Perspectives on Promoting Hospital Primary Vaginal Birth: A Qualitative Study

Abstract

Caregivers and first-time mothers identified early labor management and childbirth preparation as important factors to promote primary vaginal birth in hospital settings. Both deserve further inquiry as potential strategies to decrease rising cesarean delivery rates.

Non-clinical interventions to reduce unnecessary caesarean section targeted at organisations, facilities and systems: Systematic review of qualitative studies

“…Four further studies were identified by key informants and through back-chaining reference lists. [27,29,40,61] (Fig 1) Nineteen studies were graded A or B for quality. Five were graded C, and one D. Of the 25 studies, nine were from high-income countries, five from Africa, four from Latin America, three from China, two from Iran, one from Bangladesh and one from Lebanon.…”

“…The studies investigated stakeholder views of different types of midwife staffing models [36,50,52–54]; financial strategies [28,29,43–44,48,58–60]; and organisational culture [27,40,42,46,47,49,51,55–57,61,62]. We also included two studies of social (doula) support during labour [39,41], with the decision for inclusion made by consensus, because of their positive effect on caesarean section rate reduction in the associated Cochrane review of effectiveness studies.…”

“…Women too reported observing the negative effects of power differentials between doctors and midwives. [61] In 11 studies, reported in 13 papers [42,46,47,49,50,52–54,57,58,60–62] interventions, including initiatives to promote physiological birth in Iran [57], hospital primary vaginal birth in the US [61], normal labour and birth in the UK [50,52–54] and the humanization of birth in Japan [46] and Chile, [49,62] challenged the structural balance of power between stakeholders. In UK organisations where a more equal balance of power did exist between women, midwives, family doctors, and obstetrician, there was some evidence that midwifery-led staffing interventions to keep birth normal and reduce caesarean section empowered midwives to work more autonomously [50,52–54] by “…sort of put[ting] a little tag on that woman as a way of saying ‘leave her alone’ , which I think some doctors respect , and some don’t ” ([53]:p.232).…”

“…A further perspective on power, roles and relationships between stakeholders was offered by a nurse in the US who said; “My job is to empower them [women] . I don’t need to feel powerful…” ( [61]:p.341).…”

“…availability of equipment, theatre access) as powerful mediators of barriers or facilitators to reducing unnecessary caesarean section. [28,36,39,40–42,46,47,49,51,55–58,61,62] In high-income countries where “quick win” changes had been made to labour and delivery rooms to encourage normal labour and birth, the priority an organisation gave to maintaining them was fundamental to their effectiveness in reducing caesarean section rates. [56,61] This included changes to in-room facilities for labour and guaranteed access to operating theatres when necessary.…”