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Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S, Jones LV, Shennan AH, Rayment-Jones H. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database Syst Rev 2024; 4:CD004667. [PMID: 38597126 PMCID: PMC11005019 DOI: 10.1002/14651858.cd004667.pub6] [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] [Indexed: 04/11/2024]
Abstract
BACKGROUND Midwives are primary providers of care for childbearing women globally and there is a need to establish whether there are differences in effectiveness between midwife continuity of care models and other models of care. This is an update of a review published in 2016. OBJECTIVES To compare the effects of midwife continuity of care models with other models of care for childbearing women and their infants. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) (17 August 2022), as well as the reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished trials in which pregnant women are randomly allocated to midwife continuity of care models or other models of care during pregnancy and birth. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies for inclusion criteria, scientific integrity, and risk of bias, and carried out data extraction and entry. Primary outcomes were spontaneous vaginal birth, caesarean section, regional anaesthesia, intact perineum, fetal loss after 24 weeks gestation, preterm birth, and neonatal death. We used GRADE to rate the certainty of evidence. MAIN RESULTS We included 17 studies involving 18,533 randomised women. We assessed all studies as being at low risk of scientific integrity/trustworthiness concerns. Studies were conducted in Australia, Canada, China, Ireland, and the United Kingdom. The majority of the included studies did not include women at high risk of complications. There are three ongoing studies targeting disadvantaged women. Primary outcomes Based on control group risks observed in the studies, midwife continuity of care models, as compared to other models of care, likely increase spontaneous vaginal birth from 66% to 70% (risk ratio (RR) 1.05, 95% confidence interval (CI) 1.03 to 1.07; 15 studies, 17,864 participants; moderate-certainty evidence), likelyreduce caesarean sections from 16% to 15% (RR 0.91, 95% CI 0.84 to 0.99; 16 studies, 18,037 participants; moderate-certainty evidence), and likely result in little to no difference in intact perineum (29% in other care models and 31% in midwife continuity of care models, average RR 1.05, 95% CI 0.98 to 1.12; 12 studies, 14,268 participants; moderate-certainty evidence). There may belittle or no difference in preterm birth (< 37 weeks) (6% under both care models, average RR 0.95, 95% CI 0.78 to 1.16; 10 studies, 13,850 participants; low-certainty evidence). We arevery uncertain about the effect of midwife continuity of care models on regional analgesia (average RR 0.85, 95% CI 0.79 to 0.92; 15 studies, 17,754 participants, very low-certainty evidence), fetal loss at or after 24 weeks gestation (average RR 1.24, 95% CI 0.73 to 2.13; 12 studies, 16,122 participants; very low-certainty evidence), and neonatal death (average RR 0.85, 95% CI 0.43 to 1.71; 10 studies, 14,718 participants; very low-certainty evidence). Secondary outcomes When compared to other models of care, midwife continuity of care models likely reduce instrumental vaginal birth (forceps/vacuum) from 14% to 13% (average RR 0.89, 95% CI 0.83 to 0.96; 14 studies, 17,769 participants; moderate-certainty evidence), and may reduceepisiotomy 23% to 19% (average RR 0.83, 95% CI 0.77 to 0.91; 15 studies, 17,839 participants; low-certainty evidence). When compared to other models of care, midwife continuity of care models likelyresult in little to no difference inpostpartum haemorrhage (average RR 0.92, 95% CI 0.82 to 1.03; 11 studies, 14,407 participants; moderate-certainty evidence) and admission to special care nursery/neonatal intensive care unit (average RR 0.89, 95% CI 0.77 to 1.03; 13 studies, 16,260 participants; moderate-certainty evidence). There may be little or no difference in induction of labour (average RR 0.92, 95% CI 0.85 to 1.00; 14 studies, 17,666 participants; low-certainty evidence), breastfeeding initiation (average RR 1.06, 95% CI 1.00 to 1.12; 8 studies, 8575 participants; low-certainty evidence), and birth weight less than 2500 g (average RR 0.92, 95% CI 0.79 to 1.08; 9 studies, 12,420 participants; low-certainty evidence). We are very uncertain about the effect of midwife continuity of care models compared to other models of care onthird or fourth-degree tear (average RR 1.10, 95% CI 0.81 to 1.49; 7 studies, 9437 participants; very low-certainty evidence), maternal readmission within 28 days (average RR 1.52, 95% CI 0.78 to 2.96; 1 study, 1195 participants; very low-certainty evidence), attendance at birth by a known midwife (average RR 9.13, 95% CI 5.87 to 