Sensitive Midwifery - Issue 44 - October 2019

VBAC the midwife way Pregnant women considering a vaginal birth after a previous C-section have specific concerns and needs, explains Yolande Maritz. M idwives supporting these women must be able to o ff er sensitive care that nurtures and empowers, safely. There is a golden rule in my practice: if it is not safe, it is not allowed . As an example, I often refer to cases when moms request inductions simply because they are feeling impatient and anxious to meet their babies. No, I say, explaining that we cannot induce labour for that reason, especially if the woman hopes for a successful VBAC. Inductions increase the risks way too much and are not safe. If you’re a midwife taking on VBAC clients, you must be up to date on evidence-based practice, and you must adhere to safety guidelines. Not only is VBAC considered safer, with fewer complications, than a repeat C-section, but research shows that 60–80% of women who have previously had a C-section can have a successful vaginal birth, meaning VBAC is an option for many women. That said, there is more to a successful VBAC than purely medical knowledge. Care providers must acknowledge the journey a woman has been through and understand that she will have unique concerns that need to be addressed if she is to begin her next birth with a sense of empowerment. Setting o ff In the birth world, where doctors have created the false idea that all VBACs are dangerous, the midwife might be the only person believing in the mother, the birth, the baby, and that the VBAC will be successful. Many women in South Africa tend to be quite uneducated about pregnancy, the birthing process and their birthing rights. To midwives, it can feel like they are indoctrinated by a fear-mongering society, and that making decisions, based on what they want for themselves, their birth and their babies, has become incredibly di ffi cult. Thankfully, some women do question and seek guidance on birthing matters, especially if these are out of the ‘norm’, like a VBAC. Here, midwives have an important role to play – holding a woman’s hand and showing her the way to a new outlook on pregnancy, birth and beyond. First and foremost, midwives must understand that VBAC clients need longer appointments. They have a lot of emotion (often disappointment and Yolande Maritz is an independent midwife specialist of 15 years and 2 000 births, and the owner of You & Me Birth Home in Pretoria East. Find out more on www.youandmebirths.com. Birth Continued on page 25 24 eSensitive Midwifery Magazine Issue 44