into the rest of her life may be cruicial 
to how she sees herself, her relationship with the infant, with her 
partner, and with her other children. And incidentally - I have learned 
more than you could know, or I could have possibly believed from these 
women - many go through agony before they get to the point of actually 
giving birth, and the agony begins long before the labour...and often 
doesn't include the labour either.

Some women go a long way, both emotionally and distance wise to find that 
support, but it is a fact that most have no or little support from family 
or friends for their decision, and less from the medical profession on the 
whole. A well know ob in Bris is often quoted as saying "you will never get 
sued for doing a caesarean but you will if you don't". I happen to 
disagree, and the really unfortunate thing about this is that either a 
woman or a baby, or both, will have to die or be badly

Re: [ozmidwifery] VBAC

[Aviva Sheb'a]

I knew someone in Melbourne who called them 
Obstinatricians! Well, more than one.
aviva
- Original Message - 
From: Jenny 
Balnaves 
To: [EMAIL PROTECTED] 
Sent: Wednesday, November 06, 2002 11:44 AM
Subject: Re: [ozmidwifery] VBAC
Thank you for your reply Lynne. Unfortunately, the model of care 
where I practice is 95% medical, so consequently, options are rather 
limited. All obstetricians here would veto the choice of VBAC...litigation 
being foremost in their minds. One GP incorporates Team Midwifery into his 
practice, but even there we are still "under his banner" so to 
speak.

Re: [ozmidwifery] VBAC

[Rhonda]

   
  How sad for this woman - that red tape and politics are going to scar 
  her for life in so many ways.
  This is the sad reality of our free and lucky country.
  Now speachless..
  Rhonda
   
  ---Original Message---
   
  
  From: [EMAIL PROTECTED]
  Date: Thursday, 
  November 07, 2002 19:05:58
  To: [EMAIL PROTECTED]
  Subject: Re: 
  [ozmidwifery] VBAC
   Thank you for your reply Lynne. Unfortunately, the model 
  of care where I practice is 95% medical, so consequently, options are 
  rather limited. All obstetricians here would veto the choice of 
  VBAC...litigation being foremost in their minds. One GP incorporates 
  Team Midwifery into his practice, but even there we are still "under 
  his banner" so to speak.A midwifery model of care has been bandied 
  about for many years here. This has been met with great resistance 
  from the obstetricians who view the model as being one where they get 
  to clean up the mess as one so delicatly put it.(We should 
  wish!)This particular woman has been advised that the only option 
  was caesarian section. She has seen her obstetrician privately 
  throughout her pregnancy and as a consequence, our only 'access' to 
  her is when she was admitted as I said at 36 weeks gestation, although 
  the cry..."Its never too late" could be used in this instance.She 
  is certainly aware of her options though, being advised by the midwives 
  who have met her since her admission.Unfortunately, because 
  she would have to change hospitals (none of the other obstetricians 
  would take on her care at this stage, in support of the other 
  obstetrician), it is all too much of a bother to have to address the 
  issues of booking else where etc etc apparently, and woe betide the 
  midwife who is found culpable of directing this woman to an 
  alternative hospital, let alone another doctor!Hope this is 
  not too long 
  winded.Regards,Jenny 
  src="http://graphics.hotmail.com/emrose.gif" 
  width=12>>From: 
  "Lynne Staff" <[EMAIL PROTECTED]>>Reply-To: 
  [EMAIL PROTECTED]>To: 
  <[EMAIL PROTECTED]>>Subject: 
  Re: [ozmidwifery] VBAC>Date: Wed, 6 Nov 2002 10:03:48 
  +1000>>Hi Jenny - How does this woman feel about the 
  decision to have another >caesarean? Does she know that she is 
  entitled to a second (and third...) >opinion? Or will she be 
  jumping out of the frying pan and into the fire >with the other 
  opinions she seeks (if all of the obs are like-minded)? And >not 
  just obs either. I remember many years ago at a homebirth meeting, a 
  >woman approached me who had had three caesareans and asked me 
  whether I >thought she could labour and give birth vaginally, and I 
  said "No, it is >unlikely". In my ignorance and naievety, and 
  working within a system where >no woman was encouraged, nor mostly 
  "allowed" to have a "trial of scar" >(ugh...), I did not know, nor 
  had the experience to support a woman through >this experience. I 
  had therefore never seen what women could do, except for >those who 
  were dripped and monitored continually and told if they hadn't 
  >dilated x centimeters by x time they would 'need' a caesarean. 
  Talk about >setting them up for one!>>Anyway, years 
  have gone by when I have been able to be with women choosing >this 
  option and yes, it was at home. I got to know women who had done 
  >amazing things to get their babies born, and I remember telling ab 
  ob I >know about these experiences, and others I had heard about. 
  He asked me why >he had never heard of women achieving these 
  incredible births after one and >more caesareans. I can remember 
  just looking at him, and asking back "Would >you or colleagues of 
  yours have listened to them had they requested support >for this?" 
  He could not answer me.>>I was at two amazing births a 
  fortnight ago where the woman had had >previous caesareans - I am 
  fortunate enough to work in a hospital now with >people who support 
  the concept of vaginal birth following caesarean, and >our "stats" 
  are exceptional. But what is far more important than stats is >how 
  the woman planning to give birth vaginally feels about it, whether she 
  >gives birth vaginally or by caesarean (or as a friend of mine and 
  I hear >"from above, or from below" - WHAT mesages does that 
  give!!!).>>She is the 'liver' of the experience - the giver 
  of birth, and 

RE: [ozmidwifery] VBAC

[Vicki Chan]

The decision always rests with the mother!! And more power to the
midwife who is willing to put all on the line to give the woman the
information, support, and love she deserves.

Vicki 

-Original Message-
From: [EMAIL PROTECTED]
[mailto:owner-ozmidwifery@;acegraphics.com.au] On Behalf Of Jenny
Balnaves
Sent: Wednesday, November 06, 2002 11:15 AM
To: [EMAIL PROTECTED]
Subject: Re: [ozmidwifery] VBAC


Thank you for your reply Lynne. Unfortunately, the model of care where I

practice is 95% medical, so consequently, options are rather limited.
All 
obstetricians here would veto the choice of VBAC...litigation being
foremost 
in their minds. One GP incorporates Team Midwifery into his practice,
but 
even there we are still "under his banner" so to speak.

A midwifery model of care has been bandied about for many years here.
This 
has been met with great resistance from the obstetricians who view the
model 
as being one where they get to clean up the mess as one so delicatly put

it.(We should wish!)

This particular woman has been advised that the only option was
caesarian 
section. She has seen her obstetrician privately throughout her
pregnancy 
and as a consequence, our only 'access' to her is when she was admitted
as I 
said at 36 weeks gestation, although the cry..."Its never too late"
could be 
used in this instance.
She is certainly aware of her options though, being advised by the
midwives 
who have met her since her admission.

Unfortunately, because she would have to change hospitals (none of the
other 
obstetricians would take on her care at this stage, in support of the
other 
obstetrician), it is all too much of a bother to have to address the
issues 
of booking else where etc etc apparently, and woe betide the midwife who
is 
found culpable of directing this woman to an alternative hospital, let
alone 
another doctor!

Hope this is not too long winded.
Regards,

Jenny http://graphics.hotmail.com/emrose.gif";
width=12>



>From: "Lynne Staff" <[EMAIL PROTECTED]>
>Reply-To: [EMAIL PROTECTED]
>To: <[EMAIL PROTECTED]>
>Subject: Re: [ozmidwifery] VBAC
>Date: Wed, 6 Nov 2002 10:03:48 +1000
>
>Hi Jenny - How does this woman feel about the decision to have another
>caesarean? Does she know that she is entitled to a second (and
third...) 
>opinion? Or will she be jumping out of the frying pan and into the fire

>with the other opinions she seeks (if all of the obs are like-minded)?
And 
>not just obs either. I remember many years ago at a homebirth meeting,
a 
>woman approached me who had had three caesareans and asked me whether I

>thought she could labour and give birth vaginally, and I said "No, it
is 
>unlikely". In my ignorance and naievety, and working within a system
where 
>no woman was encouraged, nor mostly "allowed" to have a "trial of scar"

>(ugh...), I did not know, nor had the experience to support a woman
through 
>this experience. I had therefore never seen what women could do, except
for 
>those who were dripped and monitored continually and told if they
hadn't 
>dilated x centimeters by x time they would 'need' a caesarean. Talk
about 
>setting them up for one!
>
>Anyway, years have gone by when I have been able to be with women 
>choosing
>this option and yes, it was at home. I got to know women who had done 
>amazing things to get their babies born, and I remember telling ab ob I

