I do 😀
So here are two quick snippets that caught my eye as I updated my Recipes for Normal Birth research database, from which I think we can take hope…
Firstly, let’s look at a study published in the Journal of Perinatology which aimed to identify factors associated with vaginal birth after caesarean (VBAC) in women deemed at high risk (by which they meant that had hypertension, diabetes and/or a BMI>30). The authors of this research analysed 280,000 birth records and found that, although women who have such risk factors do not often decide to have a vaginal birth the next time around (for reasons that warrant more discussion than I have room for here), those who do aim for a VBAC have quite a high rate of success*. A childbirth educator colleague reminded me that Nancy Wainer shared the same thing years ago, so it may not be a completely new finding, but given all that we hear about how risky it is to be high-risk(!), I think this is news worth sharing.
* There is more to be pulled out of and critiqued in this research if this is a topic you’re interested in, but I’m just focusing on headlines today 😉
And my second happy finding? Another retrospective study, this time from the Netherlands, analysed the reasons that women were referred from primary to secondary care in labour and the outcomes once they got to a secondary care setting. Now I realise that cultures can be very different from each other, which means that findings are not necessarily directly relevant in other areas, but we can at least see from such studies what is possible and potentially achievable.
What this study shows is that women who are referred to secondary care still have a high chance – 65.7% – of having a normal birth. The authors suggest that, “to improve continuity of care and satisfaction for this group of women, management of labor could be continued by trained primary care midwives” and it is, of course, important to ensure that we are only transferring the women who need (or want) to be transferred, but I have recently been facilitating workshops with midwives whose units have far lower rates of normal birth for transferred women than this, and I think it is good to remember what is possible.
Perdok H, Jans S, Verhoeven C et al (2015). Intrapartum Referral from Primary to Secondary Care in The Netherlands: A Retrospective Cohort Study on Management of Labor and Outcomes. Birth DOI: 10.1111/birt.12160
J Regan, C Keup, K Wolfe et al (2015). Vaginal birth after cesarean success in high-risk women: a population-based study. Journal of Perinatology 35: 252-257 doi:10.1038/jp.2014.196