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Zahroh RI, Hazfiarini A, Martiningtyas MA, Ekawati FM, Emilia O, Cheong M, Betran AP, Homer CS, Bohren MA. Rising caesarean section rates and factors affecting women's decision-making about mode of birth in Indonesia: a longitudinal qualitative study. BMJ Glob Health 2024; 9:e014602. [PMID: 38897616 PMCID: PMC11191729 DOI: 10.1136/bmjgh-2023-014602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/08/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Caesarean section (CS) rates in Indonesia are increasing rapidly. Understanding women's preferences about mode of birth is important to help contextualise these rising rates and can help develop interventions to optimise CS. This study aimed to explore Indonesian women's preferences and decision-making about mode of birth, and how their preferences may change throughout pregnancy and birth. METHODS We conducted a longitudinal qualitative study using in-depth interviews with 28 women accessing private and public health facilities in Jakarta, the region with the highest CS rates. Interviews were conducted two times: during the woman's third trimester of pregnancy and in the postpartum period, between October 2022 and March 2023. We used a reflexive thematic approach for analysis. RESULTS We generated three themes: (1) preferences about the mode of birth, (2) decision-making about the mode of birth and (3) regrets about the actual mode of birth. Most women preferred vaginal birth. However, they were influenced by advertisements promoting enhanced recovery after CS (ERACS) as an 'advanced technique' of CS, promising a comfortable, painless and faster recovery birth. This messaging influenced women to perceive CS as equivalent or even superior to vaginal birth. Where women's preferences for mode of birth shifted around the time of birth, this was primarily due to the obstetricians' discretion. Women felt they did not receive adequate information from obstetricians on the benefits and risks of CS and vaginal birth and felt disappointed when their actual mode of birth was not aligned with their preferences. CONCLUSION Our study shows that despite rising CS rates, Indonesian women prefer vaginal birth. This highlights the need for better communication strategies and evidence-based information from healthcare providers. Given the rising popularity of ERACS, more work is urgently needed to standardise and regulate its use.
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Affiliation(s)
- Rana Islamiah Zahroh
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Alya Hazfiarini
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Moya Ad Martiningtyas
- Technology, Health, Education, Social, and Environment (THESE) Initiatives, Mataram, Indonesia
| | - Fitriana Murriya Ekawati
- Department of Family and Community Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ova Emilia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Marc Cheong
- Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Victoria, Australia
- Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, Victoria, Australia
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Caroline Se Homer
- Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, Victoria, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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Shurong Z, Li M, Jie X. Decision-making experiences and the need for decision aids in women considering vaginal birth after cesarean: A qualitative meta-synthesis. Birth 2024; 51:3-12. [PMID: 37766494 DOI: 10.1111/birt.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 07/21/2023] [Accepted: 08/05/2023] [Indexed: 09/29/2023]
Abstract
AIMS This study aims to comprehensively explore the decision-making requirements of women contemplating vaginal birth after cesarean (VBAC). DESIGN & METHODS A meta-synthesis approach was employed for this study. Using an integrative methodology, we conducted a systematic assessment of women's experiences and needs related to VBAC decision-making. A comprehensive search was conducted across The Cochrane Library, PubMed, EMBASE, Ovid Medline, SCOPUS, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Wan Fang databases to identify pertinent studies between 2000 and 2022. Furthermore, the reference lists of the included studies were thoroughly examined. RESULTS Fifteen studies were incorporated, from which seven themes emerged: emotional changes, preference for vaginal birth, unmet information needs, influences on decision-making, decision-making autonomy, aligning information provision with decision-support needs, and the requirement for support systems. Two primary syntheses were constructed on the decision-making process and the need for decision-making aids, respectively. CONCLUSION Women opting for VBAC experienced emotional shifts during their decision-making process in pregnancy. There remains a need for an enhanced decision-making tool to guide them in their choice. Recommendations for implementation in VBAC decision aids include facilitating women's involvement in decision-making, satisfying their information needs, and delivering appropriate emotional support.
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Affiliation(s)
- Zhou Shurong
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Mengyuan Li
- Peking University School of Nursing, Beijing, China
| | - Xiang Jie
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Lennon RA, Kearns K, O'Dowd S, Biesty L. VBAC or elective CS? An exploration of decision-making process employed by women on their mode of birth following a previous lower segment caesarean section. Women Birth 2023; 36:e623-e630. [PMID: 37308355 DOI: 10.1016/j.wombi.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 05/18/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Part of the caseload of an Advanced Midwife Practitioner (AMP) service in a Northwest of Ireland maternity unit includes vaginal birth after caesarean section (VBAC) women. Despite evidence about VBAC being a safe option for women, the numbers attempting a VBAC remain small. This research was undertaken to give an insight into how VBAC eligible women opt for an elective repeat CS (ERCS) or VBAC birth. METHODS Forty-four postnatal women with one previous CS who birthed between August 2021 and March 2022 were invited to participate in a qualitative study. Thirteen semi-structured interviews were undertaken in 2022. Thematic Analysis guided the analysis of the data and the findings are framed using the domains of the Socio-Ecological Model. FINDINGS Decision making in relation to ERCS and VBAC is complex. Women want accurate VBAC information and time for discussions. Decisions are influenced by the woman's own confidence to birth naturally, family size, rite of passage to motherhood, control, previous birth experience, postnatal recovery and friends and family. DISCUSSION Previous experience can influence but not predict the next mode of birth. However, there is no one script that healthcare professionals (HCP) can use for this decision making given the various factors that influence this. To meet women's individual needs, HCPs should discuss VBAC suitability postnatally, offer VBAC antenatal clinics and specific VBAC classes. CONCLUSION Discussions about suitability for VBAC should occur following the primary CS. Continuity of care (COC), time for discussions and VBAC supportive HCP should be an option for all of this cohort.
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Affiliation(s)
- Roisin Ailbhe Lennon
- Master of Health Sciences (Advanced Practice with Prescribing), Women and Infants' Services, Sligo University Hospital, Sligo, Republic of Ireland.
| | - Karlene Kearns
- Master Health Science, Clinical Placement coordinator, Sligo University Hospital, Sligo, Republic of Ireland
| | - Siobhan O'Dowd
- Department of Nursing, Health Sciences and Disability Studies. St Angela's College, Sligo, Republic of Ireland
| | - Linda Biesty
- School of Nursing & Midwifery, University of Galway, Galway, Republic of Ireland
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Awawdeh S, Rawashdeh H, Aljalodi H, Shamleh RA, Alshorman S. Vaginal birth after cesarean section prediction model for Jordanian population. Comput Biol Chem 2023; 104:107877. [PMID: 37182360 DOI: 10.1016/j.compbiolchem.2023.107877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/08/2023] [Accepted: 04/29/2023] [Indexed: 05/16/2023]
Abstract
The rate of cesarean section has increased significantly worldwide, creating a group of women with one lower segment cesarean section concerned about the mode of delivery in their future pregnancies. This group of mothers will face a complex discussion because the likelihood for a successful vaginal birth after cesarean section provided to them is a general one. The probability of having a successful vaginal birth is the cornerstone factor of the mothers' decision. Therefore, providing a case-specific likelihood that respects the characteristics of each pregnancy will refine counseling, lower the decision conflict, and improve the success rate of vaginal birth trials eventually improving maternal and fetal outcomes. This paper aims to develop a clinical decision support system to evaluate the individualized likelihood mode of delivery for pregnant women with a previous lower segment cesarean section based on their unique characteristics. The study included six hundred fifty-nine pregnant women, where three hundred twenty-seven records had missing values. Various pre-processing steps, including missing data imputation and feature selection, were applied to the original dataset before model development to improve the data quality. Missing values were handled first, then a feature selection process using a genetic algorithm was applied to select the relevant features and to exclude features that may have been affected negatively by missing data imputation. After that, four machine learning classifiers, namely Decision Tree, Random Forest, K-Nearest Neighbors (KNN), and Logistic Regression, were used to build the prediction model. The results showed that imputing missing values followed by feature selection was more efficient than deleting them since the Area Under the Curve (AUC) has increased from 0.655 to 0.812 using the KNN classifier.
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Affiliation(s)
- Shatha Awawdeh
- King Abdullah II School for Information Technology, The University of Jordan, Amman, Jordan; School of Information Technology, Applied Science Private University, Amman, Jordan.
| | - Hasan Rawashdeh
- Department of Obstetrics and Gynaecology, Jordan University of Science and Technology, Jordan
| | - Haneen Aljalodi
- Department of Obstetrics and Gynaecology, Jordan University of Science and Technology, Jordan
| | - Rafeef Abu Shamleh
- Department of Obstetrics and Gynaecology, Jordan University of Science and Technology, Jordan
| | - Sumyah Alshorman
- Obstetrics and Gynecology Department, King Abdullah University Hospital, Al-Ramtha, Jordan
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Rawashdeh H, Aljalodi H, shamleh RA, Alshorman S, AboShindi H, Awawdeh S. Validation of the Grobman model for successful vaginal birth after cesarean section in Jordanian women. BMC Pregnancy Childbirth 2023; 23:49. [PMID: 36670392 PMCID: PMC9854026 DOI: 10.1186/s12884-023-05385-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To validate both models of Grobman nomogram (The antenatal and the intrapartum model) for predicting successful intended Vaginal Birth After Caesarean delivery (VBAC) in a Jordanian population. METHODS A retrospective study has identified all live, singleton, term, cephalic pregnancies with a previous lower segment cesarean section who opted for a Trial Of Labour After Caesarean Section (TOLAC) between January 2014 to December 2020. Five variables were used for the antenatal model, while ten variables were used for the intrapartum model. Two sets of patients were created: one for the antenatal model and the other for the intrapartum model. The predicted probability for each woman was calculated and compared with the successful VBAC for each category. The predictive ability was assessed with a receiver operating characteristic, and the area under the curve (AUC) was determined. RESULTS There were seven hundred and fourteen complete cases for the antenatal model and six hundred ninety-seven for the intrapartum model. Our population's overall number of VBAC is 83.89% for the antenatal group and 82.92% for the intrapartum group. The mean predicted probability for a successful intended VBAC using the antenatal and intrapartum models were 79.53 ± 13.47 and 78.64 ± 14.03, respectively. The antenatal and intrapartum predictive models ROC had an AUC of 65% (95% CI: 60%-71%) and 64% (95% CI: 58%-69%), respectively. CONCLUSIONS Both models are validated in the Jordanian population. Adapting the antenatal model as supporting evidence can lead to a higher rate of TOLAC.