>know about these experiences, and others I had heard about. He asked me
why 
>he had never heard of women achieving these incredible births after one
and 
>more caesareans. I can remember just looking at him, and asking back
"Would 
>you or colleagues of yours have listened to them had they requested
support 
>for this?" He could not answer me.
>
>I was at two amazing births a fortnight ago where the woman had had
>previous caesareans - I am fortunate enough to work in a hospital now
with 
>people who support the concept of vaginal birth following caesarean,
and 
>our "stats" are exceptional. But what is far more important than stats
is 
>how the woman planning to give birth vaginally feels about it, whether
she 
>gives birth vaginally or by caesarean (or as a friend of mine and I
hear 
>"from above, or from below" - WHAT mesages does that give!!!).
>
>She is the 'liver' of the experience - the giver of birth, and what she
>feels as she moves through it and into the rest of her life may be
cruicial 
>to how she sees herself, her relationship with the infant, with her 
>partner, and with her other children. And incidentally - I have learned

>more than you could know, or I could have possibly believed from these 
>women - many go through agony before they get to the point of actually 
>giving birth, and the agony 

[ozmidwifery] VBAC Pamphlet

[Laraine Hood]

Yesterday, when visiting one of my clients who is 
planning a VBAC, she showed me a pamphlet her Obs had given her (he is pro VBAC 
obviously).  It is a new 'release' from the RCOG for women and is positive 
toward VBACs!! The pamphlet is quite well written, decent language generally, 
and points out the PROs and cons. I was impressed. Now, lets wait and see how 
many of the obs give them to their clients 
Laraine

[ozmidwifery] VBAC support

[HELEN]

Has anyone got info on a support group for women who have had a traumatic
birth ( & caesarean) and  are contemplating a future baby?  This mothe lives
in Melbourne.  She lady has been told her pelvis is too small  (one of her
measurements is 0.7cm too small), scan done sometime after the first birth,
when she was not pregnant!  She is doing lots of research and has seen a
supportive Gp & is soon to see a 2nd Obs.  I wonder if there is a lovely
midwife that would be happy to coomunicate with her by email or phone on the
issue of CPD and future birth.   She has
been fed so much misinformation and I'm unsure of how to reassure her
further.  Her breastfeeding experience after the caesarean birth wasn't all
that great, but there I can assist her.   Thank-you all
Helen Grainger  [EMAIL PROTECTED]

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[ozmidwifery] VBAC book

[Tim and Katrina]

Hi All,

I would like some recommendations on a good VBAC book for our local ABA
library Any ideas?

Katrina Matthews

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[ozmidwifery] vbac friendly

[Jo & Dean Bainbridge]

Can anyone contact me if you are aware of any vbac 
friendly models of care that are in place anywhere in Australia currently?  
I am after any KYM vbac; case loading vbac; high education levels for staff and 
or women 9 clinics and education classes specific to vbac) and so on.  I 
really need some feed back ASAP, so can anyone help?
cheers
Jo Bainbridgefounding member CARES SAwww.cares-sa.org.au[EMAIL PROTECTED]phone: 08 8388 
6918birth with trust, faith & love...

[ozmidwifery] KYM VBAC

[Jo & Dean Bainbridge]

Kathy wrote:  "It seems to me that women success rate of VBAC increase with
the
woman's determination, partners and midwifery support."
Oh if only we could have some research proof for this!  WE know it is true
but those who are determined to compare vbac with repeat cs and only factor
in the medically managed vbacs with little to no support just don't seem to
want to look at it.
I am trying to combat the impending ACTOBAC trial by bringing about some
awareness of vbac and the support needed.  The more we hear about the
institutions who do a vbac supportive model of care the better.  The
hospitals in Adelaide are resistant to separating vbac from the norm...but
as I keep telling them we are not considered normal anywayso why not let
us be separated but in a positive way.  The critics claim that by having
this sort of vbac focus it is setting women up to fail.  I thought the focus
could be a "Welcome BAC" (welcome to Birth After Caesarean and also the fact
that she has birthed before and this is a welcome back to the hospital...)
Therefore the focus is not on a vaginal birth but offers the support most
women need to get one.  There could be a element of the care that addresses
the need for a repeat cs and therefore combat the negativity that can be
associated with failing (although we know there is no such thing as failure
in birthing...)

The women receive a VBAC package in your careLOVE to see one?  Any
chance of having one slipped out of the building and into the post?????
CARES are working on a vbac information package and what you have done
sounds like something we are strongly recommending the hospitals implement.
By encouraging them to do something like this we are actually getting them
to look at the way they currently treat vbac.
Sorry, but I am going to have to cut it short there...I am so tired and I
have to work tomorrow so I will talk again soon.  Please email me off list
if you like; but I do know that if you keep posting details of what you are
doing them others on the list will benefit too.
cheers
Jo Bainbridge
founding member CARES SA
www.cares-sa.org.au
[EMAIL PROTECTED]
phone: 08 8388 6918
birth with trust, faith & love...
- Original Message -
From: "Kathy McCarthy-Bushby" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Saturday, May 31, 2003 12:32 PM
Subject: Re: [ozmidwifery] Reply to Kathy


> 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 in

[ozmidwifery] VBAC booklet

[Dean & Jo]

Hi to everyone who has requested a copy of the booklet.
I am waiting on Carolyn to come back from a well deserved holiday so we
can confirm the cost for the booklet.  Hard copies will be pricey due to
the size of the booklet and postage, so I am investigating th option of
burning it onto a CD which people can the use to run their own copies
off.  Would this be a more suitable option for people or would yu prefer
hard copies?
I have taken you names and such and will send an email out with all the
confirmed details.
Thanks for your support!
Cheers  
Jo
CARES SA

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[ozmidwifery] Vbac booklet

[Dean & Jo]

Oh, 
And payments can be sent to:

 
CARES SA 
PO Box 1013
Nairne SA
5252

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[ozmidwifery] Successful VBAC

[Judy Chapman]

We were all so happy at work this morning. Woman having third baby and at term. First CS for  breech, second SVB. OB in tertiary hospital telling her that she should not be seeing midwives "They can't fix up the ruptured uterus can they?"
She an intelligent professional but very unsure, pulled both ways. Booked in for ARM and probable CS later for the next day (today). Heaps of talking with her midwife who ended up telling her that we would not be telling her about stuff that we did not think was safe as we also have our reputation to think of. Strip and stretch offered and accepted. 
Later in the day, rapid labour (how sad, too fast to get to the tertiary hospital an hours drive away) and an SVB in all fours on the floor. Today walking on air. Would love to have seen his face when he got told what had happened. 
Cheers
Judy 
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[ozmidwifery] VBAC constraints

[Jo & Dean Bainbridge]

From Midwifery Today:
 


  
  
labor longer than 12 hours

  OP 
  49.7%
Persistent fetal occiput posterior position: obstetric outcomes. 
Obstet Gynecol 2003; 101:917
 
Interestingly enough, in reading VBAC 
management terms, one of the guidelines is that a partogram should be used and 
if a vbac woman slips past the 'accepted' cm/hour that obstetric intervention 
should be discussed.
 
Now if the above stat is accurate then 50% 
of all OP vbacs would fail to meet the criteria of the 
cm/hour...
 
No wonder that vbac success rates do not 
truly reflect the accepted possible numbers of successful vbac 
rates!
 
just venting.
Jo

Re: [ozmidwifery] VBAC

[Jen Semple]

How common is the use of misoprostol for induction in Australia?
 
I've read it's used quite a lot in the US & that it's used in abortion in Australia, but all I've seen used for induction (in my 2 years as a mid student) in Oz is Prostin.
 
Would love to hear your thoughts/experiences.
 
Jen
3rd year BMid, MelbourneMary Murphy <[EMAIL PROTECTED]> wrote:








20040414-39 Uterine rupture  associated with misoprostol labor induction in women with previous cesarean delivery - European Journal of Obstetrics and Gynecology and Reproductive Biology , vol 113, no 1, March 2004, pp 45-48 Aslan H; Unlu E; Agar M; et al - (2004)

 
OBJECTIVE: To review our experience with uterine rupture in patients undergoing a trial of labor with a history of previous cesarean delivery in which labor was induced with misoprostol. STUDY DESIGN: A retrospective chart review was used to select patients who underwent induction of labor with misoprostol during the period from February 1999 to June 2002. Women with a history of cesarean delivery were retrospectively compared with those without uterine scarring. RESULTS: Uterine rupture occurred in 4 of 41 patients with previous cesarean delivery who had labor induced with misoprostol. The rate of uterine rupture (9.7%) was significantly higher in patients with a previous cesarean delivery (P<0.001). No uterine rupture occurred in 50 patients without uterine scarring. Women with a history of cesarean delivery were more likely to have oxytocin augmentation than those without uterine scar!
 ring (41%
 versus 20%; P=0.037). CONCLUSION: Misoprostol induction of labor increases the risk of uterine rupture in women with a history of cesarean delivery. (16 references) (Author) 



Article Type: 
Original research



Standard Search: P107 L14 L21 
Yet VBAC  women are still being induced this way.  4 out of 41 is pretty definite.  M
Find local movie times and trailers on Yahoo! Movies.

