Introduction
This work is intended to discuss the aspect of midwives’ participation in facilitating decision-making about the importance of vaginal birth after cesarean section (VBAC) by identifying responsibilities and defining the key principles of interaction. The possibility of natural childbirth in women who have undergone surgery during the first pregnancy is assessed as a favorable prospect, which makes it possible to exclude risks to the health of the newborn. Communication between midwives and patients is an essential factor influencing the decision-making of women in labor. Therefore, the role of medical personnel in ensuring a safe second birth is high.
The work will include a description of the process of collecting valid data on the presented topic. It will contain the analysis of the resources used, the evaluation of the findings, and the identification of relevant solutions for obstetric practice. Guidelines that are freely available can offer valuable information regarding the interaction between midwives and women in labor. In addition, relevant ethical issues will be considered, which, according to the International Code of Ethics, define the special nature of partnerships between midwives and patients and dictate the principles of professional practice (International Confederation of Midwives, 2014). The analysis of additional data needed for women’s decision-making will also be performed.
The importance of this work is due to the existing differences in views on the issue under consideration. Contrary to some current stereotypes, VBAC is a safe practice for most women (Lundgren et al., 2017). At the same time, individual indications are crucial to consider because, in some cases, such as complications in a previous pregnancy or uterine rupture, VBAC may be contraindicated (Queensland Clinical Guidelines, 2020). Therefore, the relevance of this topic is explained by the need to help pregnant women with decision-making, and midwives act as authoritative stakeholders. Respect for patients’ personal dignity is a mandatory ethical aspect of obstetric practice, which explains the importance of constant communication and support for women (American College of Nurse-Midwives, 2015). Providing unbiased, evidence-based information to simplify women’s decision-making regarding VBAC is a crucial method of maintaining favorable midwife-patient interaction.
Analysis of the Evidence
Search Process
To obtain credible data regarding the issue under consideration, relevant resources were studied, and the findings were identified. To review the necessary information, academic sources were taken from such popular journals as “BMC Pregnancy and Childbirth” and “Sexual and Reproductive Healthcare”. As the keywords used for the search, such words and phrases were utilized as “VBAC”, “midwives”, “cesarean section”, “communication”, “ethics”, and “decision-making”. Through a keyword search, relevant resources were found, which explored the topic at hand from the perspective of midwives’ assistance. The articles by Birara and Gebrehiwot (2013), Chen et al. (2018), Lundgren et al. (2016), and Portz et al. (2021) were analyzed for credible findings and conclusions. In addition, the national and local guidelines were involved, such as the International Code of Ethics for Midwives (International Confederation of Midwives, 2014) and the general Code of Ethics (American College of Nurse-Midwives, 2015). Professional recommendations in these sources helped match the findings with the issue in question and highlight the necessary conclusions. Based on these findings, valuable outcomes for both second-time mothers and midwives were obtained, which allowed compiling a list of objective reasons for the use of VBAC.
Findings Discussion
Based on the findings from the resources involved, one can suggest that VBAC is a valid procedure for women, and midwives should educate women to agree to it. According to Birara and Gebrehiwot (2013), individual factors may be deterrents to natural childbearing. In addition, as the authors state, failed VBAC is associated with the “presence of meconium, malposition and history of stillbirth” (Birara and Gebrehiwot, 2013, p. 1). Particular attention is paid to some stereotyped factors, such as maternal age and birth weight, which do not appear to be barriers to successful VBAC. With these findings in mind, midwives can provide women with the information they need to offer them objective data to base their decisions on, thereby facilitating decision-making.
The assistance of midwives to the target women in making decisions is imperative due to many concerns that women in labor experience. Chen et al. (2018) devote their research to this topic and note that depending on the type of interaction, the morale of women varies. Particularly, the authors mention passive and shared decision-making (Chen et al., 2018). The former process is usually associated with risk prevention only, while the latter one implies alternative options based not only on subjective vision but also clinical indications. One of the main points is that, regardless of views on VBAC and its potential consequences, women have the right to expect comprehensive information about all the nuances of this procedure as an alternative method of second childbirth (Chen et al., 2018). Thus, this resource addresses both professional medical aspects and ethical factors related to the issue.
