Maralyn Foureur1, Sabera Turkmani1, Danielle C Clack1, Deborah L Davis2, Lyndall Mollart1, Bernadette Leiser3, Caroline S E Homer4. 1. Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia. 2. University of Canberra, Australian Capital Territory (ACT), Australia; The ACT Government, Health Directorate, Australia. 3. Central Coast Local Health District, Holden Street, Gosford, New South Wales, Australia. 4. Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia. Electronic address: caroline.homer@uts.edu.au.
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.
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.
Authors: Mercedes Colomar; Newton Opiyo; Carol Kingdon; Qian Long; Soledad Nion; Meghan A Bohren; Ana Pilar Betran Journal: PLoS One Date: 2021-05-05 Impact factor: 3.240