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Affiliation(s)
- Hasan Rawashdeh
- grid.37553.370000 0001 0097 5797Obstetrics and Gynecology Department, Jordan University of Science and Technology, Amman, Jordan
| | - Haneen Aljalodi
- grid.37553.370000 0001 0097 5797Obstetrics and Gynecology Department, Jordan University of Science and Technology, Amman, Jordan
| | - Rafeef Abu shamleh
- grid.37553.370000 0001 0097 5797Obstetrics and Gynecology Department, Jordan University of Science and Technology, Amman, Jordan
| | - Sumyah Alshorman
- Obstetrics and Gynecology Department, King Abdulla University Hospital, Ar-Ramtha, Jordan
| | - Heba AboShindi
- USAID Health Services Quality Accelerator Activity / University Research Co., Amman, Jordan
| | - Shatha Awawdeh
- grid.9670.80000 0001 2174 4509King Abdullah II School for Information Technology, The University of Jordan, Amman, Jordan
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Mesay F, Melese E, Wudie G, Feleke SF, Dessie AM. A Prognostic Study for the Development of Risk Prediction Model for the Success of Vaginal Birth Following a Cesarean Surgery at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia. Healthc Policy 2023; 16:55-68. [PMID: 36714193 PMCID: PMC9880561 DOI: 10.2147/rmhp.s395388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
Background An attempt at vaginal delivery by a woman who has previously had a cesarean section is known as a trial of labor after cesarean section. The most important issues are how to accurately anticipate successful vaginal birth after cesarean surgery and how to calculate the likelihood of success of vaginal birth after caesarean section that is suitable for women. Consequently, a tailored prediction of vaginal birth after caesarean section may result in a more effective counseling. Objective To create a clinical risk score and prediction model for the success of vaginal birth following a previous caesarean section in women. Methods A prognostic analysis was carried out at Felege Hiwot Comprehensive and Specialized Referral Hospital from 30 February 2017 to 30 March 2021. R statistical programming language version 4.0 was used for analysis once the data had been coded and entered into Epidata, version 3.02. Significant factors (P< 0.05) were kept in the backward multivariable logistic regression model, and variables with (P<0.25) from the bi-variable logistic regression analysis were also added. Results After a cesarean section, 67% of women were successful in giving birth vaginally. Previous successful vaginal birth after cesarean surgery, rupture of the membranes, and initiation time of ANC, the beginning of labor, parity and time since the previous delivery were remained in the final multivariable prediction model. The AUC of the model was 0.748 (95% CI: 0.714-0.781). Conclusion Overall, this study demonstrated the likelihood of predicting vaginal birth utilizing the ideal confluence of parity, membrane rupture, and onset of labor, prior history of VBAC, inter-delivery gap, and ANC beginning time. Sixty-seven percent of VBACs were successful. As a result, this model may aid in identifying pregnant women who are candidates for VBAC and who have a better likelihood of success.
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Affiliation(s)
- Filipos Mesay
- Department of Public Health, Gafat Health Center, Debre Tabor, Ethiopia
| | - Ergoye Melese
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gebiyaw Wudie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia,Correspondence: Sefineh Fenta Feleke; Filipos Mesay, Tel +251928573882; Tel +251984929331, Email ;
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Panda S, Begley C, Daly D. Clinicians' views of factors influencing decision-making for CS for first-time mothers-A qualitative descriptive study. PLoS One 2022; 17:e0279403. [PMID: 36576912 PMCID: PMC9797090 DOI: 10.1371/journal.pone.0279403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/07/2022] [Indexed: 12/29/2022] Open
Abstract
Clinicians' perspectives of the reasons for performing caesarean section (CS) are fundamental to deepening knowledge and understanding of factors influencing decision-making for CS. The aim of this study was to explore midwives' and obstetricians' views of factors influencing decision-making for CS for first-time mothers. A qualitative descriptive study with semi-structured one-to-one audio-recorded interviews was used to gather data from clinicians (15 midwives and 20 senior obstetricians). Following research ethics committee approval, clinicians, who were directly involved in the decision-making process for CS during the period of data collection, were purposively selected from three maternity units in the Republic of Ireland between June 2016 to July 2017. The interviews were transcribed verbatim and analysed thematically. Three interrelated themes with several subthemes reflective of clinicians' views and experiences emerged following data analysis. These were: 'A fear factor' describing clinicians' fear of adverse outcomes and subsequent litigation, 'Personal preferences versus a threshold-clinician driven factors emphasising the influence of clinicians' personal beliefs, and 'Standardised versus individualised care-a system perspective' explaining the effects of, or lack of, organisational policy and its direct and indirect impact on the decision-making process. Findings show that decisions to perform a CS are, on occasion, based on clinicians' personal beliefs and interpretation, similar to findings from other published literature. Consideration of broader issues related to organisational, socio-cultural and political context is essential when seeking solutions to the rising CS rates. The findings will enable clinicians to reflect on their day-to-day practice, in order to look for modifiable factors that influence their decision-making, and help women understand the multitude of factors that can lead to a decision to perform a CS. Findings will also contribute to the development of the 'next step action' and assist in devising future intervention studies to reduce any unnecessary CSs.
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Affiliation(s)
- Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Attanasio LB, Paterno MT, Kjerulff KH. Factors associated with labor after cesarean in a prospective cohort. Birth 2022; 49:833-842. [PMID: 35608986 PMCID: PMC9649839 DOI: 10.1111/birt.12656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/08/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The goals of this study were (a) to determine how experiences in the first perinatal period shape birth mode preference among individuals with a first birth by cesarean; and (b) to examine the relationship between birth mode preference and other factors and subsequent labor after cesarean (LAC). METHODS Data are from the First Baby Study, a prospective cohort of 3006 primiparous individuals. The analytic sample includes individuals with a first cesarean birth and a second birth during the 5-year follow-up period (n = 394). We used multivariable logistic regression to examine the relationship between experiences in the first perinatal period and subsequent preference for vaginal birth, and between preference for vaginal birth and LAC in the second birth. RESULTS About a third of the sample preferred vaginal birth in a future birth, and 20% had LAC. Factors associated with higher odds of future vaginal birth preference were favorable prenatal attitude toward vaginal birth, lower perceived maternal-infant bonding at 1 month after the first birth, post-traumatic stress symptoms after the first birth, and desiring more than 1 additional child after the first birth. Odds of LAC were nearly 8 times higher among those who preferred vaginal birth (AOR = 7.69, P < .001). Fatigue after the first birth, post-traumatic stress symptoms after the first birth, and having higher predicted chances of vaginal birth after cesarean were also associated with higher odds of LAC. CONCLUSIONS Our findings suggest that the formation of preferences around vaginal birth may present a modifiable target for future counseling and shared decision-making interventions.
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Affiliation(s)
- Laura B Attanasio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Mary T Paterno
- Midwifery Services at Cooley Dickinson ObGyn & Midwifery, Cooley Dickinson Medical Group, Northampton, MA, USA
| | - Kristen H Kjerulff
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA, USA
- Department of Obstetrics and Gynecology, College of Medicine, Hershey, PA, USA
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Williams AC, Martinez LI, Garrison A, Frost CJ, Gren LH. Factors leading to satisfaction with counseling for Labor after Cesarean among Latina women in the United States. Birth 2022; 49:71-79. [PMID: 34263970 DOI: 10.1111/birt.12575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 06/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cesarean birth, especially repeat cesarean, is associated with significantly higher morbidity than vaginal birth. Appropriately counseling women who are candidates for labor after cesarean (LAC) has the potential to confer significant health benefits for women. Little guidance exists about optimal counseling techniques, especially for Latina women. The aim of this study was to evaluate satisfaction among Latinas about how LAC counseling is performed, specifically as it relates to shared decision making. METHODS We conducted a qualitative study of pregnant women at several clinics in a Federally Qualified Health Center system in Utah. We interviewed eleven Latina women about satisfaction with recent LAC counseling with a specific aim of obtaining rich, personal narratives rather than reaching data saturation. A codebook representing the most common themes was developed. RESULTS Three major themes emerged related to LAC counseling including influences on satisfaction, influences on the birth decision process, and preferences surrounding method and timing of counseling. Women experienced greater satisfaction from providers who used jargon-free communication, were perceived as trustworthy, cared about her experiences, and empowered her to make an informed decision. Women's decisions were influenced by prior birth experiences, desire for a safe delivery and easy recovery, and future family planning. CONCLUSIONS Understanding the aspects of LAC counseling that are most meaningful for Latina women can promote effective communication between patient and provider and improve patient satisfaction. Globally, our findings highlight the importance of evaluating the experiences and preferences of minority groups; majority populations cannot be assumed to speak for minority populations.
