Choosing vaginal birth after caesarean section: Motivating factors

Insights of healthcare professionals regarding waterbirths and water immersion during labour: A mixed studies review

AIM

To consolidate healthcare professionals' insights about waterbirths and water immersion during labour.

DESIGN

Mixed studies review.

DATA SOURCES

Seven electronic databases were searched from their inception dates till June 2023: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, ProQuest Dissertations and Theses Global.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and Pluye and Hong's mixed studies review framework guided this review. The quality of included studies was evaluated using the Mixed Methods Appraisal Tool. Findings were synthesized using the convergent qualitative synthesis method, and results were thematically analysed using Braun and Clarke's framework.

RESULTS

Three main themes were identified from the 22 included studies: (1) believing in waterbirths, (2) opposing forces and (3) plotting the course ahead.

CONCLUSION

Healthcare professionals reported different views about waterbirths and water immersion practices; midwives were most likely to support these practices, followed by nurses and lastly, few physicians supported them. Reasons for opposing waterbirths include insufficient training and support from colleagues as well as concerns about work efficiency, waterbirth safety and litigation issues.

IMPACT

The available evidence suggests the need to provide waterbirth training for healthcare professionals, equip healthcare facilities with necessary waterbirth-related infrastructure and develop appropriate waterbirth policies/guidelines. Healthcare professionals could also consider providing antenatal waterbirth education to women and obtain women's feedback to improve current policies/guidelines. Future research should explore the views of different types of healthcare professionals from more diverse cultures.

REPORTING METHOD

The PRISMA guidelines.

NO PATIENT OR PUBLIC CONTRIBUTION

Systematic review.

Facilitating childbirth choice for positive postnatal mental health well-being among women: a Namibian case study

Childbirth affects women in a myriad of ways including feelings of tiredness, being overwhelmed, stressed, and having baby blues, and if not attended to, this can lead to postpartum depression, which is a mental condition that can have disastrous effects. Childbirth can affect the mental and physical status of a woman and having supportive midwives who guide women by giving adequate information is an issue of critical concern for a positive birth experience. The World Health Organisation (WHO) has emphasised the need to facilitate childbirth choices for women as a means of having a safe and memorable experience as the experience in childbirth affects the psychological status of a woman. Some women may experience worry and anxiety during labour and childbirth, which may be exacerbated by bias and a lack of childbirth choice facilitation during pregnancy. A negative childbirth experience may lead to negative psychological distress and postpartum depression, which will interfere with the bond between the mother, baby, and family. Midwives, thus, need to understand the emotional aspects that are attached to childbirth and be able to facilitate and support the emotional as well as the psychosocial needs of women under their care. However, there is a dearth of empirical evidence within the Namibian context that can provide direction and context-specific solutions to the present challenge. The current study followed a qualitative research design with an exploratory approach with one-on-one interviews with 10 midwives who were purposively selected. The midwives' experiences in this study depicted their zeal towards the issue at hand; however, what stood out were some barriers in the facilitation of childbirth choices (theme 1) as they expressed the shortages of staff, the timing of information, information sharing, and cultural influences as some of their experiences in facilitating childbirth. Furthermore, midwives shared a lack of provision for childbirth choice (theme 2) as the rights of women were not observed, and a lack of women-centred care despite protocols and guidelines being there, and yet they are not adhered to. In conclusion, midwives as primary caregivers actively need to provide unbiased childbirth information to achieve positive postpartum health. Initiating childbirth choices early in pregnancy gives women the time to weigh options and clearing of any misconceptions relating to childbirth types as well as reducing anxiety and fear of birth, which could lead to postpartum depression and by extension, the mental well-being of the women. Facilitating childbirth choices is critical in positive birth experiences and the management of childbirth as well as crafting guidelines and policy formulation that ensure a mentally healthy woman and society.

Construction and evaluation of nursing-sensitive quality indicators for vaginal birth after cesarean: A Delphi study based on Chinese population

Aim

To develop scientific, systematic and clinically applicable nursing-sensitive quality indicators for vaginal birth after cesarean in obstetrics, which provide a theoretical and clinical basis for monitoring and improving the nursing quality of vaginal birth after cesarean in China.

