A clinician’s handbook that synthesises current evidence on VBAC and elective repeat caesarean, clarifying the real-world risks, benefits and nuances of each pathway.

The framework introduces Dr Keedle’s PhD-derived “four factors” framework to help you identify and respond to each woman’s needs and preferences with clarity and confidence.

Includes reflections and practical strategies from Australian and Indonesian midwives and doulas—broadening perspective and enriching clinical judgement.

• Evidence you can use tomorrow. Translates research into actionable, clinic-ready guidance for antenatal consults and birth planning.
• Clear, woman-centred decision support. Helps you communicate balanced risk/benefit information and uphold autonomy, without overwhelm.
• A shared language for teams with the four-factors framework creating consistency across midwifery, obstetrics, physio, GP and doula care.
• Cross-cultural insights sharpen critical thinking and expand your toolkit beyond one health system.
• Practical strategies to navigate complexity, strengthen therapeutic alliance, and support safer, more satisfying birth experiences after caesarean.

Best for

• Midwives, obstetricians & GP shared-care providers seeking up-to-date, practical guidance on VBAC and repeat caesarean counselling.
• Perinatal physiotherapists, doulas & childbirth educators wanting a research-backed, compassionate framework for supporting clients.
• Students & early-career clinicians building foundations in evidence-based, woman-centred practice.
• Clinical leads & educators standardising team approach and in-service training on birth after caesarean.

Dr Hazel Keedle is a Senior Lecturer in Midwifery at Western Sydney University and completed her PhD in 2021. With 25+ years’ experience across nursing, midwifery, education and research, Hazel’s work is internationally recognised. Her research focuses on midwifery practice and education, and on women’s experiences of maternity care.

Deeply passionate about improving support during pregnancy, birth and the early transition to mothering, Hazel developed the “four factors” framework from her PhD—now a practical, empowering tool for clinicians to individualise care and champion informed, woman-led decision-making.