Caring for women wanting a vaginal birth after previous caesarean section: A qualitative study of the experiences of midwives and obstetricians.

PROBLEM: One of the greatest contributors to the overall caesarean section rate is elective repeat caesarean section. BACKGROUND: Decisions around mode of birth are often complex for women and influenced by the views of the doctors and midwives who care for and counsel women. Women may be more likely to choose a repeat elective caesarean section (CS) if their health care providers lack skills and confidence in supporting vaginal birth after caesarean section (VBAC). AIM: To explore the views and experiences of providers in caring for women considering VBAC, in particular the decision-making processes and the communication of risk and safety to women. METHODS: A descriptive interpretive method was utilised. Four focus groups with doctors and midwives were conducted. FINDINGS: The central themes were: 'developing trust', 'navigating the system' and 'optimising support'. The impact of past professional experiences; the critical importance of continuity of carer and positive relationships; the ability to weigh up risks versus benefits; and the language used were all important elements. The role of policy and guidelines on providing standardised care for women who had a previous CS was also highlighted. CONCLUSION: Midwives and doctors in this study were positively oriented towards assisting and supporting women to attempt a VBAC. Care providers considered that women who have experienced a prior CS need access to midwifery continuity of care with a focus on support, information-sharing and effective communication.

Antenatal GBS screening: an Australian perspective.

Women in Australia are offered a variety of options for screening and treatment of group B streptococcus (GBS), depending on which health service they are engaged with, including a risk-based approach or universal screening. The difficulty for midwives when addressing the evidence supporting these differing policies is that there is no unified national policy on GBS screening in Australia. Furthermore, the Australian population is a discerning one, questioning the implications of procedures and exploring all options. This paper discusses the varying evidence and limitations that midwives need to be aware of in order to inform women, empower their decision-making and provide holistic woman-centred care.