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Affiliation(s)
| | | | | | | | - Lisa H Gren
- University of Utah, Salt Lake City, Utah, USA
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Thirukumar P, Henry A, Coates D. Women's Experiences and Involvement in Decision-Making in Relation to Planned Cesarean Birth: An Interview Study. J Perinat Educ 2021; 30:213-222. [PMID: 34908820 PMCID: PMC8663766 DOI: 10.1891/j-pe-d-20-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Actively engaging women in decision-making about their own care is critical to providing woman-centered maternity care. The aim was to understand women's mode-of-birth preferences and shared decision-making experiences during planned cesarean birth (CB). Semi-structured telephone interviews were conducted with 33 women who had planned CB at eight Australian metropolitan hospitals. Inductive thematic analysis was conducted using NVivo-12. Many women preferred a vaginal birth but were willing to have a CB if the clinician recommended. Most women looked to their clinicians for information and guidance. Although many women reported receiving enough information to make informed decisions, others felt pressured into having or not having a CB, or expected to make decisions themselves. Women wished for longer consultation times, more information, and care continuity.
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The Perspectives of Women and Their Health-Care Providers Regarding Using an ECA to Support Mode of Birth Decisions. J Perinat Educ 2021; 30:135-144. [DOI: 10.1891/j-pe-d-20-00027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study used focus groups to assess the feasibility and acceptability of adapting an Embodied Conversational Agent (ECA) to support decision-making about mode of birth after previous cesarean. Twelve women with previous cesareans, and eight prenatal providers at an academic, tertiary-care medical center, viewed a prototype ECA and were asked to share feedback on the potential role in helping women prepare for decision-making. Both groups felt that although it was somewhat “robot-like,” the ECA could provide easy access to information for patients and could augment the visit with providers. Future work is needed to improve ECA visual appeal and clarify the role and timing for utilization of decision aids using ECA technology to enhance the shared decision-making process.
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Basile Ibrahim B, Kennedy HP, Holland ML. Demographic, Socioeconomic, Health Systems, and Geographic Factors Associated with Vaginal Birth After Cesarean: An Analysis of 2017 U.S. Birth Certificate Data. Matern Child Health J 2021; 25:1069-1080. [PMID: 33201453 PMCID: PMC8126565 DOI: 10.1007/s10995-020-03066-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In order to better understand the current rates of vaginal birth after cesarean (VBAC) in the United States, 2017 U.S. birth certificate data were used to examine sociodemographic and geographic factors associated with the outcome of a VBAC. METHODS The 2017 Natality Limited Geography Dataset and block sequential logistic regression were used to examine sociodemographic and geographic factors associated with subsequent births in 2017 in the United States to women with a history of 1 or 2 cesareans (N = 540,711). RESULTS The adjusted odds of VBAC were 6% higher for Black women (1.06; 95% CI: 1.04, 1.08) and 18% higher for American Indian/Alaska Native women (aOR 1.18; 95% CI: 1.10, 1.27) relative to white women. Asian/Pacific Islander women were 9% less likely to have a VBAC (aOR 0.91; 95% CI: 0.88, 0.94) than similar white women with a history of cesarean delivery. Latina women had a 10% less likelihood of a VBAC (aOR 0.90; 95% CI: 0.88, 0.92) when compared with non-Latina women. Women with a high school education (aOR 0.85; 95% CI: 0.83, 0.88) or some college (aOR 0.85; 95% CI: 0.84, 0.87) were less likely to have a VBAC than women educated at a baccalaureate level or higher. Women whose births were paid for by Medicaid had a 5% increased likelihood of VBAC over women with private insurance (aOR 1.05, 95% CI: 1.03, 1.07). Women who self-pay have twice the likelihood of VBAC (aOR 1.99; 95% CI: 1.92, 2.07) compared to women with private insurance. The adjusted odds of VBAC were lowest for women giving birth in Southern states (aOR 0.72; 95% CI: 0.71, 0.74) and highest for women giving birth in the Midwest (aOR 1.19; 95% CI: 1.16, 1.22) relative to women in the Northeastern U.S. Thirteen percent (13%) of women who had a VBAC had a certified nurse-midwife (CNM) birth attendant, which is 44% higher than the national CNM-attended birth rate. CONCLUSIONS FOR PRACTICE Significant variation exists in VBAC rates based on a number of sociodemographic and geographic factors, likely reflecting disparities in access to vaginal birth after cesarean and differences in preference regarding mode of birth after cesarean. Further research is recommended to better understand and address these disparities to improve maternity care.
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Affiliation(s)
| | - Holly Powell Kennedy
- Yale University School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
| | - Margaret L Holland
- Yale University School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
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Basile Ibrahim B, Knobf MT, Shorten A, Vedam S, Cheyney M, Illuzzi J, Kennedy HP. "I had to fight for my VBAC": A mixed methods exploration of women's experiences of pregnancy and vaginal birth after cesarean in the United States. Birth 2021; 48:164-177. [PMID: 33274500 PMCID: PMC8122048 DOI: 10.1111/birt.12513] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Vaginal birth after cesarean (VBAC) is safe, cost-effective, and beneficial. Despite professional recommendations supporting VBAC and high success rates, VBAC rates in the United States (US) have remained below 15% since 2002. Very little has been written about access to VBAC in the United States from the perspectives of birthing people. We describe findings from a mixed methods study examining experiences seeking a VBAC in the United States. METHODS Individuals with a history of cesarean and recent subsequent birth were recruited through social media groups. Using an online questionnaire, we collected sociodemographic and birth history information, qualitative accounts of participants' experiences, and scores on the Mothers on Respect Index, the Mothers Autonomy in Decision Making Scale, and the Generalized Self-Efficacy Scale. RESULTS Participants (N = 1711) representing all 50 states completed the questionnaire; 1151 provided qualitative data. Participants who planned a VBAC reported significantly greater decision-making autonomy and respectful treatment in their maternity care compared with those who did not. The qualitative theme: "I had to fight for my VBAC" describes participants' accounts of navigating obstacles to VBAC, including finding a supportive provider and traveling long distances to locate a clinician and/or hospital willing to provide care. Participants cited support from providers, doulas, and peers as critical to their ability to acquire the requisite knowledge and power to effectively self-advocate. DISCUSSION Findings highlight the difficulties individuals face accessing VBAC within the context of a complex health system and help to explain why rates of attempted VBAC remain low.
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Affiliation(s)
- Bridget Basile Ibrahim
- University of Minnesota School of Public Health, Minneapolis, MN, USA
- School of Nursing, Yale University, Orange, CT, USA
| | - M Tish Knobf
- School of Nursing, Yale University, Orange, CT, USA
| | - Allison Shorten
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Saraswathi Vedam
- Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Colomar M, Opiyo N, Kingdon C, Long Q, Nion S, Bohren MA, Betran AP. Do women prefer caesarean sections? A qualitative evidence synthesis of their views and experiences. PLoS One 2021; 16:e0251072. [PMID: 33951101 PMCID: PMC8099111 DOI: 10.1371/journal.pone.0251072] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/19/2021] [Indexed: 11/19/2022] Open
Abstract
Background Caesarean sections (CS) continue to increase worldwide. Multiple and complex factors are contributing to the increase, including non-clinical factors related to individual women, families and their interactions with health providers. This global qualitative evidence synthesis explores women’s preferences for mode of birth and factors underlying preferences for CS. Methods Systematic database searches (MEDLINE, EMBASE, CINAHL, PsycINFO) were conducted in December 2016 and updated in May 2019 and February 2021. Studies conducted across all resource settings were eligible for inclusion, except those from China and Taiwan which have been reported in a companion publication. Phenomena of interest were opinions, views and perspectives of women regarding preferences for mode of birth, attributes of CS, societal and cultural beliefs about modes of birth, and right to choose mode of birth. Thematic synthesis of data was conducted. Confidence in findings was assessed using GRADE-CERQual. Results We included 52 studies, from 28 countries, encompassing the views and perspectives of pregnant women, non-pregnant women, women with previous CS, postpartum women, and women’s partners. Most of the studies were conducted in high-income countries and published between 2011 and 2021. Factors underlying women preferences for CS had to do mainly with strong fear of pain and injuries to the mother and child during labour or birth (High confidence), uncertainty regarding vaginal birth (High confidence), and positive views or perceived advantages of CS (High confidence). Women who preferred CS expressed resoluteness about it, but there were also many women who had a clear preference for vaginal birth and those who even developed strategies to keep their birth plans in environments that were not supportive of vaginal births (High confidence). The findings also identified that social, cultural and personal factors as well as attributes related to health systems impact on the reasons underlying women preferences for various modes of birth (High confidence). Conclusions A wide variety of factors underlie women’s preferences for CS in the absence of medical indications. Major factors contributing to perceptions of CS as preferable include fear of pain, uncertainty with vaginal birth and positive views on CS. Interventions need to address these factors to reduce unnecessary CS.
