Vaginal birth after caesarean section: why is uptake so low? Insights from a meta-ethnographic synthesis of women's accounts of their birth choices

Abstract

ObjectiveTo identify what women report influences their preferred mode of birth after caesarean section.DesignSystematic review of qualitative literature using meta-ethnography.Data sourcesMedline, EMBASE, ASSIA, CINAHL and PsycINFO (1996 until April 2013; updated September 2015). Hand-searched journals, reference lists and abstract authors.Study selectionPrimary qualitative studies reporting women's accounts of what influenced their preferred mode of birth after caesarean section.Data extraction and synthesisPrimary data (quotations from study participants) and authors’ interpretations of these were extracted, compared and contrasted between studies, and grouped into themes to support the development of a ‘line of argument’ synthesis.Results20 papers reporting the views of 507 women from four countries were included. Distinctive clusters of influences were identified for each of three groups of women. Women who confidently sought vaginal birth after a caesarean section were typically driven by a long-standing anticipation of vaginal birth. Women who sought a repeat caesarean section were strongly influenced by distressing previous birth experiences, and at times, by encouragement from social contacts. Women who were more open to information and professional guidance had fewer strong preconceptions and concerns, and viewed a range of considerations as potentially important.ConclusionsWomen's attitudes towards birth after caesarean section appear to be shaped by distinct clusters of influences, suggesting that opportunities exist for clinicians to stratify and personalise decision support by addressing relevant ideas, concerns and experiences from the first caesarean section birth onwards.

Women's decision‐making processes and experiences of vaginal birth after caesarean birth: A phenomenological study

“…This aligns with findings in Turkey from Yanıkkerem (), where it was determined that approximately half of 269 women (49.5%), who had experienced CS, wanted VBAC for their next birth, and 41.3% of these women believed they would be successful with this. Similarly, negative CS experiences have been observed to increase the desire of women for VB (Black, Entwistle, Bhattacharya, & Gillies, ; Tatano Beck, ).…”

An analysis of indications of caesarean sections at Tezpur medical college and hospital, Tezpur (a government hospital)

“…15 So focus should be placed on trial of more cases for VBAC (Vaginal Birth after Caesarean) and most importantly reducing primary Caesarean Section rate. 16 Timely done and properly performed by skilled persons, Caesarean section carries a low morbidity and mortality rate. This can be attributed to improved surgical technique and modern anaesthetic procedures.…”

Factors influencing decision-making to accept elective caesarean section in a hospital in Ghana: A descriptive cross-sectional study

“…Caesarean section (CS) rates are on the rise and elective caesarean section is being performed more often than it was a few decades ago [1,2] with very high rates of over 40% in some developed countries and 7.3% in Africa [3]. Some factors responsible for the rise include high socioeconomic status, availability of service; psychological factors, perceptions of safety, socio-cultural in uences, women's experience with previous vaginal birth and advanced maternal age [4][5][6][7]. In Ghana, an average of 12.8% of deliveries is by caesarean section [8].…”