Providing women in labor with relevant and valid data is described in the study by Lundgren et al. (2016) as a significant factor that makes it easier to make decisions and eliminate fear. The authors discuss the role of some organizational factors, such as support and care regimen, and communication quality (Lundgren et al., 2016). One of the main conditions that should be followed to eliminate bias and not violate the ethical principles of interaction is the provision of comprehensive data that has clinical justification. If patients are aware of the whole picture of the issue, including favorable outcomes and potential risks, this is an objective incentive for them to make an appropriate decision regarding the procedure for childbirth. Otherwise, disagreements with the medical staff may arise, which is fraught not only with reputational problems for the clinic but also with negative health outcomes for the newborn. Therefore, support, care regimen, and fear reduction strategies are critical factors in enabling midwives to communicate relevant information about VBAC and assist in decision-making.
A relevant question to address is to assess the views of not only women in labor but also midwives themselves on the VBAC procedure from the perspective of individual perception. In their study, Portz et al. (2021) explore this topic and note the distinctive positions of healthcare professionals. Individual experiences, cultural backgrounds, and other internal and external drivers can influence this perception (Portz et al., 2021). The position of midwives, in turn, is transmitted to women because, without narrow knowledge of the procedure, women in labor are forced to rely on professional employees’ opinions. This means that to assist in decision-making, midwives are to have comprehensive information about all the features of VBAC, its potential consequences, and indications for each individual case. Otherwise, the risk of bias increases, which is unacceptable in such a critical topic as childbearing. Portz et al. (2021) state that midwives’ views on VBAC range from negative to highly positive. Therefore, given the above criteria, medical professionals should take into account not only personal opinions but also an objective picture of the intervention.
The relevant professional guidelines provide information for midwives regarding the ethical principles of interaction with women. As per the American College of Nurse-Midwives (2015), developing partnerships with women in labor to ensure informed decision-making is a crucial responsibility for medical professionals to follow. The guideline also considers the inadmissibility of any form of discrimination, whether it be age, race, religion, or other forms of bias (American College of Nurse-Midwives, 2015). The International Code of Ethics for Midwives, presented by the International Confederation of Midwives (2014), argues that medical professionals have an obligation to address any emotional and psychological anxieties of women. These also include those related to the fear caused by the lack of credible information. The Australian manual, developed by the Queensland Clinical Guidelines (2020), evaluates the issue of VBAC in detail and describes all the nuances of this procedure. Based on this resource, midwives can find and provide clinical findings to women in labor, thereby ensuring informed decision-making (Queensland Clinical Guidelines, 2020). Thus, the resources involved highlight the important role of midwives in helping women make decisions about VBAC and maintaining a favorable care regimen.
Application of the Findings to Midwifery Practice
Applying the aforementioned findings to midwifery practice is expressed in the development of effective programs of interaction with expectant mothers. Firstly, to assist women in making adequate decisions regarding the procedure for childbirth, medical professionals should develop an appropriate evidence base. These can be special digital materials offered to women in labor, as well as brochures describing all the nuances of VBAC. Lundgren et al. (2016) confirm that providing valid and verified information is a powerful tool to reduce the fear of natural childbirth and communicate the necessary data as accurately and reliably as possible. While using the evidence base, midwives can develop a course of work with expectant mothers, such as regular meetings, where current issues are discussed. This format may be subject to change due to the current COVID-19 pandemic and can be implemented through remote interaction, such as video conferencing. Enabling women to ask their concerns is a critical factor in helping them make an objective decision.
Secondly, in addition to the necessary evidence base, the mechanism of communication between expectant mothers and midwives is an important factor to take into account, as the findings suggest. Particular attention should be paid to ethical communication in which the woman in labor can count on the full support and absence of bias from a midwife. Getting the right message about the specifics of VBAC to target women should be easy. Professional vocabulary should be kept to a minimum to ensure productive conversation and communicate in an understandable language for the other party (American College of Nurse-Midwives, 2015). Ignoring this principle casts doubt on the qualifications of a midwife because the task of a medical specialist is not to convince a woman but to present the necessary information in the most accessible form. This, in turn, stimulates shared decision-making, which is a crucial perspective to accomplish (Lundgren et al., 2016). Since not all women in labor are well aware of the clinical aspects of VBAC, healthcare professionals should pay attention to the ethics of communication and focus on the availability of data rather than its complexity.
