Women’s, partners’ and healthcare providers’ views and experiences of assisted vaginal birth: a systematic mixed methods review

Abstract

Background: When certain complications arise during the second stage of labour, assisted vaginal delivery (AVD), a vaginal birth with forceps or vacuum extractor, can effectively improve outcomes by ending prolonged labour or by ensuring rapid birth in response to maternal or fetal compromise. In recent decades, the use of AVD has decreased in many settings in favour of caesarean section (CS). This review aimed to improve understanding of experiences, barriers and facilitators for AVD use. Methods: Systematic searches of eight databases using predefined search terms to identify studies reporting views and experiences of maternity service users, their partners, health care providers, policymakers, and funders in relation to AVD. Relevant studies were assessed for methodological quality. Qualitative findings were synthesised using a meta-ethnographic approach. Confidence in review findings was assessed using GRADE CERQual. Findings from quantitative studies were synthesised narratively and assessed using an adaptation of CERQual. Qualitative and quantitative review findings were triangulated using a convergence coding matrix. Results: Forty-two studies (published 1985-2019) were included: six qualitative, one mixed-method and 35 quantitative. Thirty-five were from high-income countries, and seven from LMIC settings. Confidence in the findings was moderate or low. Spontaneous vaginal birth was most likely to be associated with positive short and long-term outcomes, and emergency CS least likely. Views and experiences of AVD tended to fall somewhere between these two extremes. Where indicated, AVD can be an effective, acceptable alternative to caesarean section. There was agreement or partial agreement across qualitative studies and surveys that the experience of AVD is impacted by the unexpected nature of events and, particularly in high-income settings, unmet expectations. Positive relationships, good communication, involvement in decision-making, and (believing in) the reason for intervention were important mediators of birth experience. Professional attitudes and skills (development) were simultaneously barriers and facilitators of AVD in quantitative studies.

It’s complicated…: Exploring the missed opportunities and reasons for non-performance of assisted vaginal births in Kenya

“…The lack of functioning basic equipment was a barrier to the practice of AVB in some instances, and in line with the findings of research in other high, middle and low-income countries [9], [22], [23]. Staff generally expressed a preference for the Kiwi Omni-cup device as it was easy to use and only required a single individual to perform the procedure, but these devices are designed to be single-use.…”

“Because it eases my Childbirth Plan”: a qualitative study on factors contributing to preferences for caesarean section in Thailand

“…The study of Parás et al [ 56 ] revealed that 60.9% of obstetricians perceived being skillful at CS; 35% had scheduled a CS for convenience, and 83.8% believed that women prefer CS. The issue of physician skills for management in vaginal birth and using instrumental vaginal birth may require doctors to train or re-train in obstetric skills in order to increase doctors’ confidence and confirm positive vaginal birth outcomes for now and in the future [ 57 , 58 ]. The support system for staff competencies at the hospital and national levels should be set up effectively.…”

From evidence to tailored decision-making: a qualitative research of barriers and facilitating factors for the implementation of non-clinical interventions to reduce unnecessary caesarean section in Romania

“…Although in some countries some anecdotal reports reveal that lawsuits by women submitted to unnecessary CSs have started to emerge, in this research respondents always referred to lawsuits from complications associated with vaginal birth. O&G physicians fear complications that may occur during vaginal birth and recognise that they need more training and practice on instrumental vaginal deliveries, VBAC and TOLAC 23. O&G physicians request better regulatory frameworks for legal liability of the medical profession.…”