Vaginal birth after caesarean section (VBAC): exploring women's perceptions

Abstract

Vaginal birth after caesarean section (VBAC): exploring women's PerceptionsAims and objectives. This study was designed to complement local audit data by examining the lived experience of women who elected to attempt a vaginal birth following a previous caesarean delivery. The study sought to determine whether or not women were able to exercise informed choice and to explore how they made decisions about the method of delivery and how they interpreted their experiences following the birth. Background. The rising operative birth rate in the UK concerns both obstetricians and midwives. Although the popular press has characterized birth by caesarean section as the socialites' choice, in reality, maternal choice is only one factor in determining the method of birth. However, in considering the next delivery following a caesarean section, maternal choice may be a significant indicator. While accepted current UK practice favours vaginal birth after caesarean (VBAC) in line with the research evidence indicating reduced maternal morbidity, lower costs and satisfactory neonatal outcomes, Lavender et al. point out that partnership in choice has emerged as a key factor in the decision-making process over the past few decades. Chaung and Jenders explored the issue of choice in an earlier study and concluded that the best method of subsequent delivery, following a caesarean birth, is dependent on a woman's preference. Design and methodology. Using a phenomenological approach enabled a holistic exploration of women's lived experiences of vaginal birth after the caesarean section.Results. This was a qualitative study and, as such, the findings are not transferable to women in general. However, the results confirmed the importance of informed choice and raised some interesting issues meriting the further exploration. Conclusions. Informed choice is the key to effective women-centred care. Women must have access to non-biased evidence-based information in order to engage in a collaborative partnership of equals with midwives and obstetricians. Relevance to clinical practice. This study is relevant to clinical practice as it highlights the importance of informed choice and reminds practitioners that, for women, psycho-social implications may supersede their physical concerns about birth

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

“…The results show that four studies are from Australia [13,18,19,29], three from UK [2,20,30], and one from US [31]. The women's experiences were requested concerning different aspects of the following phenomena: experiences of decision-making - whether to give birth vaginally or with CS during the subsequent birth [2,13,20], experiences of the influence of health professionals on decision-making [30], reason for trying a vaginal birth after a previous CS [18,20,31], experiences when choosing VBAC [18,19,29], experiences during the subsequent birth giving birth vaginally [18,20,31], and experiences with CS during the subsequent birth [13,30].…”

“…The women's experiences were requested concerning different aspects of the following phenomena: experiences of decision-making - whether to give birth vaginally or with CS during the subsequent birth [2,13,20], experiences of the influence of health professionals on decision-making [30], reason for trying a vaginal birth after a previous CS [18,20,31], experiences when choosing VBAC [18,19,29], experiences during the subsequent birth giving birth vaginally [18,20,31], and experiences with CS during the subsequent birth [13,30]. Experiences of giving birth vaginally [13,18-20,31], and with CS [2,13,18-20,29,31] are described. In one study no information was given about the subsequent birth experience [30].…”

“…In one study no information was given about the subsequent birth experience [30]. Interviews with women were performed during pregnancy [19,20,30], and two to eight months after birth [2,13,18-20,29,31]. Altogether 94 women participated in the studies.…”

“…Women experience decisional conflicts and uncertainty and need individual and structured information [6,10,15-17]. Studies focusing on women's experiences of giving birth vaginally after a previous CS birth shows that they express a belief in the importance of a natural birth [18,19], and that psycho-social dimensions that go beyond the birth are of importance for them [20]. …”

Current evidence in the management of previous caesarean section: clinical review

“…Additionally, they recommended that strategies are required to better equip organisations and practitioners to empower women so that they can translate informed preferences into practice [116]. Informed choice is the key to effective womencentered care because psychosocial implications may supercede their physical concerns about birth in making a decision about mode of delivery [117].…”