Midwifery Care for Women Planning Vaginal Birth After Caesarean: A Survey of Ontario Midwifery Practices

Christine Sternberg, RM, BA, Patricia McNiven, RM, PhD

ABSTRACT
Due to new evidence, the safety of vaginal birth after Caesarean (VBAC) is again generating controversy in maternity care. A survey of midwifery practices was undertaken to determine midwifery practice patterns and the factors that influence their care of women with a prior Caesarean birth. A two-part questionnaire, pertaining to practice characeristics and VBAC care, was mailed to all 40 Ontario midwifery practices. Data from closed-ended questions were analysed using SPSS, while open-ended responses were examined for common themes. A survey response rate of 92.5% was obtained. While 73% of practices that responded reported that they will not accept women with more than one lower segment Caesarean birth into care, 65% indicated that they will attend home births for women with one prior Caesarean birth. For practices that do not attend women with a prior Caesarean birth at home, prohibitive hospital policies (64%) and lack of obstetrical support (86%) were the most frequently reported reasons. Concern about increased risk and lack of experience were also identified. Variations in practice patterns do not appear to be related to geographic practice characteristics. The survey has identified some of the factors that influence how Ontario midwives care for women with a prior Caesarean birth. Hospital policies and support from consultant obstetricians appear to have a greater impact on midwifery care for women with prior Caesarean birth than midwives' perception of increased risk or lack of experience.

KEYWORDS
VBAC, Caesarean, midwifery, policy

This article has been peer-reviewed.