Why do women choose vbac

Porchia and her doulas assist women with a variety of birthing issues, including seeking VBAC and avoiding unnecessary C-section. Photo courtesy of Chanel Porchia. Gurney said the fear of being sued can be a deciding factor for providers.

Fear of litigation, combined with conflicting interpretations of the different risk factors, can sometimes turn practitioners and patients against each other, Alexander said. Porchia said she has personally dealt with many women being pressured into C-sections. She said that after her years working as a doula, she thought there was very little chance of being able to go through with a VBAC in a hospital.

Press three, and the message will ask whether the caller is currently in labor. Alexander said she fields many of the calls herself, and has talked through hospital situations with countless women. ACOG issued guidelines in stating that pregnant women have the right to refuse treatment, including a C-section. Support Provided By: Learn more. Wednesday, Nov The Latest.

World Agents for Change. Health Long-Term Care. A nurse midwife can help women decide. VBACs enable women to: Avoid major abdominal surgery: C-sections are an invasive procedure requiring a significant recuperation period. They also carry common surgery risks such as hemorrhage, infection, and injury to other organs.

Women giving birth vaginally tend to recover faster, experience less pain, and have a lower risk of infection. Prevent future pregnancy complications: The risk of placenta accreta , an abnormal implantation of the placenta that prevents it from easily detaching from the uterine wall, increases with each C-section due to additional scarring.

Avoiding a C-section is particularly important for moms who plan on having more children. Hold baby immediately: A mom giving birth vaginally can gather her newborn into her arms right away and can start nursing at the first sign of rooting.

Signs that a VBAC is recommended include: Successful previous vaginal delivery Previous C-section with a low transverse incision Baby who is positioned head-down after a previous breech baby Women who have had a premature baby via C-section or an emergency C-section are less likely to be candidates because they may have a different kind of scar on their uterus. Scheduling: Vancouver Clinic appreciates the diversity of human beings and does not discriminate based on race, color, national origin, religion, age, disability, sex, sexual orientation or gender identity.

These are when:. You will be advised to labour in hospital so that an emergency caesarean birth can be carried out if it becomes necessary. There should also be facilities for immediate blood transfusion and neonatal resuscitation if required. These are the reasons why a home birth or birth centre birth are not recommended for a woman planning a VBAC.

Contact the hospital as soon as you think you have gone into labour or if your waters break. You can have an epidural if you choose. You can opt to have a pool birth if available on Central Delivery Suite CDS with telemetry, which is wireless fetal heart monitoring enabling you to be more active in labour.

In this paper the term HBAC is also used. The latest Australian statistics indicate that 0. The majority of research surrounding VBAC focuses on the rates of uterine rupture and factors that may affect this rate [ 17 — 20 ]. VBAC undertaken at home is discussed in the literature but there are few studies that have specifically looked at the safety of VBAC at home.

A recent German study found that women planning an out-of-hospital VBAC birth centre and homebirth had a The study also concluded that out of hospital VBAC was safe where there were appropriately qualified midwives and clear risk screening criteria [ 21 ].

The higher VBAC rates are also found in studies that look at the safety and outcomes of births undertaken at home or in birth centres compared with hospital births, ranging from In comparison, Australian statistics indicate that only This paper aims to explore the reasons for, and the experiences of, women who choose to have a HBAC. This group of women can offer invaluable insights into the decision-making and experiences of women when choosing to have a VBAC at home.

These insights may in turn help health professionals understand the factors that are important to women planning a subsequent birth after caesarean section.

A qualitative interpretive approach underpinned by a feminist framework informed this study. A feminist framework is grounded in the knowledge that contemporary western society is patriarchal and hierarchal [ 26 ]. In particular, in relation to this study, a feminist approach provides an appropriate lens to consider the gender and power relationships that can occur within the health care setting [ 27 ].

As described above, the dominant biomedical health system identifies VBAC and homebirth as risky. With this in mind, a feminist approach provides an appropriate theoretical framework when exploring why women choose to go against the dominant cultural beliefs or practices and have a VBAC at home. I am also a privately practising homebirth midwife who supports women who plan to have a HBAC. This information was shared with participants and allowed for an easy rapport at the beginning of the interviews.

Researchers who have had previous experience, relevant to the group being researched, have reported benefits from this insider status such as gaining rapport and accessing the group [ 28 ]. Reflexivity was particularly important in this study as I held the status of insider. Reflexivity increases validity and transparency in research [ 30 ] and is necessary through all stages of the research process [ 31 ]. To ensure this I kept field notes and memos about my experience, my thoughts and feelings as I interviewed the women and undertook the analysis.

I made a point of noting how my own views or experiences were consistent with what women had stated in an interview as well as identifying the times their perspective differed. This can be seen in the following excerpt from field notes:. She thought it was due to having a better support team rather than just him field notes. Women have been de-identified and given pseudonyms. A range of recruitment strategies were used to gain access to potential participants such as advertising on home birth specific webpages, social network sites and through informal snowballing techniques.

Social networking was the most successful recruitment strategy with 36 women making contact within 48 h of a social networking advertisement. Women were invited to make contact via email and information on the study and consent forms were sent by return email. The inclusion criterion was women who had achieved a VBAC at home within the last 5 years. The number of previous caesareans or previous vaginal births was not identified within the inclusion criteria and as such women with more than one caesarean or vaginal birth were included.

Four women were excluded due to not fulfilling the inclusion criteria for the time frame or were planning to HBAC with a current pregnancy. These women were contacted by phone and thanked for their willingness to be involved and given an explanation on why they were unable to be part of the study, the women were understanding and expressed their excitement for the study.

