FOCUS ON: Caesarean birth and next birth after a caesarean birth
IN THIS ISSUE:
Author: Jane Svensson
Author title: Clinical Midwifery Consultant for Health Education and Diversity Health
Description writer: Clinical Midwifery Consultant for Health Education and Diversity Health at the Royal Hospital for Women in Sydney
Keywords: caesarean birth, infant microbiome, infant immune system, VBAC, empowered birth, language
Author: Felicity Wingrove
Author title: Trainer, Certified Coach, The Ultimate Advantage, UK.
Description: Language is powerful, but communication is a minefield at the best of times. When we’re at our most vulnerable, it’s tougher still. And yet awareness of what’s going on for the people involved in any communication can provide us with a powerful window into their world. And once we understand their filters, triggers, and truths, we can navigate a clear course to the ultimate end goal; a compelling, authentic, and grounded exchange where all parties feel heard, seen, and understood and where a clear path forward is agreed. Rarely is equality of power and consensus of approach more important than in the field of birth. A time when women are truly at their most vulnerable. In this article, Felicity Wingrove draws back the veil on what leads to such personal interpretations of language and communications and shares some insights for ways in which you can support and empower the women, birthing people, and birth partners you work with to empower themselves in requesting the type of birth they desire, and in communicating their thoughts and feelings throughout.
Description writer: Trainer, Certified Coach, The Ultimate Advantage, UK.
Keywords: empowerment, language, boundaries, communication, birth environment, overheard conversations, tools for conversations, informed consent, informed refusal, birth plan
Author: Toni Harman
Author title: Education Leader
Description: A summary from the maker of the film Microbirth of the impact of being born by caesarean and what parents can do to optimise their child’s long term health.
Description writer: Education Leader Alto Films
Keywords: c-section, caesarean birth, Microbirth, Seeding the microbiome, breastfeeding, elective c-section, immune system training, dysbiotic gut microbiome, skin to skin in caesarean, expressing colostrum, donor human milk, probiotics, vaginal seeding
Author: Bridget Basile Ibrahim
Author title: Assistant Professor in Nursing, Yale University, USA.
Description: This article translates findings from a study of women’s experiences of pregnancy and birth after cesarean to operationalise the Quality Maternal and Newborn Care (QMNC) Framework into practice recommendations. Recommendations are provided for birth care practitioners to improve care for women with a history of cesarean. These recommendations may be widely applied to promote provision of high quality, respectful birth care for all women and birthing people. By improving the quality of care for those who have been marginalised and are at higher risk for negative birth outcomes, we may work toward improving maternal health inequities.
Description writer: Assistant Professor in Nursing, Yale University, USA.
Keywords: vaginal birth after cesarean, VBAC, respectful maternity care, health equity, maternal health outcomes, quality maternal and newborn care framework, medicalised birth, birth inequalities, racialised women, perinatal mental health, postpartum depression, PTSD, BIPOC, birth trauma, respectful care, QMNC, trauma informed care
Author: Hazel Keedle
Author title: Senior Lecturer of Midwifery
Description: An impact of a rising primary caesarean rate is the increase in women planning a subsequent birth after caesarean. The options for women with a previous caesarean are planning a repeat elective caesarean or planning a Vaginal Birth After Caesarean (VBAC). For women planning a VBAC they will either have a VBAC or a repeat emergency caesarean. Although for most women planning a VBAC is a safe and satisfying experience, in most countries, including Australia, a repeat caesarean is the most common mode of birth for women with a previous caesarean.
