Cesarean Awareness Month is a time to reflect on our practice

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Thoughts & musings on midwifery related topics for the April Education Newsletter. 

Ruth King, Midwifery Advisor, Education Unit

My first exposure to caesarean birth was from discussions with my mum when she was pregnant with my younger brother and I (with two of my sisters) was given the opportunity to be at his birth (in a hospital).  We had been talking about the marks on her abdomen and she mentioned that for my eldest sister (one of six children) she had birthed by caesarean because she (my sister) was a malpresentation (she did not of course use those terms to us, it was more a description of her being unable to be pushed out vaginally).  

My next significant encounter with caesarean birth was as a first year student when my sister (who had been born by caesarean) had her first birth and despite all she had planned ended up with an emergency caesarean.  This threw me into a tail spin.  Here I was learning about normal birth and all that should happen, and yet someone close to me was experiencing something that was the opposite - I knew so much, but really not enough.  The emotional and physical fallout for my sister and her new family was also unexpected and I was left questioning the experience and care that she received.  The positive side is that it gave me a focus, which I channelled into future assignments looking at the options for women to birth vaginally after a caesarean.  I remember looking back to compare to current research and practices and wondering why the rates of vaginal birth after caesarean were not higher when for my mother, there was never any question that for her next babies she would birth vaginally (which was handy as when I came along next I would be her biggest baby).  

From that point on learning about and attending caesarean births became part of my practice.  I will always be amazed at the procedure and the complexities of the human body that enable this surgery to occur, yet I continued to feel disjointed at these types of births – knowing my place and my role in the operating theatre and doing my best to make it a positively memorable experience for the woman and her partner, but at the same time feeling like a fish out of water.  

We have a fabulous webinar recording* by Theatre Nurse/Midwife Cathy Ebel addressing the role of midwives when it comes to “Working with Birth in Theatre

And I think, if I felt like that – what would the woman be feeling and experiencing?  Then a few years ago I attended a conference in South Australia, run by the fabulous SA Branch Professional Development Committee and I got the opportunity to earn more about what the women feel, need and want.  


The conference covered a variety of topics, but the one that resonated the most with me was one by Tessa Kowaliw.  Tessa was there to present about the consumers perspective of having a caesarean section - and the implications this medical procedure has on women’s (her) physical as well as emotional health and most importantly to raise the profile of the consumer (the women) with midwives – as they are without doubt the entire reason we are in our profession.  

At the time I had not met Tessa and so I knew little about her work, but from the moment she started to speak I was hooked.  Her passion and energy flowed out to every corner of the room as she shared her own birth story.  To bring home the experience of the woman she got us all to engage in an activity aimed at helping us to understand the impact of the power balance and language used when talking with (or to) women during decision making moments in the birthing journey.  I am not sure anyone felt entirely comfortable at the end of that - but that was the point - and it was a well-timed and delivered lesson about our practice.  

At that time Tessa was a well-known consumer advocate in South Australia and since then she has gone on to do even more amazing work supporting women who want to know more about options for birthing after a caesarean and also lobbying governments and facilities for better services and greater consumer engagement (especially in decision and policy making discussions).  

I reached out to Tessa and asked her whether she would be willing to share her time and passion with midwives via a webinar.  In 2016 Tessa presented the "Support Vaginal Birth after Cesarean by thinking outside the box" webinar*.  She wanted midwives to understand about women’s choices (or lack of) when it comes to birth choices.  She also wanted to share with midwives her experiences so that they could learn about the ‘everywoman VBAC journey’ and how each midwife could be an effective guide whilst gaining an insight into VBAC from the woman’s perspective.  A key part of this is to understand how to work within system frameworks and existing networks to provide meaningful VBAC support for birthing women as part of the greater VBAC birthing community.  

I have since joined a number of Facebook groups here in SA (and I know there are others in others States & Territories) so that I can keep my finger on the pulse of what women are actually asking for and wanting for their birth options, so that when it comes time for me to work with a woman who has had a previous caesarean or who will be having their first I can be a better midwife to them.

*ACM Members you have free access to all of the listed webinar recordings (as well as over 60+ hours of other webinars recordings) as part of your membership.  Non-members you can access this for a small fee, or you may want to consider joining the ACM.  For less than the price of six webinar recordings you can have access to over 60 recordings as well as an addition live webinar released every month.

A little more about Tessa:

The patient perspective can form an integral bridge between effective health service planning and delivery. As a qualified teacher with over 8 years' experience in the Health sector and specialising in maternity care, Tessa brings a unique ability to work in partnership with health organisations and their consumers through advising, advocating, presenting and educating.

A regular presenter on a range of patient perspective-related topics at national and international conferences, Tessa develops, utilises and implements a wide range of consumer engagement strategies, plays an active role as a consumer representative, and is the Founder and Principal Consultant of One Mother to Another.

Tessa designs and facilitates consumer engagement projects, such as the 'Birthing Stories' project (launched 2017), and workshops for consumers and professionals. She has developed numerous educational resources which include videos, webinars and literature. Tessa is published in the Australian Midwifery News and her educational video, 'The Importance of Patient Perspective in Outcome Measurement', premiered in Utrecht, the Netherlands in 2016 and forms part of the University of New South Wales Masters of Health Data Science course.


So what does this mean for you for the month of April and managing your CPD and linking it to learning about Caesarean birth

REFLECT: Using the ACM Reflective Activity template, take a look at your practice and current knowledge in regards to cesarean births and then birthing after a cesarean. Consider how your practice aligns with the latest research and think about what you do to support women (what questions do you ask and do you really try to find out what they want and need?).  Then use this to identify where you might need or want to learn more. 

TAKE ACTION: Once you have a base line on your knowledge then perhaps WATCH one of our webinar recordings such as Support Vaginal Birth after Cesarean by thinking outside the box, or the Working with Birth in Theatre, or READ some resources, research or articles - there are a variety that have been published in the ACM's International Peer Reviewed Journal - Women & Birth;

ASSESS & REVIEW: Then when you have completed your continuous professional development activities don’t forget to go back to wrap up your learning by REFLECTING on all that you have addressed and learnt and consider how this might change your practice.  If you are a member you can do this in your MidPLUS portfolio, or you may just want to use a template or another resource.

ACM Resources and information for your CPD

  • You can access information about ACM webinars here
  • You can check out our recordings available in our shop
  • Or you might want to book into one of our upcoming webinars for this year in Our Events
  • Information about ACM Reflective Activities (and why we think they are important) can be found here 
  • Information on MidPLUS can be found here.  If you want to record your activities you must log into your member portal first. And MidPLUS resources can be found here.


About ACM Webinars

We have a new one every month.  If you want a particular topic addressed or you know of a fabulous presenter, please let us know at and we will do our best to incorporate your suggestion into our future schedule.

AND for ACM members ALL webinars are now free to access.  That is over $3000 value for our webinar library and $300 per year for our live webinars (so over 70 hours of CPD all for the cost of your membership).  

Know someone who is not a member that might be interested?  Get them to join and they too can access all of this CPD goodness with you - Join here