Re: [ozmidwifery] VBAC

[Jo & Dean Bainbridge]

They have started using misoprostol here in Australia; 
W&CH SA were doing studies in it using women but assured me they would not 
be using VBAC women as VBAC is a contra-indication for using the drug.  
These were the same people who were/are doing the ACTOBAC trial.  

The thing that worries me is they say it is not 
suitable and for darn good reason, but then it becomes the norm for nonvbacs and 
then over time it starts to be used and whammo!  VBAC is once again 
endangered not by being a vbac but by mismanagement.  A great number of the 
studies into the safety of vbac are ones done where induction drugs such as this 
is usedand they wonder why Uterine Rupture occurs!!!
sorry...just venting!!!
Jo

  - Original Message - 
  From: 
  Jen 
  Semple 
  To: [EMAIL PROTECTED] 
  
  Sent: Sunday, April 18, 2004 11:21 
  AM
  Subject: Re: [ozmidwifery] VBAC
  
  How common is the use of misoprostol for induction in Australia?
   
  I've read it's used quite a lot in the US & that it's used in 
  abortion in Australia, but all I've seen used for induction (in my 2 years as 
  a mid student) in Oz is Prostin.
   
  Would love to hear your thoughts/experiences.
   
  Jen
  3rd year BMid, MelbourneMary Murphy <[EMAIL PROTECTED]> 
  wrote:
  





  
  
20040414-39 Uterine 
  rupture  associated with misoprostol labor induction in 
  women with previous cesarean delivery - European Journal of Obstetrics and Gynecology and Reproductive 
  Biology , vol 113, no 1, March 2004, pp 45-48 Aslan H; 
  Unlu E; Agar M; et al - (2004)
  
 
OBJECTIVE: To review our experience with uterine 
  rupture in patients undergoing a trial of labor with a history of 
  previous cesarean delivery in which labor was induced with 
  misoprostol. STUDY DESIGN: A retrospective chart review was used to 
  select patients who underwent induction of labor with misoprostol 
  during the period from February 1999 to June 2002. Women with a 
  history of cesarean delivery were retrospectively compared with those 
  without uterine scarring. RESULTS: Uterine rupture occurred in 4 of 41 
  patients with previous cesarean delivery who had labor induced with 
  misoprostol. The rate of uterine rupture (9.7%) was significantly 
  higher in patients with a previous cesarean delivery (P<0.001). No 
  uterine rupture occurred in 50 patients without uterine scarring. 
  Women with a history of cesarean delivery were more likely to have 
  oxytocin augmentation than those without uterine scar! ring (41% 
  versus 20%; P=0.037). CONCLUSION: Misoprostol induction of labor 
  increases the risk of uterine rupture in women with a history of 
  cesarean delivery. (16 references) (Author) 
  


  Article Type: 
  Original research
  


  Standard Search: P107 L14 L21 
Yet VBAC  women are still being induced this 
way.  4 out of 41 is pretty definite. 
   M
  
  
  Find local movie times and trailers on Yahoo! 
  Movies.

Re: [ozmidwifery] VBAC

[Judy Chapman]

Jen,
I have not seen it used other than for termination. That is several hospitals in Nth Qld.
Cheers
JudyJen Semple <[EMAIL PROTECTED]> wrote:

How common is the use of misoprostol for induction in Australia?
 
I've read it's used quite a lot in the US & that it's used in abortion in Australia, but all I've seen used for induction (in my 2 years as a mid student) in Oz is Prostin.
 
Would love to hear your thoughts/experiences.
 
Jen
3rd year BMid, MelbourneMary Murphy <[EMAIL PROTECTED]> wrote:








20040414-39 Uterine rupture  associated with misoprostol labor induction in women with previous cesarean delivery - European Journal of Obstetrics and Gynecology and Reproductive Biology , vol 113, no 1, March 2004, pp 45-48 Aslan H; Unlu E; Agar M; et al - (2004)

 
OBJECTIVE: To review our experience with uterine rupture in patients undergoing a trial of labor with a history of previous cesarean delivery in which labor was induced with misoprostol. STUDY DESIGN: A retrospective chart review was used to select patients who underwent induction of labor with misoprostol during the period from February 1999 to June 2002. Women with a history of cesarean delivery were retrospectively compared with those without uterine scarring. RESULTS: Uterine rupture occurred in 4 of 41 patients with previous cesarean delivery who had labor induced with misoprostol. The rate of uterine rupture (9.7%) was significantly higher in patients with a previous cesarean delivery (P<0.001). No uterine rupture occurred in 50 patients without uterine scarring. Women with a history of cesarean delivery were more likely to have oxytocin augmentation than those without uterine scar!
 ! ring
 (41% versus 20%; P=0.037). CONCLUSION: Misoprostol induction of labor increases the risk of uterine rupture in women with a history of cesarean delivery. (16 references) (Author) 



Article Type: 
Original research



Standard Search: P107 L14 L21 
Yet VBAC  women are still being induced this way.  4 out of 41 is pretty definite.  M


Find local movie times and trailers on Yahoo! Movies.
Find local movie times and trailers on Yahoo! Movies.

RE: [ozmidwifery] VBAC

[Larry & Megan]

My 
understanding is that the company that makes Misoprostol does not support the 
use of it as an induction drug AT ALL. If this is the case, I can only wonder 
how an ethics committee can approve any trial using this drug. It is 
considerably cheaper than alternatives and is promoted as being kinder to woman 
as it is less invasive than insertion of gels. Also there isn't a storage 
problem with having to keep it in a fridge, benefits remote areas aimed at 
"helping" developing countries, etc.
The 
mind boggles,
Megan
 

  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of Jo & Dean 
  BainbridgeSent: Sunday, 18 April 2004 12:51To: 
  [EMAIL PROTECTED]Subject: Re: [ozmidwifery] 
  VBAC
  They have started using misoprostol here in Australia; 
  W&CH SA were doing studies in it using women but assured me they would not 
  be using VBAC women as VBAC is a contra-indication for using the drug.  
  These were the same people who were/are doing the ACTOBAC trial.  
  
  The thing that worries me is they say it is not 
  suitable and for darn good reason, but then it becomes the norm for nonvbacs 
  and then over time it starts to be used and whammo!  VBAC is once 
  again endangered not by being a vbac but by mismanagement.  A great 
  number of the studies into the safety of vbac are ones done where induction 
  drugs such as this is usedand they wonder why Uterine Rupture 
  occurs!!!
  sorry...just venting!!!
  Jo
  
- Original Message - 
From: 
Jen 
Semple 
To: [EMAIL PROTECTED] 

Sent: Sunday, April 18, 2004 11:21 
AM
Subject: Re: [ozmidwifery] VBAC

How common is the use of misoprostol for induction in Australia?
 
I've read it's used quite a lot in the US & that it's used in 
abortion in Australia, but all I've seen used for induction (in my 2 years 
as a mid student) in Oz is Prostin.
 
Would love to hear your thoughts/experiences.
 
Jen
3rd year BMid, MelbourneMary Murphy <[EMAIL PROTECTED]> 
wrote:

  
  

  
  


  20040414-39 Uterine 
rupture  associated with misoprostol labor induction in 
women with previous cesarean delivery - European Journal of Obstetrics and Gynecology and 
Reproductive Biology , vol 113, no 1, March 2004, pp 
45-48 Aslan H; Unlu E; Agar M; et 
al - (2004)

   
  OBJECTIVE: To review our experience with 
uterine rupture in patients undergoing a trial of labor with a 
history of previous cesarean delivery in which labor was induced 
with misoprostol. STUDY DESIGN: A retrospective chart review was 
used to select patients who underwent induction of labor with 
misoprostol during the period from February 1999 to June 2002. Women 
with a history of cesarean delivery were retrospectively compared 
with those without uterine scarring. RESULTS: Uterine rupture 
occurred in 4 of 41 patients with previous cesarean delivery who had 
labor induced with misoprostol. The rate of uterine rupture (9.7%) 
was significantly higher in patients with a previous cesarean 
delivery (P<0.001). No uterine rupture occurred in 50 patients 
without uterine scarring. Women with a history of cesarean delivery 
were more likely to have oxytocin augmentation than those without 
uterine scar! ring (41% versus 20%; P=0.037). CONCLUSION: 
Misoprostol induction of labor increases the risk of uterine rupture 
in women with a history of cesarean delivery. (16 references) 
(Author) 

  
  
Article Type: 
Original research

  
  
    Standard Search: P107 L14 L21 
  Yet VBAC  women are still being induced this 
  way.  4 out of 41 is pretty definite. 
 M


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Re: [ozmidwifery] VBAC

[leanne wynne]

I believe there is a random controlled trial of Misoprostil for IOL 
happening at one of the major maternity hospitals in Sydney. I dont think 
the results have ben published as yet.


From: Jen Semple <[EMAIL PROTECTED]>
Reply-To: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Subject: Re: [ozmidwifery] VBAC
Date: Sun, 18 Apr 2004 11:51:20 +1000 (EST)
How common is the use of misoprostol for induction in Australia?

