I don't doubt the benefit of hand holding when taking bird shots, but for macro I would not dream of hand holding. More often than not the exposure is about 1/10" so a tripod is the only option. And as for focussing and framing without a tripod, I could not do it. That's not to say that others can't succeed.
A Dutch photographer takes all of his macros, which are typically twice life size, without a tripod, though he uses flash to freeze the action. The fact that his images are amazing is proof that it can be done. I've tried and failed.
One point though. IS and VR do not work well, in the close up range, and lose most of their effectiveness. I think it is because they work by detecting and counteracting pitch and yaw, whereas for close ups the problem is more to do with vertical and horizontal shifts.
I guess you have to find a modus operandi that suits your temperament.