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Affiliation(s)
- Mercedes Colomar
- Montevideo Clinical and Epidemiological Research Unit, Montevideo, Uruguay
- * E-mail:
| | - Newton Opiyo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Carol Kingdon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China
| | - Soledad Nion
- Faculty of Social Sciences, Sociology Department, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Meghan A. Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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15
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Greyson D, Roosevelt L, Boyd CJ. Desistance, Self-treatment, or Substitution: Decisions about Cannabis Use During Pregnancy. J Midwifery Womens Health 2021; 66:96-100. [PMID: 33534190 PMCID: PMC7897278 DOI: 10.1111/jmwh.13205] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 11/29/2022]
Abstract
Cannabis is the most commonly used drug during pregnancy in the United States and Canada, and the American College of Obstetricians and Gynecologists recommends that all pregnant individuals be screened for cannabis use and counseled regarding potential adverse health impacts of use. However, those considering or using cannabis during pregnancy report experiencing stigma and lack of information from health care providers and, thus, frequently rely on friends, family, and the internet for information. This article describes 3 types of decisions individuals may be making about cannabis use during pregnancy and suggests approaches health care providers may take to minimize judgment and provide optimal support for informed cannabis use decisions among pregnant individuals. Desistance decisions involve consideration of whether and how to reduce or stop using during pregnancy. Self‐treatment decisions are made by those exploring cannabis to help alleviate troublesome symptoms such as nausea or anxiety. Substitution decisions entail weighing whether to use cannabis instead of another substance with greater perceived harms. Health care providers should be able to recognize the various types of cannabis use decisions that are being made in pregnancy and be ready to have a supportive conversation to provide current and evidence‐based information to individuals making desistance, self‐treatment, and substitution decisions. Individuals making desistance decisions may require support with potential adverse consequences such as withdrawal or return of symptoms for which cannabis was being used, as well as potentially navigating social situations during which cannabis use is expected. Those making self‐treatment decisions should be helped to fully explore treatment options for their symptoms, including evidence on risks and benefits. Regarding substitution decisions, health care providers should endeavor to help pregnant individuals understand the available evidence regarding risks and benefits of available options and be open to revisiting the topic over time.
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Affiliation(s)
- Devon Greyson
- Department of Communication, University of Massachusetts, Amherst, Massachusetts
| | - Lee Roosevelt
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan.,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Chan MH, Hauck Y, Kuliukas L, Lewis L. Women's experiences of their involvement around care decisions during a subsequent pregnancy after a previous caesarean birth in Western Australia. Women Birth 2020; 34:e442-e450. [PMID: 33004288 DOI: 10.1016/j.wombi.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/14/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women who have a caesarean birth can have an experience that may impact decision-making for subsequent births. For some women this decision-making can be associated with anxiety. AIM To provide rich, surface level descriptions by exploring women's experiences of their involvement in decision-making during a subsequent pregnancy after a previous caesarean birth. METHODS A descriptive qualitative study was performed between May 2018 and February 2019 using Braun and Clarke's six steps guided analysis. Pregnant women with a previous caesarean birth, receiving antenatal care at a tertiary maternity hospital in Western Australia, and self-reported low to moderate levels of anxiety were invited to participate in a telephone interview. FINDINGS Women's (n = 17) experiences revealed four themes: 1) Learning from past experiences (two sub-themes loss of control and coming to terms), 2) Claiming ownership in decisions (two sub-themes challenging professional judgement and prioritising her needs, wishes and preferences), 3) Being empowered (three sub-themes getting a full picture, speaking out, and not just the baby or a number), 4) Moving forward (two sub-themes building trust in health professionals and establishing guardrails to minimise loss of control). DISCUSSION Women's experiences around decision-making in a subsequent pregnancy can vary according to whether their fears and anxieties are acknowledged and addressed. Women who are informed, and receive support and respect are empowered to move forward. CONCLUSION Continuity of care may provide women with more opportunities to build trusting relationships with clinicians and be truly known as an individual with unique preferences and desires.
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Affiliation(s)
- Maria Hakyung Chan
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley WA 6102, Australia.
| | - Yvonne Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley WA 6102, Australia.
| | - Lesley Kuliukas
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley WA 6102, Australia.
| | - Lucy Lewis
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley WA 6102, Australia.
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17
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Validation of a Vaginal Birth after Cesarean Delivery Prediction Model in Teaching Hospitals of Addis Ababa University: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1540460. [PMID: 33015154 PMCID: PMC7520680 DOI: 10.1155/2020/1540460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 11/03/2022]
Abstract
Background External validation of a vaginal birth after cesarean delivery (VBAC) prediction model is important before implementation in other settings. The primary aim of this study is to validate the Grobman prenatal VBAC calculator in the Ethiopian setting. Secondarily, the study was aimed at developing and comparing a new VBAC model that includes both the prenatal and intrapartum variables. Methods A cross-sectional survey was conducted, complemented by a medical chart review of 268 women admitted at three teaching hospitals of Addis Ababa University and who underwent a trial of labor after one prior cesarean birth. Maternal age, prepregnancy BMI, prior vaginal delivery, prior VBAC, and prior cesarean delivery indication type were included in the Grobman model. Observed delivery outcomes were recorded and then compared with the outcomes predicted by the calculator. We assessed the predictive abilities of the Grobman model and the new model using a receiver operating characteristic (ROC) curve. Multivariate logistic regression analysis was conducted to identify variables associated with successful VBAC. Results Out of the 268 participants, 186 (69.4%) (95% CI 57.5-81.3) had successful VBAC. The area under the ROC curve (AUC) of the Grobman model was 0.75 (95% CI 0.69-0.81). Notably, the novel model including both the prenatal and intrapartum variables had a better predictive value than the original model, with an AUC of 0.87 (95% CI 0.81-0.93). Prior VBAC, prepregnancy BMI, fetal membrane status, and fetal station at admission were predictors of VBAC in the newly developed logistic regression model. Conclusions The success rate of VBAC was similar to other sub-Saharan African countries. The Grobman model performed adequately in the study setting; however, the model including both the prenatal and intrapartum variables was more predictive. Thus, intrapartum predictors used in the new model should be considered during intrapartum counseling.
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18
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Coates D, Thirukumar P, Spear V, Brown G, Henry A. What are women’s mode of birth preferences and why? A systematic scoping review. Women Birth 2020; 33:323-333. [DOI: 10.1016/j.wombi.2019.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 12/26/2022]
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19
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Preis H, Mor P, Grisaru-Granovsky S, Samueloff A, Gabbay-Benziv R, Chen R, Eisner M, Pardo J, Peled Y, Wiznitzer A, Benyamini Y. Women's preferences for mode of second birth-A prospective study of two Israeli birth cohorts. Birth 2020; 47:237-245. [PMID: 32052497 DOI: 10.1111/birt.12484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/22/2019] [Accepted: 01/20/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Various biopsychosocial factors affect women's preferences with respect to mode of birth, but they are usually not examined simultaneously and prospectively. In the current study, we assessed the contribution of personal characteristics of first-time mothers, their prior prenatal perceptions, events during birth, and subjective birth experiences, on their preference about mode of second birth. METHODS This was a secondary analysis of two prospective birth cohort studies. Participants included 832 primiparous women recruited mostly from women's health centers in Israel, and through natural birth communities and cesarean birth websites. Women completed questionnaires prenatally and were followed up at 6-8 weeks postpartum to understand their preferences for a second birth. RESULTS Regression models indicated that after vaginal first birth, being less religious, believing that birth is a medical process, and having a negative experience increased the odds of preferring primary cesarean for the second birth. After cesarean birth, being more religious, having higher education, conceiving spontaneously, having a more negative birth experience, and perceiving better treatment from the staff during birth contributed to preferring vaginal birth for the second birth. CONCLUSIONS Religiosity is central to women's preferences, probably because of its association with the desire to have many children. Modifiable factors, such as women's beliefs about the nature of birth, their overall birth experience, and their perceived treatment from the staff, could influence the uptake of having vaginal births. Intrapartum care that is empathic and encouraging, along with education about modes of birth, could help decrease cesarean birth rates.
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Affiliation(s)
- Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA.,Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Pnina Mor
- Medical Genetics Institute, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Arnon Samueloff
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Technion School of Medicine, Hadera, Israel
| | - Rony Chen
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Eisner
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Pardo
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Peled
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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20
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Davis D, S Homer C, Clack D, Turkmani S, Foureur M. Choosing vaginal birth after caesarean section: Motivating factors. Midwifery 2020; 88:102766. [PMID: 32526606 DOI: 10.1016/j.midw.2020.102766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
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.
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Affiliation(s)
- Deborah Davis
- University of Canberra and ACT Government Health Directorate, Faculty of Health, Bruce, 2617, ACT, Australia.
| | - Caroline S Homer
- Maternal and Child Health Program, Burnet Institute, Melbourne, Australia; Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Danielle Clack
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Sabera Turkmani
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Australia; Hunter New England Local Health District & University of Newcastle, NSW, Australia
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21
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Firoozi M, Tara F, Ahanchian MR, Latifnejad Roudsari R. Health Care System Barriers to Vaginal Birth after Cesarean Section: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:202-211. [PMID: 32724765 PMCID: PMC7299419 DOI: 10.4103/ijnmr.ijnmr_150_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/16/2019] [Accepted: 02/03/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Approximately half of mothers give birth by cesarean section in Iran and two-thirds of them are repeated cesareans. Repeated cesarean is threatening for the mothers and newborns and not compatible with fertility policies in Iran. Vaginal Birth After Cesarean (VBAC) is a reasonable strategy but its prevalence is very low due to some barriers. The aim of this study was to explore barriers to VBAC in health care system. MATERIALS AND METHODS In this qualitative study, 26 semi-structured individual interviews with maternity care providers and mothers with prior cesarean section as well as one focus group discussion with maternity care providers were conducted. Interviews and focus group discussions were tape-recorded, transcribed verbatim and analyzed with conventional content analysis developed by Graneheim and Lundman using MXQDA10 software. RESULTS Barriers to VBAC in health care system identified in the main category of "the climate of restriction, fear and discourage" and eight subcategories including: "defective access to specialized services," "insufficient encouragement system," "modeling in cesarean section," "physician-centeredness in VBAC," "fear of legal responsibilities," "imposed policies," "marginalization of midwives," and "unsupportive birth team." CONCLUSIONS To remove barriers of VBAC in health care system, appropriate strategies including establishment of specialized VBAC counseling centers, performance-based incentive policies, cultural development and promotion of natural childbirth, promoting of teamwork culture, shared decision making, improvement of knowledge and skills of maternal care providers and implementation of clinical guidelines, should be considered. Future research could be focused on the effect of implementing these strategies to decrease repeat cesarean section rate.
