Groping Through the Fog

A Metasynthesis of Women's Experiences on VBAC (Vaginal Birth After Caesarean Section)

Ingela Lundgren; Cecily Begley; Mechthild M Gross; Terese Bondas

Disclosures

BMC Pregnancy Childbirth. 2012;12(85) 

In This Article

Background

The number of women with Caesarean section (CS) in their history is related to a high and rising CS-rate in an international perspective; for example, CS-rates rose in Sweden from 5% in the beginning of the 1970s to 17.2% in 2007,[1] in UK from 9% in 1980 to 25% in 2003,[2] and in Ireland from 11.8% in 1991 to 27% in 2009.[3] Today the CS-rate is 15.1% in Netherlands,[4] 17.1% in Finland,[4] 28% in Australia,[5] 32.7% in Taiwan,[6] and 32.7% in Germany.[7]

Due to the rising CS-rate a large group of women and health professionals have to consider the choice between an elective CS or vaginal birth (VBAC) in subsequent birth, a decision which should be individually based.[8,9] VBAC is recommended as safe and as best practice for the majority of women,[10,11] is associated with lower maternal mortality than repeat CS, and less overall morbidity for mothers and babies.[11] Similar to the CS-rate, VBAC-rates differ internationally. In Ireland, Germany and Italy the VBAC-rate is 29–36% compared to 45–55% in Netherlands, Sweden and Finland;[4] in the the United States it is 10.1%, and in Australia 19%, and has declined over time.[9] VBAC guidelines from UK, Australia, New Zealand, Canada, and the US are characterized by quasi-experimental evidence, which led to wide variability in clinical practice.[12]

The perspective of pregnant women regarding birth risks in a subsequent pregnancy following prior CS are not well understood.[13] There is a great deal of research based on quantitative approaches on VBAC but very few qualitative studies about women's experiences.[5,14] Studies have focused on women's perspective of decision-making in relation to mode of delivery in the subsequent birth after a previous CS. Women experience decisional conflicts and uncertainty and need individual and structured information.[6,10,15–17] Studies focusing on women's experiences of giving birth vaginally after a previous CS birth shows that they express a belief in the importance of a natural birth,[18,19] and that psycho-social dimensions that go beyond the birth are of importance for them.[20]

In summary, VBAC is a phenomenon relevant for a large group of women due to the rising CS-rate. There is a need to integrate qualitative findings of women's experiences of VBAC to influence evidence-based practice but also to generate new research questions.[21–24] The objective of this metasynthesis is therefore to integrate the findings and deepen the understanding of women's experiences of VBAC.

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