Methods

A modified Delphi-consensus technique was used in this study. Based on literature retrieval published between January 2012 and December 2022 and group discussion, the preliminary nursing-sensitive quality indicators were selected using a structural-process-outcome model. Then a questionnaire was designed on the preliminary indicators. The modified Delphi method was used to conduct two rounds of expert consultation among 26 hospitals in China. The survey data of experts' opinions were collected and analyzed to determine the final nursing-sensitive quality indicators. The importance of indicators, rationality of calculation formula and operability of data collection were analyzed and discussed.

Results

A total of 33 nursing-sensitive quality indicators were determined. The indicators were composed of 3-level ones, including 3 first-level indicators (structural, process and outcome indicators), 9 s-level ones and 33 third-level ones. The positive coefficients in the two rounds of expert consultation were 95.56 % and 97.67 %, respectively, and the authoritative coefficients were 0.88 and 0.94. The coefficients of variation ranged from 0.05 to 0.28.

Conclusion

The nursing-sensitive quality indicators were successfully developed using the modified Delphi method. The indicators are scientific, systematic and clinically operable, and play an important role in improving the nursing quality for pregnant women with vaginal birth after cesarean.

Childbirth-choice facilitation experiences among women in selected public healthcare facilities in Namibia

AIM AND OBJECTIVE

To describe childbirth-choice facilitation through the experiences of women, and explore women's views on their experiences of childbirth-choice facilitation.

DESIGN

This qualitative exploratory study included 12 women who gave birth in selected public hospitals in different parts of Namibia during the study period. Purposive sampling was adopted to ensure that participants had sufficient knowledge of the subject under study. The research employed individual semi-structured in-depth interviews to understand women's experiences during childbirth facilitation. Data analysis followed the six steps as proposed by Creswell: preparation and organisation of data, exploration and coding of data, coding and building descriptions of the themes, presenting and reporting findings, interpreting the findings and validation of the accuracy of findings.

FINDINGS

Women's choices on type of childbirth were assumed as they did not receive full information pertaining to different modes. The research findings were grouped into two main themes and five sub-themes, as follows: childbirth-choice experience (lack of choice, lack of shared decision-making) and information-giving (information sources, preferred information, timing of information-giving). Women expressed that they had limited knowledge and/or information pertaining to types of childbirth as midwives provided little information about how they would give birth. The women also indicated that healthcare professionals made decisions for them without any clear explanation, and that they received information when it was too late and they were unable to process it.

KEY CONCLUSIONS

Women who gave birth in public hospitals reported a lack of choice regarding type of childbirth and a lack of shared decision-making. They would have preferred to receive balanced information about types of childbirth in advance in order to make informed decisions.

IMPLICATIONS FOR PRACTICE

Health professionals need to provide information on types of childbirth to women early in antenatal care so that they understand the choices and can give informed consent regarding their chosen mode when the time comes. Previous experiences of women need to be solicited to guide the facilitation of current or subsequent pregnancies as a way of ensuring women-centred care.

Educational interventions targeting pregnant women to optimise the use of caesarean section: What are the essential elements? A qualitative comparative analysis

BACKGROUND

Caesarean section (CS) rates are increasing globally, posing risks to women and babies. To reduce CS, educational interventions targeting pregnant women have been implemented globally, however, their effectiveness is varied. To optimise benefits of these interventions, it is important to understand which intervention components influence success. In this study, we aimed to identify essential intervention components that lead to successful implementation of interventions focusing on pregnant women to optimise CS use.

METHODS

We re-analysed existing systematic reviews that were used to develop and update WHO guidelines on non-clinical interventions to optimise CS. To identify if certain combinations of intervention components (e.g., how the intervention was delivered, and contextual characteristics) are associated with successful implementation, we conducted a Qualitative Comparative Analysis (QCA). We defined successful interventions as interventions that were able to reduce CS rates. We included 36 papers, comprising 17 CS intervention studies and an additional 19 sibling studies (e.g., secondary analyses, process evaluations) reporting on these interventions to identify intervention components. We conducted QCA in six stages: 1) Identifying conditions and calibrating the data; 2) Constructing truth tables, 3) Checking quality of truth tables; 4) Identifying parsimonious configurations through Boolean minimization; 5) Checking quality of the solution; 6) Interpretation of solutions. We used existing published qualitative evidence synthesis to develop potential theories driving intervention success.

