Ingela Lundgren1, Sandra Morano2, Christina Nilsson3, Marlene Sinclair4, Cecily Begley5. 1. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30 Gothenburg, Sweden. Electronic address: ingela.lundgren@gu.se. 2. Department of Neurology, Ophthalmology, Genetics, Maternal and Infant Sciences, University of Genoa, Largo Daneo, 5 -16132 Genova, Italy. 3. Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden. 4. Ulster University, Shore Road, Newtownabbey BT37 0QB Northern Ireland, United Kingdom. 5. School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
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'.
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'.
Authors: Anna Dencker; Ida Lyckestam Thelin; Valerie Smith; Ingela Lundgren; Christina Nilsson; Huiqi Li; Lars Ladfors; Anders Elfvin Journal: BMJ Paediatr Open Date: 2022-07
Authors: Abdulrahim A Rouzi; Rana Alamoudi; Sarah Ghazali; Nisma Almansouri; Abdullah Kafy; Meshari Alrumaihi; Wajeh Hariri; Esraa Alsafri Journal: Int J Womens Health Date: 2021-11-10