Where is the best place to try for a VBAC?

It's an interesting question!  If you're planning a VBAC, you want to maximise your chance of success by choosing  supportive environment in which to birth.

But ..... outcomes for birthing depend more on a woman's choice of care provider, and much less on the place of birth.

If we look at VBAC success rates, we can divide those rates according to choice of care provider and model of care.

According to the NSW Mothers and Babies Report (2010), which is our most recent report, on average, only 5.6% women attending private hospitals under private obstetric care have a VBAC.  94.4% women have a repeat caesarean.

NSW-wide, only 12.1% women have a VBAC: 87.9% have a repeat caesarean.  This rate has not changed very much over the past four years.

Private midwifery is unique in that the women who have previously had a caesarean and request care from a private midwife are generally not planning a repeat caesarean, so the VBAC success rates with a private midwife reflect the success rate of those women who have planned a vaginal birth.  Success rates vary from 80%-90%.  This is not dependent upon place of birth.  Women planning a VBAC with a private midwife sometimes choose to birth at home, and other times choose to birth in hospital.  Either way, the private midwifery model of care results in a high chance of successful VBAC.

I think this is a reflection on the positive, preventative and holistic care that a private midwife provides, carefully and proactively ensuring that small issues are managed before they become big issues; positively encouraging women when they feel disheartened; sound preparation for birth; birth debriefing so that the woman is emotionally-clear before she embarks on her next birth, and so on.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.