RESULTS

We found successful interventions were those that leveraged social or peer support through group-based intervention delivery, provided communication materials to women, encouraged emotional support by partner or family participation, and gave women opportunities to interact with health providers. Unsuccessful interventions were characterised by the absence of at least two of these components.

CONCLUSION

We identified four key essential intervention components which can lead to successful interventions targeting women to reduce CS. These four components are 1) group-based delivery, 2) provision of IEC materials, 3) partner or family member involvement, and 4) opportunity for women to interact with health providers. Maternal health services and hospitals aiming to better prepare women for vaginal birth and reduce CS can consider including the identified components to optimise health and well-being benefits for the woman and baby.

Preferred mode of delivery and its associated factors in pregnant women with a previous cesarean scar at a tertiary care hospital in Ethiopia: institutional-based cross-sectional study

BACKGROUND

Vaginal births after cesarean or elective repeat cesarean sections (CS) are the options for delivery after one cesarean scar. However, there is a lack of data regarding the preferred next mode of delivery in Ethiopia after a previous cesarean section. Thus, this study assessed the preferred mode of delivery and determinants after one previous CS in the antenatal clinic at the University of Gondar Comprehensive Specialized Hospital (UoGCSH).

METHODS

An institutional-based cross-sectional study was conducted among pregnant mothers with one previous CS at UoGCSH from March to August 2022. Structured questionnaires were used to collect the data. The collected data were entered, cleaned, and edited using Epi-data 4.6 and exported to SPSS version 26 for analysis. A binary logistic regression was performed to assess the determinants of the preferred mode of delivery. A p-value of < 0.05 at the 95% confidence level (CI) was considered statistically significant.

RESULTS

The majority, 71.5% (95% CI: 64.7, 77.1), of participants preferred the trial of labor after cesarean (TOLAC) as their mode of delivery. Mothers who were married (AOR = 4.47, 95% CI: 1.19-16.85), had a diploma educational level (AOR = 3.77, 95% CI: 1.84-12.36), had previous post-cesarean complications (AOR = 3.25, 95% CI: 1.08-9.74), and knew about the success of the trial of labor after cesarean (AOR = 13.56, 95% CI: 4.52-37.19) were found to prefer the trial of labor compared with their counterparts.

CONCLUSION

This study concluded that most pregnant mothers preferred labor trials after one CS, which is a bit lower but comparable with recommended practice guidelines. Providing adequate information and counseling mothers to make informed decisions about their preferred mode of delivery could be substantial.

Vaginal birth after cesarean section: A quantitative study exploring women's understanding and experience regarding VBAC rates in Greece

INTRODUCTION

Vaginal birth after cesarean section (VBAC) is a choice of birth that provides many advantages for women. This study presents women's VBAC experience in a Greek population. The study's aims were mainly to determine the reasons for choosing VBAC, women's feelings during pregnancy and their experience, and level of post-birth satisfaction.

METHODS

This study is sampling research which has a cross-section retrospect study design. The study was held via the internet due to a self-administered questionnaire which is comprises both open-ended and close-ended questions. Data analysis was performed in S.P.S.S. 20 and Microsoft Excel.

RESULTS

A total number of 473 women participated in this study. The findings showed that during pregnancy and childbirth over 50% of women felt very happy and satisfied, while 35% to 40% felt moderate or no fear at all. Furthermore, 96.48% of them would attempt for a VBAC birth again while 97.36% would recommend this way of delivery to other women. There was a total of 78.85% of succeeded VBAC. The main reason for women to choose VBAC for a birth option were the desire for a normal birth (23.1%), the thought of vaginal birth as the normal way of giving birth (22.4%), to avoid another surgery (14.2%) and to experience a vaginal birth (10%).

CONCLUSIONS

VBAC is an option that needs to be offered more in Greece, and needs improvement in obtaining informed consent in obstetric care services. More studies are required to draw further conclusions.

'It will dictate how many children I will have"- Women's decision-making in pregnancy following a previous caesarean birth (CB)

Vaginal birth after caesarean (VBAC) is supported in systematic reviews (Wu et al., 2019) and national guidelines (RCOG, 2015) and women are expected to be involved in the decision-making process for either a repeat caesarean birth or planned VBAC.

