Abstract
BackgroundMost women who have a caesarean can safely have a vaginal birth after caesarean (VBAC) for their next birth, but more women have an elective repeat caesarean than a VBAC.MethodsThe aim of this qualitative study was to explore the experiences of women planning a vaginal birth after caesarean (VBAC) in Australia, the interactions with their health care providers and their thoughts, feelings and experiences after an antenatal appointment and following the birth. The study explored the effect of different models of care on women’s relationships with their health care provider using a feminist theoretical lens. Eleven women who had previously experienced a caesarean section and were planning a VBAC in their current pregnancy used the ‘myVBACapp’ to record their thoughts after their antenatal appointments and were followed up with in-depth interviews in the postnatal period.ResultsFifty-three antenatal logs and eleven postnatal interviews were obtained over a period of eight months in 2017. Women accessed a variety of models of care. The four contextual factors found to influence whether a woman felt resolved after having a VBAC or repeat caesarean were: ‘having confidence in themselves and in their health care providers’, ‘having control’, ‘having a supportive relationship with a health care provider’ and ‘staying active in labour’.ConclusionsThe findings highlight that when women have high feelings of control and confidence; have a supportive continual relationship with a health care provider; and are able to have an active labour; it can result in feelings of resolution, regardless of mode of birth. Women’s sense of control and confidence can be undermined through the impact of paternalistic and patriarchal maternity systems by maintaining women’s subordination and lack of control within the system. Women planning a VBAC want confident, skilled, care providers who can support them to feel in control and confident throughout the birthing process. Continuity of care (CoC) provides a supportive relationship which some women in this study found beneficial when planning a VBAC.
Highlights
Most women who have a caesarean can safely have a vaginal birth after caesarean (VBAC) for their birth, but more women have an elective repeat caesarean than a VBAC
Models of care may include: standard antenatal care, which in most instances is fragmented, women may see different midwives and/or doctors in a hospital clinic and this separates the woman’s journey into antenatal, birth and postnatal episodes of care; midwifery group practice (MGP), where women receive continuity of care (CoC) from the same midwife or small team of midwives based in hospital; GP shared care, where women see their General Practitioner (GP) and providers in a hospital; private obstetric care with a private obstetrician; and privately practising midwives (PPM) [7]
Not all models are available across Australia and not all models will accept women planning a VBAC, resulting in many women having the limited option of standard maternity care [8]
Summary
Most women who have a caesarean can safely have a vaginal birth after caesarean (VBAC) for their birth, but more women have an elective repeat caesarean than a VBAC. Vaginal birth after caesarean (VBAC) is a safe mode of birth for the majority of women [1], rates remain low in many parts of the world. Women planning a VBAC, in Australia, can access antenatal care through a variety of models, dependent on access, availability, resources and choice. Not all models are available across Australia and not all models will accept women planning a VBAC, resulting in many women having the limited option of standard maternity care [8]. Not all MGPs will accept women who have had a previous caesarean section and many birth centres have this as an exclusion criteria due to the risk of uterine rupture and the subsequent identification of women planning a VBAC as ‘high risk’ [9]
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