Choosing vaginal birth after caesarean section: Motivating factors

Abstract

Objectives: to examine the factors that motivate women who have had a previous caesarean section to consider planning a vaginal birth.

Design: a qualitative descriptive study with thematic analysis, drawing on interviews with women participating in a two arm, un-blinded randomised controlled trial (RCT) of midwifery continuity of care for increasing the proportion of women planning VBAC.

Setting: A Maternity Unit attached to a district hospital in an outer metropolitan area of Sydney, Australia.

Participants: a purposive sample of 18 women participating in an RCT who had experienced previous caesarean section and had no contraindications for vaginal birth.

Findings: These women were committed to natural birth and drew on their previous experience of caesarean section to highlight the downside of recovery post caesarean section. Decision making for these women was complex. During the decision-making process, women individualised the information provided to balance risk and chance within the context of their own circumstance. Supportive healthcare providers were important in motivating women towards vaginal birth and midwives were identified as being more supportive than obstetricians.

Conclusions: Recovery post caesarean section is an important consideration that is under emphasised in the informed consent process. There is opportunity for midwives to contribute proactively in promoting vaginal birth for women who have experienced a previous caesarean section.

Implications for practice: women should be assisted to make informed choices with balanced information that includes recovery from surgical birth. Models of care that include a significant role for midwives and strategies that proactively encourage vaginal birth for women after previous caesarean section are needed.

Keywords: Decision making; Informed consent; Midwifery; Vaginal birth after caesarean.