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

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

“…Several qualitative studies have looked at factors that influence a woman's decision to attempt VBAC following one caesarean section . These factors are wide ranging, and can be grouped into three distinct themes.…”

Women's preference for vaginal birth after a first delivery by cesarean

“…While no national data are available, state‐level studies suggest that some women may have difficulty accessing VBAC due to lack of availability at local hospitals . Beyond accessibility, several other factors affect women's decisions to attempt VBAC or not, including: attitudes toward childbirth (including orientation toward natural birth), fear of labor pain, perceptions of safety and risk, practical considerations such as scheduling convenience, expected ease of recovery, and prior birth experiences (eg, pain, unplanned cesarean delivery, bonding with the baby), perceived likelihood of VBAC success, information about the risks and benefits of VBAC, wanting the experience of vaginal birth, and perceptions of clinician attitudes . Prior research documenting these relationships predominantly comes from qualitative studies in countries other than the United States (especially the United Kingdom and Australia), and may have limited relevance to VBAC decision‐making in the United States.…”

Vaginal birth after Caesarean risk decision‐making: Australian findings on the mothers' perspective

“…2,4,[13][14][15] Major influences for a woman to choose VBAC are a woman's sense of control in the decision-making process, physician encouragement for VBAC and delivery-type outcome advantages, both physical and emotional. 16 Some studies report physician and midwife support for VBAC; 17 others report conflicting evidence. 11 A study of women intent on VBAC found that health provider support was not as important as the support of family and friends.…”