Description writer: Senior Lecturer of Midwifery, School of Nursing and Midwifery, Western Sydney University, Australia
Keywords: vaginal birth after caesarean, VBAC, midwifery models of care, birth after caesarean, induction of labour, episiotomy, cascade of intervention, uterine rupture, risks of caesarean, VBAC Study, respectful maternity care, coercive behaviour, childbirth educators, doulas, control in labour, birth trauma, mode of birth, birth plans, respectful language, previous birthing experience, PTSD, debriefing technique, birth plans, birth maps, hurtful comments, failed induction, failure to progress, evidence based information, midwifery continuity of care, relational model of care, Mothers respect index (MORi), upright labour, continuous fetal monitoring, CTG, water immersion in labour, VBAC in water
Author: Carol Kingdon
Author title: Reader in Medical Sociology
Description: The global programme for optimising caesarean section (CS) use is relevant across all world regions. In this article, I draw on my global health research learnings and apply them to the UK context where some women and birthing people experience excellent maternity care, others suffer poorer outcomes when care is too little or too late, and many encounter the overuse of interventions without evidence of benefit. Getting the balance right between CS underuse and overuse is complex. It matters because it impacts the health of the mother, her child(ren), future pregnancies, health services, and society. Medical need is an important factor that drives CS use. Contextual and cultural factors also play a part. As a social scientist and maternity care researcher, I contributed to the development of the global approach towards optimising CS use, addressing the role of women and communities, interacting with health professionals, in organisations and healthcare systems.
Description writer: Carol Kingdon, Reader in Medical Sociology, Research in Childbirth and Health Unit (REACH), University of Central Lancashire; Technical Working Group Member, World Health Organization (WHO) Guideline on non-clinical interventions to reduce unnecessary caesarean sections and co-author of The Lancet Series on Optimising Caesarean Section Use
Keywords: caesarean section, World Health Organization, unnecessary caesarean section, Robson criteria, antenatal education, maternity care, caesarean section rates, Long term outcomes of caesarean birth, The Lancet on Optimising CS, risks of caesarean, caesarean and preterm birth, maternal request caesarean, non-clinical interventions, educational interventions for caesarean, childbirth classes, relaxation, cultural norms and caesarean, fear of vaginal birth, birth beliefs, mode of birth as a medical decision, maternal choice, decision making, caregivers as experts, NICE CS guidelines, Montgomery ruling, experience of care, continuous labour support, listening to women, MBRRACE, GIRFT, Re:Birth,
Author: Bridget Supple, Helen Chaplin
Author title: Bridget Supple, Childbirth Educator, Theatre Nurse Helen Chaplin
Description: As a teaching aid, the process of a caesarean is described for parents.
Description writer: Bridget Supple, Childbirth Educator, Founder Your Baby’s Biome. Author. Helen Chaplin Theatre Nurse
Keywords: Caesarean birth, perinatal educators, elective caesarean, positive caesarean, categories of caesarean, reasons for a caesarean birth, teaching caesarean birth, spinal block, epidural, general anaesthetic, recovery after caesarean, caesarean birth plan, caesarean theatre team
Author: Leonie Rastas
Author title: Founding Director
Description: Surgical birth is a possibility for every pregnancy; antenatal education specific to surgical birth is essential for all pregnant couples. The caesarean birth rate is steadily rising around the world, with research predicting that by 2030 the highest rates are likely to be in Eastern Asia (63%), Latin America and the Caribbean (54%), Western Asia (50%), Northern Africa (48%) Southern Europe (47%) and Australia and New Zealand (45%) (World Health Organisation, WHO, 2021). After hospitals in England were told by the National Health Service (NHS) to stop using the caesarean rates to assess performance (Wilkinson, 2022), the surgical birth rate climbed approximately 10% to 37%, equal to Australia’s rate (Australian Institute of Health and Welfare, AIHW, 2020). This means over one-third of all birthing women in Australia and the UK had surgical births in 2022. It seems that childbirth educators are responsible for assisting pregnant couples with informed decision-making and realistic expectations regarding surgical birth.
Description writer: Leonie Rastas, Founding Director Caesarcare, Queensland, Australia
Keywords: antenatal education, caesarean birth rates, surgical birth, childbirth educators, process of caesarean birth, separation after caesarean, care from staff, caesarean recovery, VBAC, Childbirth Education Australia, CAPEA, UK CBE Guidelines, reasons for caesarean, risks and disadvantages of caesarean, uterine rupture, wound infections, advantages of caesarean, caesarean grief