I've read it's used quite a lot in the US & that it's used in abortion in 
Australia, but all I've seen used for induction (in my 2 years as a mid 
student) in Oz is Prostin.

Would love to hear your thoughts/experiences.

Jen
3rd year BMid, Melbourne
Mary Murphy <[EMAIL PROTECTED]> wrote:
20040414-39 Uterine rupture  associated with misoprostol labor induction in 
women with previous cesarean delivery - European Journal of Obstetrics and 
Gynecology and Reproductive Biology , vol 113, no 1, March 2004, pp 45-48 
Aslan H; Unlu E; Agar M; et al - (2004) OBJECTIVE: To review our experience 
with uterine rupture in patients undergoing a trial of labor with a history 
of previous cesarean delivery in which labor was induced with misoprostol. 
STUDY DESIGN: A retrospective chart review was used to select patients who 
underwent induction of labor with misoprostol during the period from 
February 1999 to June 2002. Women with a history of cesarean delivery were 
retrospectively compared with those without uterine scarring. RESULTS: 
Uterine rupture occurred in 4 of 41 patients with previous cesarean 
delivery who had labor induced with misoprostol. The rate of uterine 
rupture (9.7%) was significantly higher in patients with a previous 
cesarean delivery (P<0.001). No uterine ru!
 pture
 occurred in 50 patients without uterine scarring. Women with a history of 
cesarean delivery were more likely to have oxytocin augmentation than those 
without uterine scarring (41% versus 20%; P=0.037). CONCLUSION: Misoprostol 
induction of labor increases the risk of uterine rupture in women with a 
history of cesarean delivery. (16 references) (Author) Article Type: 
Original researchStandard Search: P107 L14 L21
Yet VBAC  women are still being induced this way.  4 out of 41 is pretty 
definite.  M



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Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service  Mob 0418 371862
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[ozmidwifery] VBAC education

[Susan Cudlipp]

Dear list
The recent posts on VBAC have been useful as we are 
looking into offering Childbirth classes specifically for women who have had a 
C/S, in addition to the ones presently being offered.
Does anyone have some previous class formats that 
may have worked well that they would be happy to share?
Thanks
Sue
 

[ozmidwifery] VBAC 'mangement'

[Dean & Jo]

Hi everyone, 
on the topic of VBAC I would like to ask those who 
are offering VBAC models of care to contact me with their VBAC 'management' as I 
am writing a feed back for the SA state perinatal protocols for VBAC management 
(I hate the word management as you may have guessed!!). 
 
The policies are based on the multicentred study of 
vbac from 2000 which we all know, and the things they re suggesting to be state 
wide policies include the heavy use of continuous monitoring  due to 
rupture detection.  My argument is that they are referring to studies that 
have only looked at vbac acre and outcomes from the medical model and have 
ignored the care and outcomes of birthing centre or midwifery led models.  
These policies will impact everywhere in SA.
 
To have some stats, outcomes and so forth from 
alternatives from the labour ward 'care' (that concept of care which includes 
induction/augmentation etc makes me shudder also) would be handy.  I would 
need it ASAP though.
 
Hope someone has the time to respond.
 
cheers Jo

Re: [ozmidwifery] vbac

[Tim and Katrina]

Hi Kathy, I could post you the "Choices for 
Childbirth" vbac kit, - a photocopied pack outlining the vbac issue. Very good 
for couples looking for accurate evidence-based info. If you'd like me to send 
it just email me your postal address.
 
Katrina

  - Original Message - 
  From: 
  simsarch 
  To: [EMAIL PROTECTED] 
  
  Sent: Wednesday, September 29, 2004 4:43 
  PM
  Subject: [ozmidwifery] vbac
  
  Could anyone point me in the right direction 
  for any info I could pass on to a client.  She had an emerg c/s 10 
  months ago for fetal distress and op position when fully dilated, and is 
  passionate about having a vbac this time. However, she has been scared by many 
  a friend and doctor, that as this only happened 10 months ago and she is now 
  12 weeks pregnant, she shouldn't be attempting a vbac, due to risk of uterine 
  rupture. She had her first baby in a private hospital and has now come to 
  me - I work at the W&CH in Adealide in a caseload model. I have given her 
  the Cares brochure, but english is her second language, and she seemed 
  reluctant to ring or join them in any way.  I know I have plenty of 
  opportunity to discuss these issues with her, but also want to give her lots 
  of stuff to read.  I am also not sure myself if the risk of uterine 
  rupture in her case is real as I remember reading somewhere it is ideal to 
  wait 2 years before getting pregnant again after a c/s.
  Thanks,
  Kathy
  
  
   

Re: [ozmidwifery] vbac

[Kate &/or Nick]

I'm a student midwife, member of Cares 
SA, who has VBACed. Can't remember the years thing. BUT, I would encourage her 
to contact Cares. Jo is away, so Carolyn would be the go. They are really good 
at group stuff, one-on-one if that's what's needed. Their library is fantastic 
and empowered me to fight for my VBAC. 
 
I'll email Carolyn with the timing 
question - she's not a midwife, but is a font of knowledge when it comes to 
VBAC. 
 
Also, either way and wherever she is 
birthing, I'd strongly encourage her to consider a student midwife - both 
for the VBAC and language issues. CARES has two student midwives, and I'm sure 
we both need more women!
 
Will get back to you.
 
Kate

  - Original Message - 
  From: 
  simsarch 
  To: [EMAIL PROTECTED] 
  
  Sent: Wednesday, September 29, 2004 4:13 
  PM
  Subject: [ozmidwifery] vbac
  
  Could anyone point me in the right direction 
  for any info I could pass on to a client.  She had an emerg c/s 10 
  months ago for fetal distress and op position when fully dilated, and is 
  passionate about having a vbac this time. However, she has been scared by many 
  a friend and doctor, that as this only happened 10 months ago and she is now 
  12 weeks pregnant, she shouldn't be attempting a vbac, due to risk of uterine 
  rupture. She had her first baby in a private hospital and has now come to 
  me - I work at the W&CH in Adealide in a caseload model. I have given her 
  the Cares brochure, but english is her second language, and she seemed 
  reluctant to ring or join them in any way.  I know I have plenty of 
  opportunity to discuss these issues with her, but also want to give her lots 
  of stuff to read.  I am also not sure myself if the risk of uterine 
  rupture in her case is real as I remember reading somewhere it is ideal to 
  wait 2 years before getting pregnant again after a c/s.
  Thanks,
  Kathy
  
  
   

RE: [ozmidwifery] VBAC

[Dean & Jo]

Title: Message



VBAC success rate for someone who had birthed by cs for 
previous twin birth   79%
 
 

Effect of prior vaginal delivery or prior vaginal 
birth after caesarean delivery on obstetric outcomes in women undergoing trial 
of labor.
Obstet 
Gynecol. 2004 Aug;104(2):273-7
Hendler 
I, Bujold E.
OBJECTIVE: We 
sought to study the effects of prior vaginal delivery or prior vaginal birth 
after cesarean delivery (VBAC) on the success of a trial of labor after a 
cesarean delivery. METHODS: An observational study of patients who underwent a 
trial of labor after a single low-transverse cesarean delivery. Patients with a 
previous cesarean delivery and no vaginal birth were compared with patients with 
a single vaginal delivery before or after the previous cesarean delivery. The 
rates of successful VBAC, uterine rupture, and scar dehiscence were analyzed. 
Multivariable regression was performed to adjust for confounding variables. 
RESULTS: Of 2,204 patients, 1,685 (76.4%) had a previous cesarean delivery and 
no vaginal delivery, 198 (9.0%) had a vaginal delivery before the cesarean 
delivery, and 321 (14.6%) had a prior VBAC. The rate of successful trial of 
labor was 70.1%, 81.8%, and 93.1%, respectively (P <.001). A prior VBAC was 
associated with fewer third- and fourth-degree lacerations (8.5% versus 2.5% 
versus 3.7%, P <.001) and fewer operative vaginal deliveries (14.7% versus 
5.6% versus 1.9%, P <.001) but not with uterine rupture (1.5% versus 0.5% 
versus 0.3%, P =.12). Patients with a prior VBAC had, in addition, a higher rate 
of uterine scar dehiscence (21.8%) compared with patients with a previous 
cesarean delivery and no vaginal delivery (5.3%; P =.001). CONCLUSION: A prior 
vaginal delivery and, particularly, a prior VBAC are associated with a higher 
rate of successful trial of labor compared with patients with no prior vaginal 
delivery. In addition, prior VBAC is associated with an increased rate of 
uterine scar dehiscence.
 
the emphasis on that last sentence 
is dehiscence...not rupture.
 
there are a few more studies that 
show women with a previous vagianl birth then a cs are more likely to havea 
successful vbac.  Why would a twin cs be different to a 
singleton???

