Caring for women wanting a vaginal birth after previous caesarean section: A qualitative study of the experiences of midwives and obstetricians.
OBJECTIVE
One of the greatest contributors to the overall caesarean section rate is elective repeat caesarean section.


BACKGROUND
Decisions around mode of birth are often complex for women and influenced by the views of the doctors and midwives who care for and counsel women. Women may be more likely to choose a repeat elective caesarean section (CS) if their health care providers lack skills and confidence in supporting vaginal birth after caesarean section (VBAC).


OBJECTIVE
To explore the views and experiences of providers in caring for women considering VBAC, in particular the decision-making processes and the communication of risk and safety to women.


METHODS
A descriptive interpretive method was utilised. Four focus groups with doctors and midwives were conducted.


RESULTS
The central themes were: 'developing trust', 'navigating the system' and 'optimising support'. The impact of past professional experiences; the critical importance of continuity of carer and positive relationships; the ability to weigh up risks versus benefits; and the language used were all important elements. The role of policy and guidelines on providing standardised care for women who had a previous CS was also highlighted.


CONCLUSIONS
Midwives and doctors in this study were positively oriented towards assisting and supporting women to attempt a VBAC. Care providers considered that women who have experienced a prior CS need access to midwifery continuity of care with a focus on support, information-sharing and effective communication.
Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia.
Maralyn
M
Foureur
Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia.
Sabera
S
Turkmani
Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia.
Danielle C
DC
Clack
University of Canberra, Australian Capital Territory (ACT), Australia; The ACT Government, Health Directorate, Australia.
Deborah L
DL
Davis
Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia.
Lyndall
L
Mollart
Central Coast Local Health District, Holden Street, Gosford, New South Wales, Australia.
Bernadette
B
Leiser
Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia. Electronic address: caroline.homer@uts.edu.au.
Caroline S E
CS
Homer
D000328:Adult; D002585:Cesarean Section; D017604:Cesarean Section, Repeat; D003657:Decision Making; D017558:Elective Surgical Procedures; D004645:Empathy; D005260:Female; D017144:Focus Groups; D006801:Humans; D008880:Midwifery; D009721:Nurse Midwives / Q000523:psychology*; D036801:Parturition; D018743:Perinatal Care; D010820:Physicians / Q000523:psychology*; D011247:Pregnancy; D036301:Qualitative Research; D016064:Vaginal Birth after Cesarean
Caesarean section; Caesarean section, repeat; Midwifery; Obstetrics; Vaginal birth after caesarean