AIM

To develop a Grounded Theory (GT) of women's decision making of their birth choices in pregnancy following a previous caesarean birth (CB) OBJECTIVE: To explore what determines women's birth choice and their decision making for birth following a previous CB.

DESIGN

Semi structured interviews with pregnant women were undertaken in order to develop a Glasserian Grounded Theory SETTING: Antenatal clinics and wards in a large tertiary level maternity hospital.

FINDINGS

The theory of 'Mentalizing Possibilities' is a substantive theory which explains pregnant women's decision making about their birth choices after a previous CB. Women's main concern is to achieve a positive experience. The core category of 'Mentalizing Possibilities' explains how women process their previous experience, adapt to uncertainty and deal with the decisional conflict. There are behavioural and cognitive strategies which women use to go through this process.

CONCLUSION

Women want a positive birth experience after a previous CB and require support and continuity in decision making to help them decide the optimal birth choice for their current pregnancy.

HEALTHCARE PROFESSIONALS’ ATTITUDES TOWARDS VAGINAL BIRTH AFTER CESAREAN SECTION; İSTANBUL EXAMPLE

Rapidly increasing cesarean birth rates around the world continue to cause concern. Repeated cesarean sections are the most important causes of this increase. Vaginal birth after cesarean section (VBAC) is a good solution, but is not used widely enough in clinical practice. This cross-sectional descriptive study aimed to determine the attitudes of healthcare professionals towards VBAC and the factors that affect them. The study was conducted at a maternity hospital in Istanbul and sample included 254 healthcare professionals. The data were collected using a personal information form and the VBAC Attitudes Form. Percentages, means, Pearson’s chi-squared test, the Kruskal-Wallis H test and the Mann-Whitney U test were used. The threshold for statistical significance was p

Women's views and preferences regarding the mode of birth after cesarean section: Polish cross-sectional web-based survey

OBJECTIVE

Currently, the most common indication for cesarean section is a previous cesarean section. Some of them are performed for no medical reasons. Therefore, it is crucial to recognize the preferences and expectations of women concerning birth after cesarean section. This study's main aim was to understand the women's points of view on the mode of birth after cesarean.

STUDY DESIGN

A cross-sectional study was conducted, and data was collected using an original structured online questionnaire. The study group consisted of 733 pregnant Polish women who had previously undergone a cesarean birth.

RESULTS

Women more often preferred vaginal birth after cesarean section (73.26%) and less frequently (23.33%) chose elective cesarean section. Women preferring VBAC when making decisions were guided by the benefits, opportunities, and risks associated with each mode of birth. For women preferring elective cesarean section the only highly significant factor was the experience of previous deliveries. Women mainly use Internet sources and the support of other women giving birth after cesarean section. More than half of the women did not talk about the mode of birth with their midwife, and every fifth did not talk about it with the obstetrician.

CONCLUSION

Obstetric history and personal beliefs about birth after cesarean section, motivations, and concerns about childbirth affect women's preferences regarding the mode of birth. It is necessary to educate women, in particular, talks about the opportunities and risks associated with cesarean birth carried out by the medical staff at an early stage of pregnancy.

Childbirth experience of women in a maternity hospital signatory of the Adequate Childbirth Project: mixed study

OBJECTIVE

To understand the childbirth experience of women assisted in a maternity hospital signatory of the Adequate Childbirth Project.

METHODOLOGY

Mixed study, carried out in 2018. Applied the Free Word Association Test in 62 pregnant women and then conducted an open interview with 18 of them, then puerperal women, and, for analysis, the Central Nucleus Theory, Word Cloud, and thematic Categories, respectively.

RESULTS

The predominant words revealed in the quantitative stage were: pain, wonderful, recovery, anxiety, and desires. The qualitative analysis is presented by thematic categories "Women's insecurities in the PPA model" and "New perspectives from experience in the PPA model".

CONCLUSIONS

The women's experiences demonstrated that the model favored the remodeling of childbirth care. However, they still experience pain, dissatisfaction, and lack of autonomy. The impossibility of choosing a trusted professional was a source of insecurity, and nurses had no voice in decisions and actions in care.

Women's views of birth after cesarean section

BACKGROUND

Vaginal birth is a safe mode of childbirth for the majority of women after cesarean section (CS). However, data show that women who have undergone a CS are more likely to have an elective CS (ECS) than a vaginal birth after CS (VBAC) in many areas of the world.