  
  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED] On Behalf Of Mary 
  MurphySent: Wednesday, May 17, 2006 7:21 PMTo: 
  ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] 
  VBAC
  
  Hi everyone, collective knowledge 
  sought!  Does anyone have any information that would enlighten a woman 
  who has had 2 vaginal births, then twins by C/S and now wants a VBAC.  Is 
  she at increased risk because of the twin C/S?  Thanks, 
  MM
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Re: [ozmidwifery] VBAC

[Lynne Staff]

Absolutely not Mary. The things that increase risk 
are usually complications that occur as a result of CS, such as intrauterine 
infections following CS, haematoma formation in the uterine incision, extension 
of the uterine incision at CS, and not the fact that she has had a CS for a 
twin pregnancy. She is no more likely to have a CS than any other 
multigravida. I wish her all the best for a wonderful birth.
Regards, Lynne 

  - Original Message - 
  From: 
  Mary 
  Murphy 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Wednesday, May 17, 2006 7:51 
  PM
  Subject: [ozmidwifery] VBAC
  
  
  Hi everyone, collective knowledge 
  sought!  Does anyone have any information that would enlighten a woman 
  who has had 2 vaginal births, then twins by C/S and now wants a VBAC.  Is 
  she at increased risk because of the twin C/S?  Thanks, 
  MM

Re: [ozmidwifery] VBAC

[nicole and gareth]

Hi all.

Im after some help for a woman who had a CS for first babe 18 mths ago for ??? (Failure to progress at 6cm in chart), she subsequently had a wound infection at around days 7-12 readmitted, IV abs  then oral abs to clear it up.  This woman is now 20 weeks and has been told by hospital Dr that best option would be for repeat CS due to wound infection.  
Anyone know any research that is specific  for VBAC post CS with would infection??
feel free to email me off list

thanks 
nicole

[EMAIL PROTECTED]


The things that increase risk are usually complications that occur as a result of CS, such as intrauterine infections following CS, haematoma formation in the uterine incision, extension of the uterine incision at CS,

RE: [ozmidwifery] VBAC

[Mary Murphy]

Wouldn’t the wound infection be
superficial?  I understand that the risk is following a uterine / deep incision
infection. We would all like to hear experienced midwives opinion, so please,
keep the discussion on the list. MM

 

Re: [ozmidwifery] VBAC

[Lynne Staff]

You are right Mary. To be a problem there usually 
has to be endometritis, or a uterine incision infection or haematoma formation 
in the uterine wound. I cared for a woman recently though who had extensive 
adhesions from her previous caesarean on the bowel, bladder and peritoneum 
along the scar line and this caused pain that did not feel 
'contraction-like' - she knew what contractions felt like. It started 
when she started labouring, and then her labour would stop. It would 
start again and stop, and because the pain was unusual, it frightened her. 
She had another caesarean and the adhesions found at second CS were 
extensive and thought likely to be the cause of the peculiar pain she 
experienced. 
Regards, Lynne
 
- Original Message - 

  From: 
  Mary 
  Murphy 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Saturday, May 20, 2006 12:02 
  PM
  Subject: RE: [ozmidwifery] VBAC
  
  
  Wouldn’t the wound 
  infection be superficial?  I understand that the risk is following a 
  uterine / deep incision infection. We would all like to hear experienced 
  midwives opinion, so please, keep the discussion on the list. 
  MM
   
  
  
  
  

RE: [ozmidwifery] VBAC

[Dean & Jo]

Title: Message



external wound infections are different to the internal wound are they 
not?  External should not impact on vbac success.

  


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RE: [ozmidwifery] VBAC

[leanne wynne]

Wound infection??
It seems pretty obvious to me tht if you want to avoid the wound infection 
you avoid the wound!!


Leanne.

Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service  Mob 0418 371862





From: "Mary Murphy" <[EMAIL PROTECTED]>
Reply-To: ozmidwifery@acegraphics.com.au
To: 
Subject: RE: [ozmidwifery] VBAC
Date: Sat, 20 May 2006 10:02:13 +0800

Wouldn't the wound infection be superficial?  I understand that the risk is
following a uterine / deep incision infection. We would all like to hear
experienced midwives opinion, so please, keep the discussion on the list. 
MM




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[ozmidwifery] vbac/FYI

[Mary Murphy]

Reducing post-cesarean vaginal births has no effect on
mortality
Source: Annals
of Family Medicine 2006; 4: 228-34



Looking
at the effect of introducing more restrictive guidelines on vaginal birth after
cesarean section on mortality rates. 

Although
rates of vaginal birth after cesarean delivery (VBAC) decreased significantly
after the adoption of more restrictive guidelines by the American
College of Obstetricians and
Gynecologists in 1999, there was no effect on neonatal and maternal mortality
rates, suggest US
study results.

For the
study, John Zweifler and colleagues from the University
of California in San Francisco studied the records of 386,232
women who had previously given birth by cesarean delivery and subsequently had
a singleton birth between 1996 and 2002.

Although
attempted VBAC deliveries fell significantly after the guideline revision, from
24.0 percent beforehand to just 13.5 percent afterwards, neonatal mortality
rates per 1000 live births were no different for attempted VBAC deliveries from
those for repeat cesarean among neonates weighing at least 1500 g during either
of the two study periods.

Neonatal
mortality rates for attempted VBAC among neonates weighing less than 1500 g
were higher than those for repeat cesarean deliveries, however, in both study
periods. Maternal death rates per 100,000 live births were similar in the two
study periods for attempted VBAC.

"We
recommend that a balanced presentation of risks and the encouraging outcomes
found in this analysis be included in discussions with pregnant patients who
have had a previous cesarean section," the team concludes."

Posted: 2
June 2006

©
Current Medicine Group 2006

 

Re: [ozmidwifery] VBAC

[Janet Fraser]

Gail I've heard of it being sold to women as a great thing because it means
they'll be out of OT faster and in recovery with their babies. And yes, in
Australia. Of course once you go back to your surgeon and ask if you're
"allowed" (snort!) to "attempt" (more snorting!) a VBAC, you're not and hey
presto instant justification for the surgeon's more convenient path - ERC. I
believe in Europe however that single layer is common and yet their VBAC
rates are generally higher and UR not thought to be the big scary thing it
is here where misinformation is rife.
All food for thought, hey?!
J
- Original Message - 
From: "Gail McKenzie" <[EMAIL PROTECTED]>
To: 
Sent: Tuesday, August 01, 2006 10:07 AM
Subject: [ozmidwifery] VBAC


> Hi everybody,
>
> For those of you who were at that wonderful homebirth conference in
Geelong
> last month, you may recall Ina May warning us about women in the US whose
> uterus had been sutured in one single layer instead of two following
> caesareans and the problems this poses for future VBACs.  When I went onto
> PN ward, I told the staff about this & they laughed at me and were adamant
> that it would never happen here in Australia.  Our doctors are too well
> trained.  Guess what?  I've gone through the notes this week of caesars
done
> last week & this.  Two of the women had their uteruses sutured in a single
> layer.  Can't happen here?   Just wanted to make you aware it certainly
does
> and is.
>
> Regards,  Gail
>
>
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Re: [ozmidwifery] VBAC

[Synnes]

I think perhaps this is another one that needs to be informed consent, the 
mother should be made aware of this before hand and should have the right to 
ask for it to be done "properly". Instead of finding out next birth when its 
too late!!!


Amanda
- Original Message - 
From: "Janet Fraser" <[EMAIL PROTECTED]>

To: 
Sent: Tuesday, August 01, 2006 9:41 AM
Subject: Re: [ozmidwifery] VBAC


Gail I've heard of it being sold to women as a great thing because it 
means

they'll be out of OT faster and in recovery with their babies. And yes, in
Australia. Of course once you go back to your surgeon and ask if you're
"allowed" (snort!) to "attempt" (more snorting!) a VBAC, you're not and 
hey
presto instant justification for the surgeon's more convenient path - ERC. 
I

believe in Europe however that single layer is common and yet their VBAC
rates are generally higher and UR not thought to be the big scary thing it
is here where misinformation is rife.
All food for thought, hey?!
J
- Original Message - 
From: "Gail McKenzie" <[EMAIL PROTECTED]>

To: 
Sent: Tuesday, August 01, 2006 10:07 AM
Subject: [ozmidwifery] VBAC



Hi everybody,

For those of you who were at that wonderful homebirth conference in

Geelong

last month, you may recall Ina May warning us about women in the US whose
uterus had been sutured in one single layer instead of two following
caesareans and the problems this poses for future VBACs.  When I went 
onto
PN ward, I told the staff about this & they laughed at me and were 
adamant

that it would never happen here in Australia.  Our doctors are too well
trained.  Guess what?  I've gone through the notes this week of caesars

done
last week & this.  Two of the women had their uteruses sutured in a 
single

layer.  Can't happen here?   Just wanted to make you aware it certainly

does

and is.

Regards,  Gail


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Re: [ozmidwifery] VBAC

[Susan Cudlipp]

I too have been checking notes since hearing Ina May's talk - our obs appear 
to still be using 2 layer closure, but best keep an eye on this.  Have you 
asked the surgeons who are doing the single layer why Gail?


