Vaginal Birth After Cesarean Section: Ethical Considerations for Midwives

Abstract

Vaginal birth after cesarean section (VBAC) and decisions regarding the safest mode and place of delivery can be contentious in contemporary obstetrics. The choice of birthplace adds additional layers to ethical concerns, particularly for midwives, who are often the only care providers attending birth outside the hospital setting. Current guidelines and evidence, drawing largely on obstetrical literature and the hospital environment, recommend hospital birth for anyone with a prior cesarean section. However, despite guidelines and care provider recommendations, a small proportion of women will continue to request midwife-attended homebirth. Ethical debates about VBAC have largely been inattentive to the desires of these women and the unique situation of midwives who may be presented with such requests. We will explore the ethical nuances of choice of birthplace for women planning a vaginal homebirth after cesarean section (HBAC). Analysis suggests that there may be implications to denying choice and some burden on midwives to continue to provide care for women planning HBAC, even when homebirth may not be considered the safest option.