Finally, this is essential for midwives to form a rational view of the VBAC procedure and explore all of its features and potential clinical outcomes to assist expectant mothers in their decision-making. According to the findings in the article by Portz et al. (2021), medical staff often do not have comprehensive knowledge of this topic, which is a barrier to qualified consultation. In this regard, midwives should take the time to learn the necessary guidelines and perspectives on the procedure in question. The involvement of digital courses, conference recordings, and other materials can increase the competence of medical employees and give them a clear vision of indications and contraindications for VBAC. Without this information, assistance in making rational decisions can be regarded as subjective, which is unacceptable. Therefore, personal work to improve their theoretical knowledge is the responsibility of midwives.
Appropriate Timing and Setting of Information Giving
To provide comprehensive and professional assistance in decision-making, midwives should take into account some gaps in evidence. As Birara and Gebrehiwot (2013), there are individual contraindications for VBAC, but due to the complex nature of childbearing and the possible implications for maternal health, there is no guaranteed certainty regarding health parameters. At the same time, given the information about the benefits of VBAC and its safety, midwives should notify expectant mothers of the possibility of the procedure in advance, preferably at clinic registration. To begin with, information should be conveyed personally to women registering during the second pregnancy. Further, as the observation progresses, group sessions can be organized in which expectant mothers can get answers to the necessary questions.
During group meetings, engaging additional medical staff is optimal to provide the target audience with comprehensive data. The educational team may include a practicing midwife, a neonatologist, and also a pediatrician. The order of the meetings may be adjusted, but this is desirable that all supervised women attend such a session at least once. The key criterion for inclusion in the educational group is a second pregnancy after a cesarean section. Communication with professionals is an effective tool to make the decision-making process regarding the procedure of childbearing as reasonable and objective as possible.
Conclusion
The issue of midwives’ assistance to women in making decisions regarding VBAC is an urgent task to implement so that to justify the effectiveness and safety of the procedure and create a favorable background for interaction. Based on the reviewed evidence, the features of VBAC are identified, including the attitude of medical personnel towards the procedure, its potential indications and contraindications, and implications for obstetric practice. The search for information, performed through the analysis of credible resources, has made it possible to identify objective data regarding the possibility of using VBAC. Related aspects to take into account have also been highlighted, particularly the ethical principles of interaction with expectant mothers. National guidelines and academic sources have helped identify the optimal conditions for communicating the features of the procedure. Expectant mothers are entitled to the full support of midwives and ethical communication with medical professionals both during individual and group consultations. At medical registration, appropriate information about the VBAC perspective should be communicated to target women. Recommendations regarding the procedure should be discussed directly with specialists, and receiving a comprehensive picture of the procedure is a favorable outcome of such interaction.
Reference List
American College of Nurse-Midwives (2015) Code of ethics with explanatory statements. Web.
Birara, M. and Gebrehiwot, Y. (2013) ‘Factors associated with success of vaginal birth after one caesarean section (VBAC) at three teaching hospitals in Addis Ababa, Ethiopia: a case control study’, BMC Pregnancy and Childbirth, 13(1), pp. 1-6.
Chen, S. W. et al. (2018) ‘Women’s decision-making processes and the influences on their mode of birth following a previous caesarean section in Taiwan: a qualitative study’, BMC Pregnancy and Childbirth, 18(1), pp. 1-13.
International Confederation of Midwives (2014) International Code of Ethics for Midwives. Web.
Lundgren, I. et al. (2016) ‘Clinicians’ views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a study from countries with low VBAC rates’, BMC Pregnancy and Childbirth, 16(1), pp. 1-10.
Portz, S. et al. (2021) ‘Midwives and obstetricians’ attitudes towards VBAC: development and validation of the HCAV-scale’, Sexual & Reproductive Healthcare, 27, p. 100589.
Queensland Clinical Guidelines (2020) Vaginal birth after caesarean (VBAC). Web.