A narrative analysis of women's experiences of planning a vaginal birth after caesarean (VBAC) in Australia using critical feminist theory

Abstract

Background Most 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. Methods The 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. Results Fifty-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’. Conclusions The 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. Electronic supplementary material The online version of this article (10.1186/s12884-019-2297-4) contains supplementary material, which is available to authorized users.

Women’s experiences of planning a vaginal birth after caesarean in different models of maternity care in Australia

“…The first part of the survey gathered demographic data and focused on questions related to the model of care women experienced. Questions were based around 'four factors' that emerged from the narrative stories of women planning a VBAC in Australia, including control, confidence, relationship and active labour [17]. Examples of the questions asked in the survey, based on each factor can be found in the mixed methods integration table (Table 1).…”

“…To support the feminist research principles used throughout this mixed methods study and described in Keedle et al (2019) [17], it was imperative to involve potential survey participants in the co-design and pilot testing of the survey [34]. This was achieved using online cognitive focus groups [35].…”

“…Research on VBAC focuses on decision making for women planning a next birth after caesarean (NBAC) [10][11][12] and on prediction scores for women's likelihood of having a VBAC [13][14][15], there is less qualitative research on women's experiences of planning a VBAC. Existing studies have found that women can be met with both helpful and hurtful attitudes from health providers, but the experience of having a VBAC can be triumphant and healing, which is consistently remembered years after the VBAC [16,17].…”

“…The overarching theme of the meta-ethnography was 'the journey from pain (previous caesarean) to power (VBAC)'. The second phase, published in 2019, was qualitative and focused on pregnant women who were planning a VBAC who made audio or video diary recordings, on a purpose build smartphone application, during pregnancy and were also interviewed 6 weeks after birth [17]. The second phase revealed four factors that influenced how women felt after their VBAC or repeat caesarean: having control; having confidence in themselves and in their health care providers; having a supportive relationship with a health care provider; and staying active in labour [17].…”

“…The second phase, published in 2019, was qualitative and focused on pregnant women who were planning a VBAC who made audio or video diary recordings, on a purpose build smartphone application, during pregnancy and were also interviewed 6 weeks after birth [17]. The second phase revealed four factors that influenced how women felt after their VBAC or repeat caesarean: having control; having confidence in themselves and in their health care providers; having a supportive relationship with a health care provider; and staying active in labour [17]. This third phase used the four factors as the framework for design, analysis and organisation of survey results, comparing the experiences of women who identified they had received CoC with a midwife (private / public), with a doctor (private / public / GP), with those who experienced standard, fragmented care.…”