14.21; 11 studies, 9273 participants; very low-certainty evidence), Apgar score less than or equal to seven at five minutes (average RR 0.95, 95% CI 0.72 to 1.24; 13 studies, 12,806 participants; very low-certainty evidence) andfetal loss before 24 weeks gestation (average RR 0.82, 95% CI 0.67 to 1.01; 12 studies, 15,913 participants; very low-certainty evidence). No maternal deaths were reported across three studies. Although the observed risk of adverse events was similar between midwifery continuity of care models and other models, our confidence in the findings was limited. Our confidence in the findings was lowered by possible risks of bias, inconsistency, and imprecision of some estimates. There were no available data for the outcomes: maternal health status, neonatal readmission within 28 days, infant health status, and birth weight of 4000 g or more. Maternal experiences and cost implications are described narratively. Women receiving care from midwife continuity of care models, as opposed to other care models, generally reported more positive experiences during pregnancy, labour, and postpartum. Cost savings were noted in the antenatal and intrapartum periods in midwife continuity of care models. AUTHORS' CONCLUSIONS Women receiving midwife continuity of care models were less likely to experience a caesarean section and instrumental birth, and may be less likely to experience episiotomy. They were more likely to experience spontaneous vaginal birth and report a positive experience. The certainty of some findings varies due to possible risks of bias, inconsistencies, and imprecision of some estimates. Future research should focus on the impact on women with social risk factors, and those at higher risk of complications, and implementation and scaling up of midwife continuity of care models, with emphasis on low- and middle-income countries.
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Affiliation(s)
- Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Cristina Fernandez Turienzo
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Declan Devane
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
| | - Hora Soltani
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Paddy Gillespie
- Health Economics and Policy Analysis Centre, School of Business and Economics, Institute for Lifecourse and Society, University of Galway, Galway, Ireland
| | - Simon Gates
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Leanne V Jones
- Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Hannah Rayment-Jones
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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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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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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Homer CSE, Davis DL, Mollart L, Turkmani S, Smith RM, Bullard M, Leiser B, Foureur M. Midwifery continuity of care and vaginal birth after caesarean section: A randomised controlled trial. Women Birth 2021; 35:e294-e301. [PMID: 34103270 DOI: 10.1016/j.wombi.2021.05.010] [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: 09/02/2019] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
PROBLEM AND BACKGROUND Caesarean section (CS) rates in Australia and many countries worldwide are high and increasing, with elective repeat caesarean section a significant contributor. AIM To determine whether midwifery continuity of care for women with a previous CS increases the proportion of women who plan to attempt a vaginal birth in their current pregnancy. METHODS A randomised controlled design was undertaken. Women who met the inclusion criteria were randomised to one of two groups; the Community Midwifery Program (CMP) (continuity across the full spectrum - antenatal, intrapartum and postpartum) (n=110) and the Midwifery Antenatal Care (MAC) Program (antenatal continuity of care) (n=111) using a remote randomisation service. Analysis was undertaken on an intention to treat basis. The primary outcome measure was the rate of attempted vaginal birth after caesarean section and secondary outcomes included composite measures of maternal and neonatal wellbeing. FINDINGS The model of care did not significantly impact planned vaginal birth at 36 weeks (CMP 66.7% vs MAC 57.3%) or success rate (CMP 27.8% vs MAC 32.7%). The rate of maternal and neonatal complications was similar between the groups. CONCLUSION Model of care did not significantly impact the proportion of women attempting VBAC in this study. The similarity in the number of midwives seen antenatally and during labour and birth suggests that these models of care had more similarities than differences and that the model of continuity could be described as informational continuity. Future research should focus on the impact of relationship based continuity of care.