I remember Ina May saying that there was also an increase in placenta 
accreta and percreta in subsequent pregnancies following single layer 
closure.

Sue

"The only thing necessary for the triumph of evil is for good men to do 
nothing"

Edmund Burke
- Original Message - 
From: "Gail McKenzie" <[EMAIL PROTECTED]>

To: 
Sent: Tuesday, August 01, 2006 8:07 AM
Subject: [ozmidwifery] VBAC



Hi everybody,

For those of you who were at that wonderful homebirth conference in 
Geelong last month, you may recall Ina May warning us about women in the 
US whose uterus had been sutured in one single layer instead of two 
following caesareans and the problems this poses for future VBACs.  When I 
went onto PN ward, I told the staff about this & they laughed at me and 
were adamant that it would never happen here in Australia.  Our doctors 
are too well trained.  Guess what?  I've gone through the notes this week 
of caesars done last week & this.  Two of the women had their uteruses 
sutured in a single layer.  Can't happen here?   Just wanted to make you 
aware it certainly does and is.


Regards,  Gail


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[ozmidwifery] hbac/vbac

[Janet at home]

 

 

Hi,

A member of JB has put together her HBAC and her VBAC in an easy to compare
format. Makes for very interesting reading indeed!

Just thought I'd share.

: )

J

http://www.joyousbirth.info/articles/hospital-home-comparison.html

For homebirth information go to:

http://www.joyousbirth.info/

Or email:

[EMAIL PROTECTED]

 

 

Re: KYM VBAC

[Carol Van Lochem]

Sorry,
Know Your Midwife, Vaginal Birth After Caesarian.
We are running a program to support women wanting VBAC by providing shared 
antenatal care with GP or Ob, providing care in labour and then postnatally. 
The aim is for the women to have a named midwife to follow her through the 
whole journey.
Regards Carol



>From: "Dean & Jo Bainbridge" <[EMAIL PROTECTED]>
>To: <[EMAIL PROTECTED]>
>Subject: KYM VBAC
>Date: Sat, 29 Sep 2001 21:11:20 +0930
>
>Could some one tell me what KYM VBAC means?
>cheers
>Jo Bainbridge
>founding member CARES SA
>email: [EMAIL PROTECTED]
>phone: 08 8365 7059
>birth with trust, faith & love...


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vbac pain (long)

[Dean & Jo Bainbridge]

I know this is going to be long, but this is one of 
my pet projects at the moment.  I certainly do not wish this to be taken 
negatively...I hope it might either confirm what you as midwives, see or maybe 
give a perspective that can sometimes be forgotten.  It is meant to be 
constructive.  I eagerly invite responces and or suggestions from any of 
you. 
I think the thing that care providers have to 
remember at all times is that unless they really know the labouring woman, they 
should NEVER make any sort of comment either in jest or off hand.  Some of 
the most damaging comments that we cs mums (and vbac mums) hear can be some off 
handed comment meant to cheers us up!  It is those sorts of comments that 
can make or break of our birth experince.  To say things like "at 
least you can wear a bikini still" is absolutley ludicrious and of no benefit to 
the woman.  Things that care providers must keep in mind that a woman 
having to have an emg. cs is in a hightend state of vunerablity and 
sensiivity.
  The care provider must be extremely careful 
to treat the woman and her fears with the utmost respect.
I have listed below some things that came from an 
interesting study called "Adverse psychological impact of operative obstetric 
interventions: a prospective longitudinal study" (Fisher, Astury,Smith.  
A&NZ journal of Psychiatry 1997; 31:728-738)
 
(It is a summary that I have written and also 
contains anecdotal evidence I have found through personal experience and through 
CARES)
 
 “…operative 
intervention in first child birth carries significant psychological risks 
rendering those who experience these procedures vulnerable to a grief reaction 
or to post traumatic   
disorder.” 
(Fisher, J. “Adverse psychological impact of operative obstetric interventions: 
a prospective study”, A&NZ Journal of Psychiatry 
1997;31:728-738
 
Emotional 
effects of caesarean birth can include: 
*depression, anger, 
grief
*diminished clarity of thinking, efficiency 
& enthusiasm
*marked decrease in 
self-esteem
*belief that intervention was required due to 
personal inadequacy or failing (rather than factors beyond their 
control)
*short term diminished responsiveness to 
external world, in particular to the child
*diminished social and occupational functional 
capacity
*less likely (even avoidance) of conceiving 
again
 Lowered 
Self-Esteem resulted from: “…damage to 
feminine identity and body image and , because of heightened dependence 
following surgery, to diminished self-worth.” (Fisher)
REASONS 
FOR DISTRESS

  Involvement in decision making
  Emotional stress of well being of child and self
  Less 
  likely to have partner or support person present (VD 92% v’s CS 
  81%)
  Complete change of environment and care providers
  Less 
  likely to see babies during first 5 minutes of life (VD 97% v’s CS 
  60%)
  Extremely less likely to hold baby immediately after birth (VD 90% 
  v’s CS 12%)
  Increased likelihood of substantial separation (31% didn’t hold 
  baby after birth for 8 hours or more)
Unexpected 
obstetrical intervention at a time of heightened vulnerability  
External Factors 
that can Influence a Birth Experience:
*familiarity of care providers and trust in 
their care-continuity of care and information
*mutual respect and understanding of 
perceptions of birth
*involvement in decision 
making
*full understanding of the necessity for 
intervention
*intrapartum apprehension for well being of 
child and self
*long and/or difficult labour 

 *having partner or support people 
present
*complete change of physical 
location
*introduction of strangers (other care 
providers)
*conduct of personnel in operating 
theatre
*initial contact with child; seeing, touching, 
holding etc
*respect for the actual birth of child –not 
simply a ‘extraction’
*separation during recovery 

*post operative pain
*post operative support
Nearly all of the above listed things can be 
addressed with very little effort
Those 
Who are Most at Risk of Depression:
*expected a natural 
birth
*inadequate help or support during labour, 
surgery, post operative recovery
*general anaesthesia or combination of drugs 
that cloud memory or had unpleasant side effects
*felt coerced by hospital and/or 
partner
*felt that cs was a surgical procedure not a 
‘birth’
*expected to breastfeed, but found difficult 
after surgery
*isolation or lack of support at 
home
*guilt over grief
“…women 
who experienced caesarean child birth felt significantly worse in the postpartum 
period than they did in late pregnancy.  
They reported increased symptoms of depression and irritability and a 
deterioration in efficiency and clarity of thinking.  Anxiety levels had reduced marginally 
from late pregnancy.  Their 
self-esteem was significantly diminished.” (Fisher) 
Emotional 
distress associated with traumatic birth does not become apparent for some 
weeks, months or even years.‘Healthy Mother, Healthy Baby’ ext

Re: vbac pain

[Jackie Mawson]

Title: Re: vbac pain



yesterday about 9 women met to discuss, debrief, share, gossip [all healthy stuff] their c/s and or their VBACS or plans for VBACS .

Thankyou Jan, for listening, sharing and recognising the needs of these women. Take care,

Birthing Beautifully,
Jackie Mawson.

Convenor of Birthrites: Healing After Caesarean Inc.
Visit our Website at: http://www.birthrites.org
Email: [EMAIL PROTECTED]
Phone: 61 08 9418 8949

Please note I am not a Professional Healthcare Provider, and all opinions given in this email are not to be taken as medical, or legal, advice. Please seek such advice from the relevant professional service.

Email me your postal details for a FREE copy of our quarterly magazine, if you live within Australia - Overseas postage costs are above budget, sorry!

Too many Gods;
so many creeds,
Too many paths
 that wind and
 wind,
When just the art
 of being kind
 Is all the sad
  world needs...
-- 

VBAC soap box

[Jo & Dean Bainbridge]

okay, this is my little bi*ch for the day!  I 
was shocked , saddened and angered by the latest Pregnancy Outcome stats for 
South Australia.  Our cs has risen again and the main reason cited for 
elective cs was "previous cs" which rose from 46% in 98 to 49.9% in 99 and is 
now a shocking 56.6%
 
SOMETHING IS GOING TO HAVE TO BE DONE!   
What information and support are women getting from doctors and midwives that 
they are so unwilling to go vbac?  This is an area of care that has to be 
looked at.  We have to approach this issue with a holistic approach.  
Women need to be able to work through issues they have (both physical and 
emotional) regarding their previous birth experience and given the support, continuity of care and quality information in 
order to make the choice for vbac.  
 
Education for ALL involved needs to be 
improved.  Public as well as private sectors need to seriously look at why 
women are not choosing vbac.  Are the reasons cited BEST MEDICAL 
PRACTICE??  Are they things that could be changed by a change of attitude 
or procedures?  Are they things that women fully understand??  Are 
these questions every asked to women and the staff who care for them?  

