Abstract
BackgroundIn many countries caesarean section rates are increasing and this impacts on choices made around mode of birth in subsequent pregnancies. Having a vaginal birth after caesarean (VBAC) can be a safe and empowering experience for women, yet most women have repeat caesareans. High caesarean section rates increase maternal and neonatal morbidity, health costs and burden on hospitals. Women can experience varied support from health care providers when planning a VBAC. The aim of this paper is to explore the nature and impact of the interactions between women planning a VBAC and health care providers from the women’s perspective.MethodsA national Australian VBAC survey was undertaken in 2019. In total 559 women participated and provided 721 open-ended responses to six questions. Content analysis was used to categorise respondents’ answers to the open-ended questions.ResultsTwo main categories were found capturing the positive and negative interactions women had with health care providers. The first main category, ‘Someone in my corner’, included the sub-categories ‘belief in women birthing’, ‘supported my decisions’ and ‘respectful maternity care’. The negative main category ‘Fighting for my birthing rights’ included the sub-categories ‘the odds were against me’, ‘lack of belief in women giving birth’ and ‘coercion’. Negative interactions included the use of coercive comments such as threats and demeaning language. Positive interactions included showing support for VBAC and demonstrating respectful maternity care.ConclusionsIn this study women who planned a VBAC experienced a variety of positive and negative interactions. Individualised care and continuity of care are strategies that support the provision of positive respectful maternity care.
Highlights
In many countries caesarean section rates are increasing and this impacts on choices made around mode of birth in subsequent pregnancies
The survey was split into two separate pathways, one pathway was for women who were currently pregnant and planning a vaginal birth after caesarean (VBAC) at the time of the survey and the second pathway was for women who had planned a VBAC in the past five years and had given birth
Women accessed a range of models of care: 20% had public hospital maternity care which is fragmented in design; 16% accessed a private obstetrician; 19% accessed a midwifery group practice (MGP) and 16% of women hired a privately practising midwife (PPM)
Summary
In many countries caesarean section rates are increasing and this impacts on choices made around mode of birth in subsequent pregnancies. Women can experience varied support from health care providers when planning a VBAC. The aim of this paper is to explore the nature and impact of the interactions between women planning a VBAC and health care providers from the women’s perspective. Women with a previous caesarean can plan a vaginal birth after caesarean (VBAC) or a repeat caesarean before labour. There are some identified factors that impact VBAC rates such as having a previous vaginal birth or VBAC, body mass index (BMI), interpregnancy interval, multiple caesareans, and onset of labour [7,8,9,10]. There is less research that explores the impact of interactions with health care providers (HCP) on VBAC rates. Lundgren et al (2019) identified a culture of shared belief in VBAC between HCPs and women in European countries with higher VBAC rates compared to a culture of differing opinions on the value of VBAC in lower VBAC rate countries [11]
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