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Affiliation(s)
- Caroline S E Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Australia; Maternal, Child and Adolescent Health, Burnet Institute, Melbourne, Australia.
| | | | - Lyndall Mollart
- School of Nursing & Midwifery, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Sabera Turkmani
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Rachel M Smith
- 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; School of Nursing & Midwifery, Faculty of Health and Medicine, University of Newcastle and Hunter New England Local Health District, Newcastle, Australia
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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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Zhang T, Liu C. Comparison between continuing midwifery care and standard maternity care in vaginal birth after cesarean. Pak J Med Sci 2016; 32:711-4. [PMID: 27375719 PMCID: PMC4928428 DOI: 10.12669/pjms.323.9546] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether continuing midwifery care has more benefits than standard maternity care in vaginal birth after cesarean (VBAC). METHODS This study was conducted on women in labour who had history of previous cesarean section and received vaginal birth in obstetrical department of our hospital from May 2013 to November 2014. The included patients were divided randomly into observation group and control group. The women in labour allocated to the observation group received continuing midwifery care, and those to control group received standard maternity care in all the stages of labour. The duration of labor stage together with the rate of fetal distress, neonatal asphyxia, vaginal birth and postpartum bleeding were compared between the two groups. RESULTS Ninety-six participants were included in the current study, forty-eight in each group. The length of labor was significantly longer (p<0.05), the vaginal birth rate was significantly lower (p<0.05) and the postpartum hemorrhage rate was significantly higher (p<0.05) in the control group than the observation group. In addition, the rate of fetal distress and neonatal asphyxia were higher in the control group, but there was no significant difference between the two groups (p>0.05). CONCLUSION The continuing midwifery care has more benefits than the standard maternity care in vaginal birth after cesarean (VBAC).
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Affiliation(s)
- Tieying Zhang
- Tieying Zhang, Chief Nurse, Obstetrical Department, Tianjin 4th Centre Hospital, Tianjin, 300140, China
| | - Chunna Liu
- Chunna Liu, Chief Nurse, Obstetrical Department, Tianjin 4th Centre Hospital, Tianjin, 300140, China
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Foureur M, Turkmani S, Clack DC, Davis DL, Mollart L, Leiser B, Homer CSE. Caring for women wanting a vaginal birth after previous caesarean section: A qualitative study of the experiences of midwives and obstetricians. Women Birth 2016; 30:3-8. [PMID: 27318563 DOI: 10.1016/j.wombi.2016.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
PROBLEM One of the greatest contributors to the overall caesarean section rate is elective repeat caesarean section. BACKGROUND Decisions around mode of birth are often complex for women and influenced by the views of the doctors and midwives who care for and counsel women. Women may be more likely to choose a repeat elective caesarean section (CS) if their health care providers lack skills and confidence in supporting vaginal birth after caesarean section (VBAC). AIM To explore the views and experiences of providers in caring for women considering VBAC, in particular the decision-making processes and the communication of risk and safety to women. METHODS A descriptive interpretive method was utilised. Four focus groups with doctors and midwives were conducted. FINDINGS The central themes were: 'developing trust', 'navigating the system' and 'optimising support'. The impact of past professional experiences; the critical importance of continuity of carer and positive relationships; the ability to weigh up risks versus benefits; and the language used were all important elements. The role of policy and guidelines on providing standardised care for women who had a previous CS was also highlighted. CONCLUSION Midwives and doctors in this study were positively oriented towards assisting and supporting women to attempt a VBAC. Care providers considered that women who have experienced a prior CS need access to midwifery continuity of care with a focus on support, information-sharing and effective communication.
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Affiliation(s)
- Maralyn Foureur
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Sabera Turkmani
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Danielle C Clack
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Deborah L Davis
- University of Canberra, Australian Capital Territory (ACT), Australia; The ACT Government, Health Directorate, Australia
| | - Lyndall Mollart
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Bernadette Leiser
- Central Coast Local Health District, Holden Street, Gosford, New South Wales, Australia
| | - Caroline S E Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia.
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Lundgren I, van Limbeek E, Vehvilainen-Julkunen K, Nilsson C. Clinicians' views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a qualitative study from countries with high VBAC rates. BMC Pregnancy Childbirth 2015; 15:196. [PMID: 26314295 PMCID: PMC4552403 DOI: 10.1186/s12884-015-0629-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 08/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The most common reason for caesarean section (CS) is repeat CS following previous CS. Vaginal birth after caesarean section (VBAC) rates vary widely in different healthcare settings and countries. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Interview studies with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of 'OptiBIRTH', an ongoing research project. The study reported here is based on interviews in high VBAC countries. The aim of the study was to investigate the views of clinicians working in countries with high VBAC rates on factors of importance for improving VBAC rates. METHODS Individual (face-to-face or telephone) interviews and focus group interviews with clinicians (in different maternity care settings) in three countries with high VBAC rates were conducted during 2012-2013. In total, 44 clinicians participated: 26 midwives and 18 obstetricians. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country. RESULTS The findings are presented in four main categories with subcategories. First, a common approach is needed, including: feeling confident with VBAC, considering VBAC as the first alternative, communicating well, working in a team, working in accordance with a model and making agreements with the woman. Second, obstetricians need to make the final decision on the mode of delivery while involving women in counselling towards VBAC. Third, a woman who has a previous CS has a similar need for support as other labouring women, but with some extra precautions and additional recommendations for her care. Finally, clinicians should help strengthen women's trust in VBAC, including building their trust in giving birth vaginally, recognising that giving birth naturally is an empowering experience for women, alleviating fear and offering extra visits to discuss the previous CS, and joining with the woman in a dialogue while leaving the decision about the mode of birth open. CONCLUSIONS This study shows that, according to midwives and obstetricians from countries with high VBAC rates, the important factors for improving the VBAC rate are related to the structure of the maternity care system in the country, to the cooperation between midwives and obstetricians, and to the care offered during pregnancy and birth. More research on clinicians' perspectives is needed from countries with low, as well as high, VBAC rates.
