‘Groping through the fog’: a metasynthesis of women's experiences on VBAC (Vaginal birth after Caesarean section)

Abstract

BackgroundVaginal birth after Caesarean section (VBAC) is a relevant question for a large number of women due to the internationally rising Caesarean section (CS) rate. There is a great deal of research based on quantitative studies but few qualitative studies about women's experiences.MethodA metasynthesis based on the interpretative meta ethnography method was conducted. The inclusion criterion was peer-review qualitative articles from different disciplines about women's experiences of VBAC. Eleven articles were checked for quality, and eight articles were included in the synthesis.ResultsThe included studies were from Australia (four), UK (three), and US (one), and studied women's experience in relation to different aspects of VBAC; decision-making whether to give birth vaginally, the influence of health professionals on decision-making, reason for trying a vaginal birth, experiences when choosing VBAC, experiences of giving birth vaginally, and giving birth with CS when preferring VBAC. The main results are presented with the metaphor groping through the fog; for the women the issue of VBAC is like being in a fog, where decision-making and information from the health care system and professionals, both during pregnancy and the birth, is unclear and contrasting. The results are further presented with four themes: ‘to be involved in decision about mode of delivery is difficult but important,’ ‘vaginal birth has several positive aspects mainly described by women,’ ‘vaginal birth after CS is a risky project,’ and ‘own strong responsibility for giving birth vaginally'.ConclusionIn order to promote VBAC, more studies are needed from different maternity settings and countries about women's experiences. Women need evidence-based information not only about the risks involved but also positive aspects of VBAC.

Clinicians’ views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a study from countries with low VBAC rates

“…Clinicians spoke about the value of evidence in making decisions about the mode of birth, but were very clear that they took into account many other factors in their decision-making process. Studies have found that significant variations in the rates of attempted VBAC [24] suggest that the decision-making process around the birth mode after a previous CS is complicated and multidimensional for both women and care providers, and this certainly was the case for the clinicians in this study. According to a meta-synthesis of the views of women, they need evidence-based information on both the risks and the positive aspects of VBAC [25].…”

Maternal and perinatal outcomes in women planning vaginal birth after caesarean (VBAC) at home in England: secondary analysis of the Birthplace national prospective cohort study

“…We do not know how many women currently have the opportunity to consider or discuss planning a vaginal birth following a prior CS, nor do we know why women in our study opted for a home birth. Studies of women's decision‐making about mode of birth in a subsequent pregnancy after CS show that this can be complex and conflicted, particularly with regard to balancing safety with women's expressed ‘need’ to experience labour and ‘normal birth’ . These studies also demonstrate the importance of information from health professionals in women's decision‐making; in one study, women reflected that this information could be unclear and contradictory and in another that they experienced ‘latent communication’ from health professionals who simultaneously presented ‘official’ messages of choice while revealing personal views which gave women the impression that their choices would be restricted .…”

Meeting the challenge of maternal choice in mode of delivery with vaginal birth after caesarean section: a medical, legal and ethical commentary

“…Third, some women have an overwhelming desire to experience labour and vaginal birth, seeing it as fundamental to their perception of femininity and motherhood. Many feel that the initial mother–baby bond is stronger with a vaginal birth compared with caesarean section …”