title: Perspectives on Promoting Hospital Primary Vaginal Birth: A Qualitative Study.
abstract: One in three women will deliver by cesarean, a procedure that can be life saving, but which also carries short- and long-term risks. There is growing interest in preventing primary cesarean deliveries, while optimizing the health of the mother and infant. The primary aim of this study was to use participatory action strategies and ethnographic interview data collected from diverse stakeholders in birth (caregivers, women, policymakers) about facilitators and barriers to the achievement of primary vaginal birth in first-time mothers in hospital settings. The secondary aim was to use the findings to identify strategies to promote primary vaginal birth and future areas of research.
  
  
  
  Individual and small group interviews were conducted with caregivers and policymakers (N = 79) and first-time mothers (N = 24) at a northeastern hospital. All interviews were audio-recorded, transcribed, and analyzed using Atlas.ti.
  
  
  
  Four broad themes were identified: 1) preparation for childbirth, 2) early labor management, 3) caregiver knowledge and practice style, and 4) birth environment (physical, cultural/emotional). The first two were closely linked from caregivers' perspectives. If the woman was not prepared for childbirth, it was perceived she would be more likely to present to the hospital in early labor. Once there, it was hard to prevent admission and interventions. A woman's knowledge and confidence were perceived as powerful mediators for vaginal birth.
  
  
  
  Caregivers and first-time mothers identified early labor management and childbirth preparation as important factors to promote primary vaginal birth in hospital settings. Both deserve further inquiry as potential strategies to decrease rising cesarean delivery rates.
authors: Yale University School of Nursing, West Haven, CT, USA.
authors: Holly P
authors: HP
authors: Kennedy
authors: Yale University School of Nursing during the time of the study.
authors: Eleanor
authors: E
authors: Doig
authors: Yale University School of Nursing during the time of the study.
authors: Stephanie
authors: S
authors: Tillman
authors: Yale University School of Nursing during the time of the study.
authors: Amanda
authors: A
authors: Strauss
authors: Yale University School of Nursing during the time of the study.
authors: Beth
authors: B
authors: Williams
authors: Yale University School of Medicine.
authors: Christian
authors: C
authors: Pettker
authors: Yale University School of Medicine.
authors: Jessica
authors: J
authors: Illuzzi
mesh_terms: D000328:Adult; D017028:Caregivers; D002585:Cesarean Section / Q000523:psychology*; D005260:Female; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D000068101:Maternal-Child Health Services / Q000639:trends*; D009035:Mothers / Q000193:education*; D036801:Parturition / Q000523:psychology*; D011247:Pregnancy; D011295:Prenatal Care / Q000639:trends*; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: cesarean prevention; qualitative research; vaginal birth