 
If a woman has 
emotional issues (fear of what happened last time) does your hospital assist her 
to fully understand what happened last time?  Do you refer her to a 
counsellor?  Does your hospital practice just 'gloss over' the issue of 
fear?  What proactive measures do you take to address the fears of wm with 
previous cs?  (other than book in for the next cs?)  How many of you 
know if there is a cs or vbac support group in your area?  How many 
hospitals offer vbac antenatal education?  
 
Come on everyone.  We need to pull our fingers 
out and start to address these issues!  If you ask groups like CARES and 
Birthrites you will find that we have been busting our butts trying to get 
someone to listen...we (volunteer consumers with small children) CANT DO IT ON 
OUR OWN!  
 
Find out what vbac rates your hospital has?  
Find out how your hospital provides information to wm with previous scar?  
Find out the deciding factors that determine whether your hospital will support 
a vbac?  Find out WHO has a higher vbac rate?  Find out who has never 
has a successful vbac client and then ask WHY!  Find out what restrictions 
are placed and vbac and then WHY!!!
 
Start asking some questions from within!  We 
are asking from the 'outside's but are not always given answers!
 
I am in no way saying that all women should be 
having vbac...but I am very concerned as to the information and support wm are 
given when they make their decisions to have elective cs.  Surely the 56.6% 
of elective cs based on previous cs is a statistic that causes great 
concern!
 
Jo Bainbridgefounding member CARES SAemail: 
[EMAIL PROTECTED]phone: 
08 8365 7059birth with trust, faith & love...

Re: VBAC help

[jireland]

DEAR DEBBY VIA tania
the Angliss in Melb is public and takes Vbacs there 
was also a client of mine that took the 3 melb BCS to task over this issue if 
you send me your no i can get her to call u I have just come home from a 
homebirth vbac love jan MIPP 

  - Original Message - 
  From: 
  Tom, Tania and Sam 
  Smallwood 
  To: [EMAIL PROTECTED] 
  Sent: Monday, March 25, 2002 8:59 
AM
  Subject: VBAC help
  
  Hi everyone,
   
  Found this on a site I browse and lurk on, I know everyone's 
  really busy, but I thought i'd post it here and see if anyone had any 
  suggestions for this enterprising (and gutsy!) young woman...
   
   
  I am currently trying to get into the 
  Brisbane Birth Centre at RWH for the birth of my 3rd child who will be my 2nd 
  natural delivery (my first child was a csec). I am currently being denied 
  on the basis of a policy which will not allow any woman with a uterine scar 
  (regardless of cause or subsequent obstetric history) access to the birth 
  centre because of the risk of uterine rupture. This means that there are a 
  group of women who have a risk of uterine rupture that varies between 0.2% (1 
  in 500) and 6% (6 in 100) who do not have access to the birth centre. The risk 
  of uterine rupture is directly related to the cause of the uterine scarring, 
  the location of the scar and subsequent obstetric history. For women such as 
  myself who had a lower segment ceasarean and a vaginal birth since the risk is 
  only 0.2% which is actually less than the risk of fetal distress, cord 
  prolapse and placental abruption; all conditions that could happen to any 
  woman in labour in the birth centre regardless of history and all of which 
  require similar emergency action to uterine rupture. 
  I have used this information and the fact that this 
  policy contradicts two other policies to which RWH are signatory to develop my 
  arguement for allowing me to the birth centre. The midwives at the birth 
  centre have indicated they would be happy to take me (and women like me). I am 
  yet to receive an answer from RWH. 
  The primary reason I am writing is two fold. Firstly to 
  find out if there are any women out there who had a VBAC (vaginal birth after 
  caesarean) delivery in the Birth Centre (as the midwives have told me they 
  have done some of these in the past but arn't allowed to give me names because 
  of medical in confidence) 
  Also to find other women who have recently been turned 
  away from the Birth Centre because of this policy. I am aware that there has 
  been at least one other in the past couple of weeks with a similar history to 
  me but do not know her name. 
  If there are also women out there who have had VBAC 
  deliveries in other public Birth Centres in Australia I would appreciate your 
  stories. 
  I can be contacted at [EMAIL PROTECTED] or on this 
  board. 
   
  The link is at http://www.essentialbaby.com.au/ubb/ubbhtml/Forum12/HTML/000355.html 
  
   
  Thanks in advance
   
  Tania

RE: VBAC help

[Sally Westbury]

One way that
this was addressed in a hospital that I worked in was that the woman was
assessed as having ‘special needs’ and was case loaded with 2
midwives who worked the Family Birthing Unit. This allowed her to birth with
known midwives in the birthing unit environment even though she was outside the
guidelines for the Birthing Unit.

 

This was
great for the very motivated woman but unfortunately did nothing to change the
status quo for other women. This was a great pity as she had done a huge amount
of research and put a great submission to the hospital for the review of VBAC’s
eligibility for access to the Family birthing Unit.

Re: VBAC help

[Andrea Robertson]

Hi Tania,

There are many women who are being affected by the restrictive policies of 
the Brisbane Birth Centre. Many are deciding to travel to Selangor Private 
Hospital in Nambour because they can be assured of having the birth they 
want there. At Selangor they have had a 100% VBAC rate for the past 12 
months

It is an expensive option, but may be worth it. Their figures certainly 
could be used to justify/demand a change of policy at the Birth Centre 
. but I suspect you already know this!

Cheers

Andrea

>I am currently trying to get into the Brisbane Birth Centre at RWH for the 
>birth of my 3rd child who will be my 2nd natural delivery (my first child 
>was a csec).
>I am currently being denied on the basis of a policy which will not allow 
>any woman with a uterine scar (regardless of cause or subsequent obstetric 
>history) access to the birth centre because of the risk of uterine rupture.
>Tania


-
Andrea Robertson
Birth International * ACE Graphics * Associates in Childbirth Education

e-mail: [EMAIL PROTECTED]
web: www.birthinternational.com


--
This mailing list is sponsored by ACE Graphics.
Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.

Tania re VBAC

[Leanne Meddemmen]

Hi Tania 
I am a Midwife and work in a BC (public). Our initial criteria said the same
thing 10 years ago when we opened. We do have women with prev uterine
surgery incl LUSCS in our birth centre however currently women having their
first VBAC are unable to birth in the BC, but if they have had other normal
births they can. We would like to change this (for the first VBAC) and hope
to do so soon! As we do both team and Primary Midwifery care we do accept
women having VBAC on our program as the Midwife is with them where ever they
birth and if fact we have no exclusion criteria for women, but women with
"needs" birth in DS. My only suggestion to you is to get POLITICAL. Send a
letter to your health minister for your state and the federal one, send one
to the AMA, the newspaper and anyone else you can think of. Don't forget to
send it to the CEO of the Hospital you wish to birth in, the Director of
women's health for the hosp or area health service, BC in charge Midwife.
Add the stats and evidence based practice, World Health Organisation
recommendations and anything else that supports your rights. Ensure that you
make it clear at the bottom of your letter with the "cc" so that the Hosp is
aware that the exact same letter is going lot of places. You could send also
any copies of the Hosp
correspondance as well. I don't know if this will change things for you I
only hope it does. It may help other women.
May you Birth in the Birth Centre but if it doesn't work out remember to
take with you lovely things from home, esp your own pillow cases so you can
bury your nose in them when in labour, a small bedside lamp to make sure you
have dim lighting and a birth wants list. Electric aromatherapy burner (no
problem with having oxygen round and naked flames) are also good.  If you
haven't already find out the hosp practices (read the manuals)re monitoring,
Check out bean bag, birth balls, matresses etc etc.

Yours "with women"
Leanne :)


--
This mailing list is sponsored by ACE Graphics.
Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.

Re: VBAC help

[L & D Staff]

Dear Tania - Andrea mentioned on the list that 
Selangor had a 100% VBAC rate for the last year - it is for the past 6 months, 
but the previous 6 months it was 85%. I know it is difficult to fond support for 
VBAC - not just in QLD either - this was an issue highlighted all around the 
country when Andrea and I did the Celebrating Midwifery tour in the past couple 
of weeks. Many midwives are feeling powerless and helpless to support women 
to achieve their desire for a vaginal birth following caesarean.
 
Andrea spoke on the tour of a series of workshops 
to be held in August and September and one half day session will be focussed on 
VBAC and how midwives can help women to achieve this. Part of this is to find 
support from the medical profession - we all know how it influences care 
practices (and the word care is the importanat one here!). There are pockets of 
really positive work happening around the country, through the concentrated 
efforts of women, midwives and doctors striving to improve and "Womanise" 
services.
 
Keep plugging - you obviously have done your 
research - don't back down!
 
Regards, Lynne  
 
 

  - Original Message - 
  From: 
  Tom, Tania and Sam 
  Smallwood 
  To: [EMAIL PROTECTED] 
  
  Sent: Monday, March 25, 2002 7:59 
AM
  Subject: VBAC help
  
  Hi everyone,
   
  Found this on a site I browse and lurk on, I know everyone's 
  really busy, but I thought i'd post it here and see if anyone had any 
  suggestions for this enterprising (and gutsy!) young woman...
   