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Affiliation(s)
- Mahboobeh Firoozi
- PhD Student of Reproductive Health, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Tara
- Professor, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Robab Latifnejad Roudsari
- Professor, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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22
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Basile Ibrahim B, Kennedy HP, Whittemore R. Women's Perceptions of Barriers and Facilitators to Vaginal Birth After Cesarean in the United States: An Integrative Review. J Midwifery Womens Health 2020; 65:349-361. [PMID: 32352635 PMCID: PMC8017908 DOI: 10.1111/jmwh.13083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this integrative review was to synthesize the literature on women's perceived barriers and facilitators to achieving a vaginal birth after cesarean. METHODS A search of Scopus and PubMed databases and relevant citations from 2000 to 2018 was conducted to identify resources meeting inclusion criteria. Conclusion drawing and verification were completed using data displays, data analysis, and comparison. RESULTS Sixteen resources met inclusion criteria. Factors identified by women with a history of cesarean that act as facilitators or barriers to achieving a vaginal birth after cesarean included (1) individual factors (knowledge, body, and psychological), (2) social factors (culture and social support), and (3) systemic factors (perinatal care provider, health system, and financial). Some factors related to barriers and facilitators reflected opposing aspects of the same phenomenon on a continuum. DISCUSSION Enhancing facilitators identified by women, while addressing perceived barriers, may increase access to labor after cesarean for women in the United States. Increasing access to labor after cesarean may subsequently improve women's experiences of care and decrease the US cesarean rate, positively affecting individual health outcomes and overall health of childbearing women in the United States.
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Affiliation(s)
- Bridget Basile Ibrahim
- Graduate School of Arts and Sciences, Yale University, Orange, Connecticut
- Yale School of Nursing, Yale University, New Haven, Connecticut
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23
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Abstract
This study evaluated a shared decision-making (SDM) Toolkit (decision aid, counseling guide, and provider scripts) designed to prepare and engage racially diverse women in shared decision-making discussions about the mode of birth after cesarean. The pilot study, involving 27 pregnant women and 63 prenatal providers, assessed women's knowledge, preferences, and satisfaction with decision making, as well as provider perspectives on the Toolkit's acceptability. Most women experienced knowledge improvement, felt more in control and that providers listened to their concerns and supported them. Providers reported that the Toolkit helped women understand their options and supported their counseling. The SDM Toolkit could be used to help women and providers improve their SDM regarding mode of birth after cesarean.
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Benton M, Salter A, Tape N, Wilkinson C, Turnbull D. Women's psychosocial outcomes following an emergency caesarean section: A systematic literature review. BMC Pregnancy Childbirth 2019; 19:535. [PMID: 31888530 PMCID: PMC6937939 DOI: 10.1186/s12884-019-2687-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Given the sudden and unexpected nature of an emergency caesarean section (EmCS) coupled with an increased risk of psychological distress, it is particularly important to understand the psychosocial outcomes for women. The aim of this systematic literature review was to identify, collate and examine the evidence surrounding women’s psychosocial outcomes of EmCS worldwide. Methods The electronic databases of EMBASE, PubMed, Scopus, and PsycINFO were searched between November 2017 and March 2018. To ensure articles were reflective of original and recently published research, the search criteria included peer-reviewed research articles published within the last 20 years (1998 to 2018). All study designs were included if they incorporated an examination of women’s psychosocial outcomes after EmCS. Due to inherent heterogeneity of study data, extraction and synthesis of both qualitative and quantitative data pertaining to key psychosocial outcomes were organised into coherent themes and analysis was attempted. Results In total 17,189 articles were identified. Of these, 208 full text articles were assessed for eligibility. One hundred forty-nine articles were further excluded, resulting in the inclusion of 66 articles in the current systematic literature review. While meta-analyses were not possible due to the nature of the heterogeneity, key psychosocial outcomes identified that were negatively impacted by EmCS included post-traumatic stress, health-related quality of life, experiences, infant-feeding, satisfaction, and self-esteem. Post-traumatic stress was one of the most commonly examined psychosocial outcomes, with a strong consensus that EmCS contributes to both symptoms and diagnosis. Conclusions EmCS was found to negatively impact several psychosocial outcomes for women in particular post-traumatic stress. While investment in technologies and clinical practice to minimise the number of EmCSs is crucial, further investigations are needed to develop effective strategies to prepare and support women who experience this type of birth.
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Affiliation(s)
- Madeleine Benton
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia.
| | - Amy Salter
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Nicole Tape
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Chris Wilkinson
- Maternal Fetal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Deborah Turnbull
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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Triunfo S, Minciotti C, Burlon B, Giovannangeli F, Danza M, Tateo S, Lanzone A. Socio-cultural and clinician determinants in the maternal decision-making process in the choice for trial of labor vs. elective repeated cesarean section: a questionnaire comparison between Italian settings. J Perinat Med 2019; 47:656-664. [PMID: 31211690 DOI: 10.1515/jpm-2019-0041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/11/2019] [Indexed: 11/15/2022]
Abstract
Objective To identify socio-cultural and clinician determinants in the decision-making process in the choice for trial of labor after cesarean (TOLAC) or elective repeat cesarean section (ERCS) in delivering women. Methods A tailored questionnaire focused on epidemiological, socio-cultural and obstetric data was administered to 133 patients; of these, 95 were admitted for assistance at birth at Fondazione Policlinico Universitario "A. Gemelli" (FPG) IRCCS, Rome, and 38 at S. Chiara Hospital (SCH), Trento, Italy. Descriptive analysis and logistic regression modeling were performed. Results Vaginal birth after cesarean (VBAC) rates were higher at SCH than at FPG (68.4% vs. 23.2%; P < 0.05). Maternal age in the TOLAC/VBAC group was significantly higher at SCH than at FPG (37.1 vs. 34.9 years, P < 0.05). High levels of education and no-working condition corresponded to a lower rate of VBAC. Proposal on delivery mode after a previous CS was missed in the majority of cases. Participation in prenatal course was significantly less among women in the ERCS groups. Using logistic regression, the following determinants were found to be statistically significant in the decision-making process: maternal age [odds ratio (OR) = 0.968 (95% confidence interval [CI] 0.941-0.999); P = 0.019], education level [OR = 0.618 (95% CI 0.419-0.995); P = 0.043], information received after the previous CS [OR = 0.401 (95% CI 0.195-1.252); P = 0.029], participation in antenatal courses [OR = 0.534 (95% CI 0.407-1.223); P = 0.045] and self-determination in attempting TOLAC [OR = 0.756 (95% CI 0.522-1.077); P = 0.037]. Conclusion In the attempt to promote person-centered care, increases in TOLAC/VBAC rates could be achieved by focusing on individual maternal needs. An ad hoc strategy for making birth safer should begin from accurate information at the time of the previous CS.
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Affiliation(s)
- Stefania Triunfo
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Barbara Burlon
- Department of Obstetrics and Gynaecology, S. Chiara Hospital, Trento, Italy
| | - Franca Giovannangeli
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michelangela Danza
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Saverio Tateo
- Department of Obstetrics and Gynaecology, S. Chiara Hospital, Trento, Italy
| | - Antonio Lanzone
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Lundgren I, Morano S, Nilsson C, Sinclair M, Begley C. Cultural perspectives on vaginal birth after previous caesarean section in countries with high and low rates - A hermeneutic study. Women Birth 2019; 33:e339-e347. [PMID: 31445846 DOI: 10.1016/j.wombi.2019.07.300] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/27/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Caesarean section (CS) rates are increasing worldwide, an increase that is multifactorial and not well understood. There is considerable variation in the rates of vaginal birth after previous Caesarean section (VBAC). Cultural differences could be one explanation of the varying rates. OBJECTIVE To interpret cultural perspectives on VBAC. METHODS A hermeneutic approach for analysing findings from four published qualitative studies that were part of the OptiBIRTH study, focusing on clinicians and women's views of important factors for improving the rate of VBAC. 115 clinicians and 73 women participated in individual interviews and focus group interviews in countries with low rates (Germany, Italy and Ireland) and countries with high rates (Sweden, Finland and the Netherlands), in the original studies. RESULTS Three themes demonstrated how the culture differs between the high and low VBAC rate countries; from being an obvious first alternative to an issue dependent on many factors; from something included in the ordinary care to something special; and from obstetrician making the final decision to a choice by the woman. The fourth theme, preparing for a new birth by early follow-up and leaving the last birth behind, reflects coherence between the cultures. DISCUSSION The findings deepen our understanding of why the VBAC rates vary across countries and healthcare settings, and can be used for improving the care for women. CONCLUSION In order to improve VBAC rates both maternity care settings and individual professionals need to reflect on their VBAC culture, and make make changes to develop a 'pro-VBAC culture'.