AIM

This study aimed to review the literature about women's mode of birth preferences and attitudes and the underlying reasons for, and factors associated with, their preferences.

METHODS

This is narrative literature review. PubMed/MEDLINE and Scopus databases were searched, limiting the results to non-interventional studies published between 1990 and 2020. Twenty-one articles were included in the analysis.

RESULTS

The review found 34 different factors that influence women's preferences. Five factors influenced both VBAC and ECS preference, depending on the study. The most common factors having a dualistic effect on preference were: medical staff recommendation, doctor's opinion, and fear of pain. The most common factors were: desire to experience natural childbirth, faster/easier recovery, support from doctor's, and midwife's opinion. Among the factors influencing the preference for ECS, two were particularly prominent: predictability, controllability and comfortability of CS and the belief that CS is safer for the baby and/or mother.

CONCLUSIONS

Our review showed that there are a variety of factors that influence women's preference for the mode of delivery after CS. Some of these have a dualistic effect according to the study. The key to making an informed decision regarding the mode of delivery is communication with medical professionals.

Defensive Medicine in the Management of Cesarean Delivery: A Survey among Italian Physicians

Background and Objectives: This study aims to contribute to the definition of the defensive medicine phenomenon between obstetricians and gynecologists, as well as to possible effects on the frequency of deliveries performed by cesarean sections (CS). Materials and Methods: a digital questionnaire was administered through a mail-list including 600 gynecological specialists (of these 168 doctors completed the test), both in public and private settings. It was made of twenty multiple choice questions, concerning their awareness about the practice of defensive medicine and the planning and execution of CS. All doctors involved received clear and complete information about the purpose of this study and about the organizations that received their answers. Analyses of variance and regression were performed to describe differences between groups and to estimate the relationships between variables. The value of p < 0.5 was considered statistically relevant. Results: our analysis revealed that most respondents are confident with the defensive medicine definition and characteristics. This survey confirmed that gynecologists fear legal actions promoted by their patients and therefore modulate their choices by implementing professional behaviors of so-called “defensive medicine”. This relates to a greater number of medical liability judgements, which more often concern omission or delayed execution of cesarean section, rather than unskillful surgical procedures. Conclusions: there are few data to support a relation between the high rate of CS and defensive medicine. Numerous scientific studies associated this CS rate with the phenomenon of defensive medicine. This practice is constantly growing in all medical areas, especially in high-risk specialties such as obstetrics and gynecology. Our study highlights physicians’ awareness of adopting defensive medicine behaviors in their clinical practice, affecting the choice of the type of delivery to be performed.

The effect of empathy training given to midwives on the empathic communication skills of midwives and the birth satisfaction of mothers giving birth with the help of these midwives: A quasi-experimental study

RATIONALE, AIMS, AND OBJECTIVES

Empathic attitudes and behaviours of midwives directly affect obstetric outcomes. The study aims to examine the effect of empathy training on the empathic communication skills of midwives and the childbirth satisfaction of primiparous mothers.

METHODS

This quasi-experimental study has two sample groups including midwives working in the delivery unit (n = 15) and mothers giving birth with the help of these midwives (n = 134). Empathy training was given to the midwives through a 32-hour program involving didactic narrative, creative drama, and psychodrama techniques. A "Descriptive Information Form," and the "Empathic Communication Skills" and "Empathic Tendencies" scales were used to collect data from the midwives, and another "Descriptive Information Form" and the "Scale for Measuring Maternal Satisfaction in Normal Birth" were used for the maternal data.

RESULTS

Empathic communication skills and empathic tendencies of the midwives were found to be higher right after and 8 weeks after the training than before the training (P = .001, P = .040, respectively). The total score and sub-dimensions of the maternal satisfaction scale (ie, midwifery care, respect for privacy, meeting expectations, postpartum care) were found to be higher in mothers giving birth after the midwives' empathy training than those giving birth before (P < .001). A higher level of maternal birth satisfaction was seen in mothers giving birth right after the training (94%) than those giving birth before training (3%).

CONCLUSION

The empathy training improved both the empathy skills of midwives, and translated to improved maternal satisfaction with birth among their mothers. It is recommended to increase the number of follow-ups to evaluate the long-term effect of empathy training.