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Affiliation(s)
- Ingela Lundgren
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.
| | - Evelien van Limbeek
- Department of Midwifery Science, Zuyd University, PO Box 1256, 6201 BG, Maastricht, The Netherlands.
| | - Katri Vehvilainen-Julkunen
- University of Eastern Finland, Faculty of Health Sciences, Kuopio University Hospital, PO Box 1627, 70211, Kuopio, Finland.
| | - Christina Nilsson
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.
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Tolmacheva L. Vaginal birth after caesarean or elective caesarean—What factors influence women's decisions? ACTA ACUST UNITED AC 2015. [DOI: 10.12968/bjom.2015.23.7.470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nilsson C, Lundgren I, Smith V, Vehvilainen-Julkunen K, Nicoletti J, Devane D, Bernloehr A, van Limbeek E, Lalor J, Begley C. Women-centred interventions to increase vaginal birth after caesarean section (VBAC): A systematic review. Midwifery 2015; 31:657-63. [PMID: 25931275 DOI: 10.1016/j.midw.2015.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/23/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE to evaluate the effectiveness of women-centred interventions during pregnancy and birth to increase rates of vaginal birth after caesarean. DESIGN we searched bibliographic databases for randomised trials or cluster randomised trials on women-centred interventions during pregnancy and birth designed to increase VBAC rates in women with at least one previous caesarean section. Comparator groups included standard or usual care or an alternative treatment aimed at increasing VBAC rates. The methodological quality of included studies was assessed independently by two authors using the Effective Public Health Practice Project quality assessment tool. Outcome data were extracted independently from each included study by two review authors. FINDINGS in total, 821 citations were identified and screened by title and abstract; 806 were excluded and full text of 15 assessed. Of these, 12 were excluded leaving three papers included in the review. Two studies evaluated the effectiveness of decision aids for mode of birth and one evaluated the effectiveness of an antenatal education programme. The findings demonstrate that neither the use of decision aids nor information/education of women have a significant effect on VBAC rates. Nevertheless, decision-aids significantly decrease women's decisional conflict about mode of birth, and information programmes significantly increase their knowledge about the risks and benefits of possible modes of birth. KEY CONCLUSIONS few studies evaluated women-centred interventions designed to improve VBAC rates, and all interventions were applied in pregnancy only, none during the birth. There is an urgent need to develop and evaluate the effectiveness of all types of women-centred interventions during pregnancy and birth, designed to improve VBAC rates. IMPLICATIONS FOR PRACTICE decision-aids and information programmes during pregnancy should be provided for women as, even though they do not affect the rate of VBAC, they decrease women's decisional conflict and increase their knowledge about possible modes of birth.
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Affiliation(s)
- Christina Nilsson
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, SE-405 30 Gothenburg, Sweden.
| | - Ingela Lundgren
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, SE-405 30 Gothenburg, Sweden.
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Katri Vehvilainen-Julkunen
- University of Eastern Finland, Faculty of Health Sciences, POB 1627, Kuopio University Hospital, 70211 Kuopio, Finland.
| | - Jane Nicoletti
- Universita Degli Studi di Genova, Via Balbi 5, 16126 Genova, Italy.
| | - Declan Devane
- School of Nursing and Midwifery, Saolta University Healthcare Group, University Road, Galway, Ireland.
| | - Annette Bernloehr
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Evelien van Limbeek
- Zuyd University, Department of Midwifery Science, POB 1256, 6201 BG Maastricht, The Netherlands.
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
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