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Affiliation(s)
- Ingela Lundgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30 Gothenburg, Sweden.
| | - Sandra Morano
- Department of Neurology, Ophthalmology, Genetics, Maternal and Infant Sciences, University of Genoa, Largo Daneo, 5 -16132 Genova, Italy
| | - Christina Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Marlene Sinclair
- Ulster University, Shore Road, Newtownabbey BT37 0QB Northern Ireland, United Kingdom
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
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Simeone S, Stile F, Assunta G, Gargiulo G, Rea T. Experience of Vaginal Birth After Cesarean: A Phenomenological Study. J Perinat Educ 2019; 28:131-141. [PMID: 31341372 DOI: 10.1891/1058-1243.28.3.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The international literature concerning cesarean surgeries (CSs) make it clear that many of these procedures are unnecessary. Using a phenomenological methodology, we seek to understand the experiences and decisions of women who have undergone vaginal birth after cesarean (VBAC). Various factors contribute to the choice of VBAC. Making VBAC a more regular practice would contribute to a decrease in the total number of repeat CSs. The purpose of this study is threefold: (a) to understand the process that women use to select a VBAC rather than a repeat cesarean, (b) to understand the mothers' lived experience of that VBAC, and (c) to use the aforementioned data to inform the development of new educational programs for mothers considering VBAC.
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Rietveld AL, van Exel NJA, Cohen de Lara MC, de Groot CJM, Teunissen PW. Giving birth after caesarean: Identifying shared preferences among pregnant women using Q methodology. Women Birth 2019; 33:273-279. [PMID: 31171497 DOI: 10.1016/j.wombi.2019.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Caesarean rates are rising worldwide, the main contributor being the elective repeat caesarean. During the past decades, rates of vaginal birth after caesarean dropped considerably. This requires insight in women's preferences regarding giving birth following a previous caesarean. AIM To gain a better understanding of women's values and preferences regarding the upcoming birth following a previous caesarean. Using Q methodology, this study systematically explores and categorises their preferences. METHODS Q methodology is an innovative research approach to explore and compare a variety of viewpoints on a certain subject. Thirty-one statements on birth after caesarean were developed based on the health belief model. Thirty-six purposively sampled pregnant women with a history of caesarean ranked these statements from least to most important. By-person factor analysis was used to identify patterns which, supplemented with interview data, were interpreted as preferences. FINDINGS Three distinct preferences for giving birth after a caesarean were found; (a) "Minimise the risks for me and my child", giving priority to professional advice and risk of adverse events, (b) "Seek the benefits of normal birth", desiring to give birth as normal as possible for both emotional and practical reasons, (c) "Opt for repeat caesarean", expressing the belief that a planned caesarean brings comfort. CONCLUSIONS Preferences for birth after caesarean vary considerably among pregnant women. The findings help to understand the different types of information valued by women who need to decide on their mode of birth after a first caesarean.
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Affiliation(s)
- Anna L Rietveld
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - N Job A van Exel
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands; Erasmus University Rotterdam, Erasmus School of Economics, Rotterdam, The Netherlands
| | | | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim W Teunissen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Attanasio LB, Kozhimannil KB, Kjerulff KH. Women's preference for vaginal birth after a first delivery by cesarean. Birth 2019; 46:51-60. [PMID: 30051510 PMCID: PMC6348143 DOI: 10.1111/birt.12386] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nearly 90% of United States pregnant women with a prior cesarean give birth by repeat cesarean. Public health goals encourage greater use of vaginal birth after cesarean (VBAC), but there is little prospective data on predictors of women's preference for VBAC. We characterized predictors of women's preferred mode of delivery after a first cesarean and thematically categorized reasons for their preference. METHODS Data were from a cohort of 3006 women whose first childbirth was in Pennsylvania in 2009-2011. The analytic sample included women who had their first birth by cesarean and reported mode of delivery preference for their next delivery at 12 months postpartum (n = 616). Associations with future birth mode preference were assessed using multivariate logistic regression, and reasons for preference were categorized using content analysis. RESULTS At 12 months postpartum, 45% of women who delivered by cesarean in their first birth wanted to have their next delivery vaginally. Independent predictors of VBAC preference were Black race/ethnicity, nonrecurrent indication for the first cesarean, planning three or more additional children, and difficulty recovering from the first cesarean. The most common reason for preferring a vaginal birth was wanting the experience of vaginal birth; the most common reason for preferring cesarean birth was that the first birth was by cesarean. CONCLUSION Nearly half of respondents preferred VBAC in future births, but national estimates indicate that only about 12% of women with prior cesareans have a VBAC. This suggests a need to ensure greater access to VBAC for women who want it.
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Affiliation(s)
- Laura B. Attanasio
- Assistant Professor in the Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA
| | - Katy B. Kozhimannil
- Associate Professor in the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
| | - Kristen H. Kjerulff
- Professor in the Department of Public Health Sciences and Department of Obstetrics and Gynecology, College of Medicine, Penn State University, Hershey, PA
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Denham SH, Humphrey T, deLabrusse C, Dougall N. Mode of birth after caesarean section: individual prediction scores using Scottish population data. BMC Pregnancy Childbirth 2019; 19:84. [PMID: 30819140 PMCID: PMC6396527 DOI: 10.1186/s12884-019-2226-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/19/2019] [Indexed: 11/30/2022] Open
Abstract
Background Rising caesarean section (CS) rates are a global health concern. Contemporary data indicates that almost 50% of CS are electively performed, with a high proportion of these being a repeat procedure. Vaginal birth after caesarean (VBAC) is recognised as a safe way to give birth in developed countries. UK national maternity policy and worldwide professional guidance supports shared decision-making about mode of birth with women following CS. Evidence suggests that women want individualised information, particularly about their likeilihood of successful VBAC, to enable them to participate in the decision making process. This study aimed to identify characteristics that could inform a predictive model which would allow women to receive personalised and clinically specific information about their likelihood of achieving a successful VBAC in subsequent pregnancies. Methods An observational study using anonymised clinical data extracted from a detailed, comprehensive socio-demographic and clinical dataset. All women who attempted a singleton term VBAC between 2000 and 2012 were included. Data were analysed using both logistic regression and Bayesian statistical techniques to identify clinical and demographic variables predictive of successful VBAC. Results Variables significantly associated with VBAC were: ethnicity (p = 0.011), maternal obstetric complications (p < 0.001), previous vaginal birth (p = < 0.001), antepartum haemorrhage (p = 0.005), pre-pregnancy BMI (p < 0.001) and a previous second stage CS (p < 0.001). Conclusions By using current literature, expert clinical opinion and having access to clinically detailed variables, this study has identified a new significant characteristic. Women who had a previous CS in the second stage of labour are more likely to have a successful VBAC. This predictor may have international significance for women and clinicians in shared VBAC decision-making. Further research is planned to validate this model on a larger national sample leading to further development of the nomogram tool developed in this study for use in clinical practice to assist women and clinicians in the decision-making process about mode of birth after CS.
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Affiliation(s)
- Sara Helen Denham
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN, UK.
| | - Tracy Humphrey
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN, UK
| | - Claire deLabrusse
- School of Health Sciences (HESAV) Midwifery Department, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN, UK
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31
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Miller YD, Holdaway W. How communication about risk and role affects women's decisions about birth after caesarean. PATIENT EDUCATION AND COUNSELING 2019; 102:68-76. [PMID: 30213641 DOI: 10.1016/j.pec.2017.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/05/2017] [Accepted: 09/26/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This study investigated how health care provider communication of risk information, and women's role in decision-making, influenced women's preferences for mode of birth after a previous caesarean birth. METHODS Women (N = 669) were randomised to one of eight conditions in a 2 (selectivity of risk information) × 2 (format of risk information) × 2 (role in decision making) experimental design. After exposure to a hypothetical decision scenario that varied information communicated by an obstetrician to a pregnant woman with a previous caesarean birth across the three factors, women were asked to decide their preferred hypothetical childbirth preference. RESULTS Women provided with selective information (incomplete/biased toward repeat caesarean) and relative risk formats (ratio of incidence being compared e.g. 2.5 times higher), perceived lower risk for caesarean and were significantly more likely to prefer repeat caesarean birth than those provided with non-selective information (complete/unbiased) and absolute risk formats (incidence rate e.g. 0.01 per 100). Role in decision-making did not significantly influence childbirth preferences CONCLUSIONS: Modifiable aspects of healthcare provider communication may influence women's decision-making about childbirth preferences PRACTICE IMPLICATIONS: Optimised communication about risks of all options may have an impact on over-use of repeat CS.
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Affiliation(s)
- Yvette D Miller
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, 4059, Queensland, Australia.
| | - Wendy Holdaway
- School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia.