   
  I am currently trying to get into the 
  Brisbane Birth Centre at RWH for the birth of my 3rd child who will be my 2nd 
  natural delivery (my first child was a csec). I am currently being denied 
  on the basis of a policy which will not allow any woman with a uterine scar 
  (regardless of cause or subsequent obstetric history) access to the birth 
  centre because of the risk of uterine rupture. This means that there are a 
  group of women who have a risk of uterine rupture that varies between 0.2% (1 
  in 500) and 6% (6 in 100) who do not have access to the birth centre. The risk 
  of uterine rupture is directly related to the cause of the uterine scarring, 
  the location of the scar and subsequent obstetric history. For women such as 
  myself who had a lower segment ceasarean and a vaginal birth since the risk is 
  only 0.2% which is actually less than the risk of fetal distress, cord 
  prolapse and placental abruption; all conditions that could happen to any 
  woman in labour in the birth centre regardless of history and all of which 
  require similar emergency action to uterine rupture. 
  I have used this information and the fact that this 
  policy contradicts two other policies to which RWH are signatory to develop my 
  arguement for allowing me to the birth centre. The midwives at the birth 
  centre have indicated they would be happy to take me (and women like me). I am 
  yet to receive an answer from RWH. 
  The primary reason I am writing is two fold. Firstly to 
  find out if there are any women out there who had a VBAC (vaginal birth after 
  caesarean) delivery in the Birth Centre (as the midwives have told me they 
  have done some of these in the past but arn't allowed to give me names because 
  of medical in confidence) 
  Also to find other women who have recently been turned 
  away from the Birth Centre because of this policy. I am aware that there has 
  been at least one other in the past couple of weeks with a similar history to 
  me but do not know her name. 
  If there are also women out there who have had VBAC 
  deliveries in other public Birth Centres in Australia I would appreciate your 
  stories. 
  I can be contacted at [EMAIL PROTECTED] or on this 
  board. 
   
  The link is at http://www.essentialbaby.com.au/ubb/ubbhtml/Forum12/HTML/000355.html 
  
   
  Thanks in advance
   
  Tania

vbac scar check

[Jo & Dean Bainbridge]

I am shocked  and appalled that any doctor 
would be doing manual scars!  I am very sure that there is some 
documentation in the 200 edition of Effective Care on vbac management and I 
positive that it dismisses the need for scar check.  If my office wasn't as 
messy as it is I could find it for you, but I am positive it is in 
there.
WHAT A ROTTEN THING TO DO!   I 
would be writing to RANZCOG about this type of appalling practice and putting 
pressure on them to get active in smartening up their membersbut I am a 
consumer so I could get away with doing that!
cheers
Jo Bainbridgefounding member CARES SAemail: 
[EMAIL PROTECTED]phone: 
08 8365 7059birth with trust, faith & love...

Re: VBAC question

[Mary Murphy]

Please explain just how he did this procedure?  I have never heard of 
it either.  MM

  - Original Message - 
  From: 
  Sue 
  Cudlipp 
  To: [EMAIL PROTECTED] 
  
  Sent: Wednesday, March 27, 2002 8:32 
  PM
  Subject: VBAC question
  
  Dear midwives
  I have been back 'listening' on the list again 
  for a few weeks now after a long pause.  
  Today I was looking after a lady who was 
  having a 'trial of scar' She ended up having a lovely VBAC and was very 
  happy.  The obstetrician came in just after the birth and proceeded to 
  don gloves in order to check the uterine scar!
   
  I was a little shocked and said that I had 
  never known of any such thing before, that I had never seen any other doctor 
  do this, and that I had had 2 vbac's myself and would have kicked any doctor 
  had he tried to do such a thing to me!  Said obs insisted that it was 
  routine procedure, that it was well documented that the uterine scar should be 
  checked to see that it had not dehisced during the birth, and proceeded to do 
  just that.
   
  So, to all of you out there, has anyone heard 
  of this before, and does anyone know of any documentation to support such a 
  barbaric act?  In 25 years of high and low- tech midwifery practise I 
  have never met this before.
   
  On a happier note, the birth was wonderful and 
  the woman was so very pleased with herself (rightly so). I have been blessed 
  with 5 lovely births in my last 5 shifts, we are BUSY again which is great 
  after our enforced closure to birthing women during January.
   
  Regards
  Susan Cudlipp
  Swan District Hospital 
WA

Re: VBAC question

[Sue Cudlipp]

He just put on gloves and felt into the 
uterus.
Thanks for all the 
feedback.  I shall copy the reference from "Effective Care" and 
all your replies and hand it to him next week.  Watch this 
space!
Sue

-Original Message-From: 
Mary Murphy <[EMAIL PROTECTED]>To: 
Sue Cudlipp <[EMAIL PROTECTED]>; [EMAIL PROTECTED] 
<[EMAIL PROTECTED]>Date: 
Saturday, 30 March 2002 6:20Subject: Re: VBAC 
question
Please explain just how he did this procedure?  I have never heard 
of it either.  MM

- Original Message - 
From: 
Sue 
Cudlipp 
To: [EMAIL PROTECTED] 

Sent: Wednesday, March 27, 2002 
    8:32 PM
Subject: VBAC question

Dear midwives
I have been back 'listening' on the list 
again for a few weeks now after a long pause.  
Today I was looking after a lady who was 
having a 'trial of scar' She ended up having a lovely VBAC and was very 
happy.  The obstetrician came in just after the birth and proceeded 
to don gloves in order to check the uterine scar!
 
I was a little shocked and said that I 
had never known of any such thing before, that I had never seen any 
other doctor do this, and that I had had 2 vbac's myself and would have 
kicked any doctor had he tried to do such a thing to me!  Said obs 
insisted that it was routine procedure, that it was well documented that 
the uterine scar should be checked to see that it had not dehisced 
during the birth, and proceeded to do just that.
 
So, to all of you out there, has anyone 
heard of this before, and does anyone know of any documentation to 
support such a barbaric act?  In 25 years of high and low- tech 
midwifery practise I have never met this before.
 
On a happier note, the birth was 
wonderful and the woman was so very pleased with herself (rightly so). I 
have been blessed with 5 lovely births in my last 5 shifts, we are BUSY 
again which is great after our enforced closure to birthing women during 
January.
 
Regards
Susan Cudlipp
Swan District Hospital 
WA

Fw: VBAC question

[Kirsten Blacker]

 

This was in a birthing room? Obviously little 
regard for infection risk. NO doubt he would also do a manual evacuation in the 
birthing room rather than theatre as well. And what sort of analgaesia did the 
woman have?
AARRGGHH
 
Kirsten

  - Original Message - 
  From: 
  Sue 
  Cudlipp 
  To: Mary Murphy ; [EMAIL PROTECTED] 
  
  Sent: Saturday, March 30, 2002 10:09 
  PM
  Subject: Re: VBAC question
  
  He just put on gloves and felt into the 
  uterus.
  Thanks for all the 
  feedback.  I shall copy the reference from "Effective Care" and all your 
  replies and hand it to him next week.  Watch this space!
  Sue
  
-Original Message-From: 
Mary Murphy <[EMAIL PROTECTED]>To: 
Sue Cudlipp <[EMAIL PROTECTED]>; [EMAIL PROTECTED] 
<[EMAIL PROTECTED]>Date: 
Saturday, 30 March 2002 6:20Subject: Re: VBAC 
question
Please explain just how he did this procedure?  I have never heard 
of it either.  MM

  - Original Message - 
  From: 
  Sue 
  Cudlipp 
  To: [EMAIL PROTECTED] 
  
  Sent: Wednesday, March 27, 2002 8:32 
  PM
  Subject: VBAC question
  
  Dear midwives
  I have been back 'listening' on the list 
  again for a few weeks now after a long pause.  
  Today I was looking after a lady who was 
  having a 'trial of scar' She ended up having a lovely VBAC and was very 
  happy.  The obstetrician came in just after the birth and proceeded 
  to don gloves in order to check the uterine scar!
   
  I was a little shocked and said that I had 
  never known of any such thing before, that I had never seen any other 
  doctor do this, and that I had had 2 vbac's myself and would have kicked 
  any doctor had he tried to do such a thing to me!  Said obs insisted 
  that it was routine procedure, that it was well documented that the 
  uterine scar should be checked to see that it had not dehisced during the 
  birth, and proceeded to do just that.
   
  So, to all of you out there, has anyone 
  heard of this before, and does anyone know of any documentation to support 
  such a barbaric act?  In 25 years of high and low- tech midwifery 
  practise I have never met this before.
   
  On a happier note, the birth was wonderful 
  and the woman was so very pleased with herself (rightly so). I have been 
  blessed with 5 lovely births in my last 5 shifts, we are BUSY again which 
  is great after our enforced closure to birthing women during 
  January.
   
  Regards
  Susan Cudlipp
  Swan District Hospital 
WA