The time frame of within the last 5 years was included to allow for recency of experience within the current climate of homebirth in Australia. Sixteen women did not return consent forms and were unable to move on to the next level of the study and two women were unable to commit to interview. The lack of returned forms may be related to the necessity to print, sign and either scan and email or post back to the research team that may have been restrictive without the necessary devices or time.

In total twelve women across Australia returned consent forms and could be interviewed. Interviews were used to collect data. Eight women from my home State of NSW participated in face-to-face interviews held in their own home.

Demographic information was collected from all participants. Interview questions are presented in Fig. These questions were used during all the interviews as well as specific questioning used for clarification of information. On average the interviews were 56 min for the face-to-face interviews and 34 min for the telephone interviews. Reciprocity was an important component of the interview and interaction with the participants. Reciprocity, is an important element of feminist research and involves the mutual sharing of information to create an open environment for the interview [ 26 ].

Building a rapport between researcher and interviewee facilitates the breakdown of the traditional hierarchal relationship that can occur with the resulting benefit of a relaxed interview and an in depth sharing of VBAC stories and this was achieved by identifying shared experiences between the interviewer and interviewee [ 32 ]. Thematic analysis was used to analyse the data set [ 33 ].

The process commences with the transcribing of interviews and then reading and re-reading over the transcripts. The fluid nature of thematic analysis occurs with coding of data items, developing lists of codes, identifying themes across the data set then returning to the data items and deciding on their relevance and fit to the themes. Themes develop out of the codes and the research story determines the overarching theme from the themes and subthemes [ 25 , 34 ].

As a Masters Honours student I undertook the preliminary analysis, and the three other authors reviewed some of the transcribed data and discussed and checked the interpretations made during data analysis. Trustworthiness is made up of credibility, transferability, dependability and conformability [ 35 , 36 ]. In this study this was demonstrated in the use of reflexivity, describing the audit trail and field notes, the involvement of my supervisors during data collection and analysis and the identification of similar themes in similar studies.

Two women had more than one previous caesarean, one woman having four previous caesareans and one woman having two previous caesareans. The participant demographics are presented in Table 1. This overarching theme captured the strong intent of the women that gave birth vaginally following a previous, often traumatic, birth or births.

For many of the twelve women interviewed the decision to have a HBAC followed a previous traumatic birth experience as Anne described:.

Each theme had related subthemes that can be found in Table 2. Within each of the three themes there were subthemes that developed and within these subthemes there were a number of key concepts. For the purpose of this paper the sub themes will be discussed with reference to some of the key concepts. The strong feelings that these experiences created often resurfaced when the women approached health care providers to assist them with a VBAC.

Although many of the women in the study had experienced a vaginal birth the interviewees commonly commenced with a reflection of their CS experience. The women were able to recall in detail the experience of having had a caesarean section. They remembered how the health professionals acted and what they had said during the operation and the casual and impersonal nature of this had lasting effects on them.

Women described feeling loss of control throughout the pregnancy and birth continuum, not just at the caesarean.

Being treated like a piece of meat meant that women often felt ignored in the process and not involved in the decision making process.

Examples of this include being given medications without informed consent or refusal to provide adequate birthing props such as birthing mats to help the woman gain comfort. I ended up asking for an epidural…I was told to sit back, have a cup of tea. I kept wanting certain things, wanting to lean forward but I just got told to sit back in the bed. Women described the process of identifying and working through the trauma surrounding the initial caesarean experience.

For some women this also included subsequent caesareans. And I did, and for a couple of weeks after my birth…I would just cry, spontaneously, just cry, because I would be so upset about it Carol.

For the five women in the study who had previously experienced a VBAC or attempted a VBAC in the hospital system prior to their HBAC there was a period of reflection in the interviews where they discussed these experiences. Although the environment of the hospital was identified as having a negative impact in all cases, the attitude and behaviours of the health professionals in the hospital environment had a greater negative impact on their experiences.

Women found that health professionals often appeared uncomfortable to care for women who wished to achieve a VBAC. My obstetrician … agreed to no monitoring for the first bit but then all of a sudden I was strapped down in the stirrups with the monitor on in the end, it was quite horrible Amy. When women were reflecting on the interactions they had with health professionals in previous births or in the preparation for the VBAC, obstetricians played a key role.

Women expressed surprise at the negative attitudes directed at them around natural birth and VBAC. Not naturally trained Anne. This sub theme reflected the experiences of women who attempted and in some cases achieved a VBAC in the system.

The obstetricians mostly did not support women wishing to have a VBAC and expected the women to elect for a repeat caesarean. The majority of women stated that at the start of the HBAC pregnancy they had approached a hospital to discuss their care and desire to avoid a range of interventions and to experience a VBAC.

They were concerned that the cascade of intervention would happen again. In the interview they reflected on the unsupportive and negative attitudes directed at them. Many of the women approached the VBAC in hospital with the attitude that this time they would negotiate the interventions that they would agree to and those that they wished to avoid.

When attempting to negotiate the VBAC women reported that they were subject to varying degrees of intimidation and bullying by hospital staff, from repeated lecturing to disrespectful scaremongering. Some women found that at each antenatal appointment they were told about the same restrictions that would occur during labour, such as continuous monitoring, IV therapy and no water births and there was a lack of willingness on behalf of health professionals to compromise on any of these.

Some of the women articulated how the intimidation and lack of co-operation they experienced in planning their VBAC in hospital reinforced the residual feelings they had from their traumatic birth. This ultimately put the women onto the path of choosing a HBAC. Once the barriers of VBAC in the hospital had been recognised the women in this study described the journey they undertook in becoming educated and confident in their ability to have a VBAC. The women identified that the unfolding of their decision to HBAC was weaved throughout the gaining of knowledge, the gathering of support and in the majority of women, hiring a privately practising midwife PPM.