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Shorten A, Shorten B, Fagerlin A, Illuzzi J, Kennedy HP, Pettker C, Raju D, Whittemore R. A Study to Assess the Feasibility of Implementing a Web-Based Decision Aid for Birth after Cesarean to Increase Opportunities for Shared Decision Making in Ethnically Diverse Settings. J Midwifery Womens Health 2018; 64:78-87. [PMID: 30334330 DOI: 10.1111/jmwh.12908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/22/2018] [Accepted: 06/28/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Decision aids are central to shared decision making and are recommended for value-sensitive pregnancy decisions, such as birth after cesarean. However, effective strategies for widespread decision aid implementation, with interactive web-based platforms, are lacking. This study tested the feasibility and acceptability of implementing a Health Insurance Portability and Accountability Act-secure, web-based decision aid to support shared decision making about birth choices after cesarean, within urban, ethnically diverse outpatient settings. METHODS A before-and-after design was used to assess feasibility and acceptability for decision aid implementation. Measures included women's knowledge, decisional conflict, birth preferences, birth outcomes, decision aid use, decision aid acceptability ratings (content, features, and functions), and views on how the decision aid supported shared decision making. RESULTS Of the 68 women who participated, most were black (46.2%) or Hispanic (35.4%). Their knowledge scores increased by 2.58 points out of 15 (P < .001; d = 0.87), and decisional conflict score reduced by 0.45 points out of 5 points (P < .001; d = 0.69). Forty-four women (65.9%) attempted a vaginal birth after cesarean, of whom 29 (65.7%) succeeded. Women rated decision aid content, features, and functions as good or excellent. Most indicated they would recommend it to others. Health care providers recommended additional strategies to simplify decision aid access and integration into routine care. DISCUSSION Implementing web-based decision aids within ethnically diverse practice settings is potentially feasible and worthwhile. However, strategies are needed to improve women's access and to encourage timely decision aid usage to prepare them for decision discussions with health care providers. Sustained implementation will require seamless integration into clinic workflow, which could include health care provider tools (counselling guides) embedded within the electronic health record, along with continuing education to support and engage health care providers in their use.
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Lindblad Wollmann C, Ahlberg M, Saltvedt S, Johansson K, Elvander C, Stephansson O. Risk of repeat cesarean delivery in women undergoing trial of labor: A population-based cohort study. Acta Obstet Gynecol Scand 2018; 97:1524-1529. [DOI: 10.1111/aogs.13447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/29/2018] [Accepted: 08/17/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Charlotte Lindblad Wollmann
- Clinical Epidemiology Division, Department of Medicine; Karolinska University Hospital and Institutet; Stockholm Sweden
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health; Karolinska University Hospital and Institutet; Stockholm Sweden
| | - Mia Ahlberg
- Clinical Epidemiology Division, Department of Medicine; Karolinska University Hospital and Institutet; Stockholm Sweden
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health; Karolinska University Hospital and Institutet; Stockholm Sweden
| | - Sissel Saltvedt
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health; Karolinska University Hospital and Institutet; Stockholm Sweden
| | - Kari Johansson
- Clinical Epidemiology Division, Department of Medicine; Karolinska University Hospital and Institutet; Stockholm Sweden
| | - Charlotte Elvander
- Clinical Epidemiology Division, Department of Medicine; Karolinska University Hospital and Institutet; Stockholm Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine; Karolinska University Hospital and Institutet; Stockholm Sweden
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health; Karolinska University Hospital and Institutet; Stockholm Sweden
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O'Donovan C, O'Donovan J. Why do women request an elective cesarean delivery for non-medical reasons? A systematic review of the qualitative literature. Birth 2018; 45:109-119. [PMID: 29105822 DOI: 10.1111/birt.12319] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cesarean rates have increased significantly over the past decade. The reasons for this are both complex and context specific, and have significant consequences for health resources. The aim of this systematic review was to assess published, peer-reviewed, and gray qualitative literature on the reasons behind cesarean delivery on maternal request (CDMR). METHODS A systematic search of MEDLINE, EMBASE, CINAHL, LILACS, and PsycINFO databases was performed for all relevant articles published between January 2006 and June 2016. Reference lists of all included studies were also searched in addition to select web-based sources. Studies were included if they qualitatively evaluated women's preferences for CDMR, with no geographic restriction. Findings from the studies were narratively and thematically synthesized. RESULTS Sixteen studies were included in this review. Three themes were identified as to why women choose CDMR, which were: social norms, emotional experiences, and personal experiences. A woman's decision was often shaped by various influences including family, friends, and the media. In addition, previous experience of childbirth and interactions with health care professionals contributed to a strong preference for CDMR. CDMR provided women with a sense of control over the birth and diminished feelings of fear. CONCLUSIONS The reasons behind CDMR are multifactorial and complex. Situation-specific cultural factors, fear of pain during childbirth, previous experience, and interactions with health care professionals are likely to have led to the increase in CDMR. Multifaceted, context-specific approaches are required if there is to be a reduction in CDMR rates.
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Affiliation(s)
- Charles O'Donovan
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK
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Refusal of recommended maternity care: Time to make a pact with women? Women Birth 2018; 31:433-441. [PMID: 29605143 DOI: 10.1016/j.wombi.2018.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/28/2018] [Accepted: 03/20/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The right to refuse medical treatment can be contentious in maternity care. Professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy, but there is little guidance available to clinicians about the appropriate clinical responses when women decline recommended care. OBJECTIVES We propose a comprehensive, woman-centred, systems-level framework for documentation and communication with the goal of supporting women, clinicians and health services in situations of maternal refusal. We term this the Personalised Alternative Care and Treatment framework. DISCUSSION The Personalised Alternative Care and Treatment framework addresses Australian policy, practice, education and professional issues to underpin woman-centred care in the context of maternal refusal. It embeds Respectful Maternity Care in system-level maternity care policy; highlights the woman's role as decision maker about her maternity care; documents information exchanged with women; creates a 'living' plan that respects the woman's birth intentions and can be reviewed as circumstances change; enables communication between clinicians; permits flexible initiation pathways; provides for professional education for clinicians, and incorporates a mediation role to act as a failsafe. CONCLUSION The Personalised Alternative Care and Treatment framework has the potential to meet the needs of women, clinicians and health services when pregnant women decline recommended maternity care.
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Torigoe I, Shorten A. Using a pregnancy decision support program for women choosing birth after a previous caesarean in Japan: A mixed methods study. Women Birth 2018; 31:e9-e19. [DOI: 10.1016/j.wombi.2017.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 04/11/2017] [Accepted: 06/02/2017] [Indexed: 11/17/2022]
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Soliday E, Grant G, James J, Noell B, Samaduroff J. University women's and men's mindsets surrounding postcesarean birth: Findings and implications for practice and policy. Birth 2017; 44:377-383. [PMID: 28681441 DOI: 10.1111/birt.12297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/12/2017] [Accepted: 05/12/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nearly twice as many women report preferring vaginal birth after cesarean (VBAC) than actually undergo it. It is unknown whether the preference pattern would hold in childbearing-aged individuals who had not yet been directly influenced by care experiences. We therefore examined postcesarean birth preferences in nulliparous university women and men to provide additional evidence to help advance related policy and practice. METHODS An online study of 558 university women and 164 men who read a hypothetical postcesarean birth scenario was conducted. Students selected the option they would prefer for themselves or a partner in a similar situation; these data were analyzed descriptively and for gender differences. Students' written rationales were analyzed qualitatively. RESULTS Of women, 38.2% reported preference for VBAC compared with 47.6% of men (P < .05). Thematic analysis revealed that women and men based their preferences on safety, quality of experience, and other concerns similar to those reported among pregnant women making the decision. Assumptions and misinformation were also noted. CONCLUSION Given the current primary cesarean rate of ~20%, the current childbearing generation will be facing cesarean and postcesarean birth decisions in appreciable numbers. The relatively high VBAC preference rate reported by our participants, particularly men, is useful in advocating for expanded access and practice. From a constructivist perspective, evidence of young adults' mindsets and misconceptions surrounding postcesarean birth is valuable for developing effective educational interventions.
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Affiliation(s)
- Elizabeth Soliday
- Department of Human Development, Washington State University Vancouver, Vancouver, WA, USA
| | - Gillian Grant
- Department of Psychology, Washington State University Vancouver, Vancouver, WA, USA
| | - Jillian James
- Department of Psychology, Washington State University Vancouver, Vancouver, WA, USA
| | - Bailey Noell
- Department of Human Development, Washington State University Vancouver, Vancouver, WA, USA
| | - Joel Samaduroff
- Department of Anthropology, Washington State University Vancouver, Vancouver, WA, USA
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Bonzon M, Gross MM, Karch A, Grylka-Baeschlin S. Deciding on the mode of birth after a previous caesarean section – An online survey investigating women's preferences in Western Switzerland. Midwifery 2017; 50:219-227. [DOI: 10.1016/j.midw.2017.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/15/2017] [Accepted: 04/17/2017] [Indexed: 12/17/2022]
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Lazo-Porras M, Bayer AM, Acuña-Villaorduña A, Zeballos-Palacios C, Cardenas-Montero D, Reyes-Diaz M, Naranjo-Caceres M, Malaga G. Perspectives, Decision Making, and Final Mode of Delivery in Pregnant Women With a Previous C-Section in a General Hospital in Peru: Prospective Analysis. MDM Policy Pract 2017; 2:2381468317724409. [PMID: 30288428 PMCID: PMC6125051 DOI: 10.1177/2381468317724409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/29/2017] [Indexed: 11/26/2022] Open
Abstract
Objective: Explore the perspectives, decision-making process, and final mode of delivery among pregnant women with a previous C-section (Cesarean section) in a general public sector hospital in Lima, Peru. Methods: A qualitative prospective study using semistructured interviews at two time points in the outpatient obstetrics and gynecology clinic of a public sector, university-affiliated reference hospital in Lima, Peru. Seventeen adult pregnant women with a prior C-section who were deemed by their attending obstetrician to be candidates for a trial of labor were interviewed. The first interview was between 37 and 38 weeks of pregnancy, and the second interview was 24 to 48 hours after delivery. MAIN OUTCOME MEASURES Predelivery decision-making process and final mode of delivery. Results: Among the 17 participants, about half (9) of the participants stated that the physician explained that they had two approaches for delivery, a trial of labor after C-section (TOLAC) or elective repeated C-section (ERCD). Two women stated that their respective providers explained only one option, either an ERCD or TOLAC. However, 6 women did not receive any information from their providers about their delivery options. Of the 10 participants that decided TOLAC, 8 ended up having a C-section, and of the 7 patients that had planned an ERCD, 1 ended up having a vaginal delivery. Conclusion: Many participants affirmed that they made the decision about their approach of delivery. However, most of the participants that decided a TOLAC ended up having a C-section because of complications during the final weeks of pregnancy or during labor.
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Affiliation(s)
- Maria Lazo-Porras
- Maria Lazo-Porras, MD, CONEVID Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima, Peru; e-mail:
| | - Angela M. Bayer
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Ana Acuña-Villaorduña
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Claudia Zeballos-Palacios
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Deborah Cardenas-Montero
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Michael Reyes-Diaz
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Monica Naranjo-Caceres
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - German Malaga
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
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Affiliation(s)
| | - Joanna Smith
- Children's Nursing, School of Healthcare, University of Leeds, UK
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Arnau-Sánchez J, Martínez-Ros MT, Castaño-Molina MÁ, Nicolás-Vigueras MD, Martínez-Roche ME. Explorando las emociones de la mujer en la atención perinatal. Un estudio cualitativo. AQUICHAN 2016. [DOI: 10.5294/aqui.2016.16.3.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: explorar las emociones que emergen en la mujer durante el embarazo, parto y el puerperio a lo largo del itinerario asistencial de atención primaria y hospitalaria. Método: estudio cualitativo basado en la Teoría Fundamentada. Se realizaron dos grupos de discusión a profesionales: obstetras, matronas y enfermeras. Igualmente, se desarrollaron entrevistas en profundidad a mujeres en el puerperio. Resultados: las emociones de la mujer en la atención perinatal aparece como categoría central. A partir de ésta, las emociones negativas emergen por la interacción de cinco metacategorías: a) Miedo: dolor al parto y desajuste de expectativas, b) Ansiedad e incertidumbre: enfrentándose a la amenaza del riesgo y la desinformación, c) Vergüenza: comprometiendo la privacidad, d) Ira y Desamparo: asimetría en la estructura relacional, e) Soledad: discontinuidad en la atención asistencial. Las emociones positivas surge de la metacategoría: f) Tranquilidad y confianza: construyendo una interacción clínica simétrica y humanizada. Conclusiones: se constata una variabilidad emocional debido a la coexistencia de los modelos tecnocrático y biopsicosocial. Este proyecta humanidad en los cuidados perinatales, frente a un modelo biomédico marcado por una estructura relacional paternalista y asistencia fragmentada; ambos serán determinantes en la emergencia de emociones en la atención perinatal.
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Chinkam S, Ewan J, Koeniger-Donohue R, Hawkins JW, Shorten A. The Effect of Evidence-Based Scripted Midwifery Counseling on Women's Choices About Mode of Birth After a Previous Cesarean. J Midwifery Womens Health 2016; 61:613-620. [DOI: 10.1111/jmwh.12466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Torigoe I, Shorten B, Yoshida S, Shorten A. Trends in birth choices after caesarean section in Japan: A national survey examining information and access to vaginal birth after caesarean. Midwifery 2016; 37:49-56. [DOI: 10.1016/j.midw.2016.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 03/27/2016] [Accepted: 04/03/2016] [Indexed: 10/22/2022]
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Rowe R, Li Y, Knight M, Brocklehurst P, Hollowell J. Maternal and perinatal outcomes in women planning vaginal birth after caesarean (VBAC) at home in England: secondary analysis of the Birthplace national prospective cohort study. BJOG 2016; 123:1123-32. [PMID: 26213223 PMCID: PMC5014182 DOI: 10.1111/1471-0528.13546] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare vaginal birth rates in women planning vaginal birth after caesarean (VBAC) at home versus in an obstetric unit (OU) and explore transfer rates in women planning home VBAC. DESIGN Prospective cohort study. SETTING OUs and planned home births in England. POPULATION 1436 women planning VBAC in the Birthplace cohort, including 209 planning home VBAC. METHODS We used Poisson regression to calculate relative risks adjusted for maternal characteristics. MAIN OUTCOME MEASURES MAIN OUTCOMES (i) vaginal birth and (ii) transfer from planned home birth to OU during labour or immediately after birth. SECONDARY OUTCOMES (i) composite of maternal blood transfusion or admission to higher level care, (ii) stillbirth or Apgar score <7 at 5 minutes, (iii) neonatal unit admission. RESULTS Planned VBAC at home was associated with a statistically significant increase in the chances of having a vaginal birth compared with planned VBAC in an OU (adjusted relative risk 1.15, 95% confidence interval 1.06-1.24). The risk of an adverse maternal outcome was around 2-3% in both settings, with a similar risk of an adverse neonatal outcome. Transfer rates were high (37%) and varied markedly by parity (para 1, 56.7% versus para 2+, 24.6%). CONCLUSION Women in the cohort who planned VBAC at home had an increased chance of a vaginal birth compared with those planning VBAC in an OU, but transfer rates were high, particularly for women with only one previous birth, and the risk of an adverse maternal or perinatal outcome was around 2-3%. No change in guidance can be recommended. TWEETABLE ABSTRACT Higher vaginal birth rates in planned VBAC at home versus in OU but 2-3% adverse outcomes and high transfer rate.
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Affiliation(s)
- R Rowe
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Y Li
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - M Knight
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - P Brocklehurst
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
- Institute for Women's HealthUniversity College LondonLondonUK
| | - J Hollowell
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
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Bayrampour H, Ali E, McNeil DA, Benzies K, MacQueen G, Tough S. Pregnancy-related anxiety: A concept analysis. Int J Nurs Stud 2016; 55:115-30. [DOI: 10.1016/j.ijnurstu.2015.10.023] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/11/2015] [Accepted: 10/22/2015] [Indexed: 12/20/2022]
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Black M, Entwistle VA, Bhattacharya S, Gillies K. Vaginal birth after caesarean section: why is uptake so low? Insights from a meta-ethnographic synthesis of women's accounts of their birth choices. BMJ Open 2016; 6:e008881. [PMID: 26747030 PMCID: PMC4716170 DOI: 10.1136/bmjopen-2015-008881] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 10/01/2015] [Accepted: 10/12/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify what women report influences their preferred mode of birth after caesarean section. DESIGN Systematic review of qualitative literature using meta-ethnography. DATA SOURCES Medline, EMBASE, ASSIA, CINAHL and PsycINFO (1996 until April 2013; updated September 2015). Hand-searched journals, reference lists and abstract authors. STUDY SELECTION Primary qualitative studies reporting women's accounts of what influenced their preferred mode of birth after caesarean section. DATA EXTRACTION AND SYNTHESIS Primary data (quotations from study participants) and authors' interpretations of these were extracted, compared and contrasted between studies, and grouped into themes to support the development of a 'line of argument' synthesis. RESULTS 20 papers reporting the views of 507 women from four countries were included. Distinctive clusters of influences were identified for each of three groups of women. Women who confidently sought vaginal birth after a caesarean section were typically driven by a long-standing anticipation of vaginal birth. Women who sought a repeat caesarean section were strongly influenced by distressing previous birth experiences, and at times, by encouragement from social contacts. Women who were more open to information and professional guidance had fewer strong preconceptions and concerns, and viewed a range of considerations as potentially important. CONCLUSIONS Women's attitudes towards birth after caesarean section appear to be shaped by distinct clusters of influences, suggesting that opportunities exist for clinicians to stratify and personalise decision support by addressing relevant ideas, concerns and experiences from the first caesarean section birth onwards.
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Affiliation(s)
- Mairead Black
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen Maternity Hospital, Aberdeen, UK
| | - Vikki A Entwistle
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Katie Gillies
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Shorten A, Fagerlin A, Illuzzi J, Kennedy HP, Lakehomer H, Pettker CM, Saran A, Witteman H, Whittemore R. Developing an Internet-Based Decision Aid for Women Choosing Between Vaginal Birth After Cesarean and Planned Repeat Cesarean. J Midwifery Womens Health 2015; 60:390-400. [DOI: 10.1111/jmwh.12298] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shorten A, Shorten B. Timing the provision of a pregnancy decision-aid: temporal patterns of preference for mode of birth during pregnancy. PATIENT EDUCATION AND COUNSELING 2014; 97:108-113. [PMID: 25082724 DOI: 10.1016/j.pec.2014.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 06/12/2014] [Accepted: 07/06/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To help identify the optimal timing for provision of pregnancy decision-aids, this paper examines temporal patterns in women's preference for mode of birth after previous cesarean, prior to a decision-aid intervention. METHODS Pregnant women (n=212) with one prior cesarean responded to surveys regarding their preference for elective repeat cesarean delivery (ERCD) or trial of labor (TOL) at 12-18 weeks and again at 28 weeks gestation. Patterns of adherence or change in preference were examined. RESULTS Women's preferences for birth were not set in early pregnancy. There was evidence of increasing uncertainty about preferred mode of birth during the first two trimesters of pregnancy (McNemar value=4.41, p=0.04), decrease in preference for TOL (McNemar value=3.79, p=0.05) and stability in preference for ERCD (McNemar value=0.31, p=0.58). Adherence to early pregnancy choice was associated with previous birth experience, maternal country of birth, emotional state and hospital site. CONCLUSION Women's growing uncertainty about mode of birth prior to 28 weeks indicates potential readiness for a decision-aid earlier in pregnancy. PRACTICE IMPLICATIONS Pregnancy decision-aids affecting mode of birth could be provided early in pregnancy to increase women's opportunity to improve knowledge, clarify personal values and reduce decision uncertainty.
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