This paper reports the findings of a small pilot study undertaken to identify women's perceptions of their Caesarean section and/or their experience of attempting to achieve a vaginal birth after Caesarean. Fifty-nine women replied to a survey designed and distributed by the consumer organisation Birthrites. The survey consisted of 22 closed and open-ended questions. Descriptive statistics and content analysis were used to analyse the data. Six major factors that impacted on women's perceptions of their birthing experience were identified: (i) 'being supported'; (ii) 'violated expectations'; (iii) 'loss of control'; (iv) 'health professionals' language, attitudes and care practices'; (v) 'the labour experience and the cascade of intervention'; and (vi) 'surgical birth and the separation from the baby'. The results support previous work in this area and demonstrate that some women suffer from psychological trauma following an emergency Caesarean section. The experiences of the women in this small study indicate a need for health professionals to not only better understand the distress that may occur but to also develop a greater understanding of the impact of their interactions with women. The study also provides a consumer 'voice' on current routine hospital policies surrounding vaginal birth after Caesarean and confirms the importance of choice, control and continuity of care for all women regardless of their 'risk' status.

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BACKGROUND: Around 20% of women report high levels of childbirth fear. An evidence-based psychoeducation intervention delivered by midwives reduced maternal childbirth fear and increased confidence for birth. Implementation of the intervention into practice is now required. Translating evidence into practice, however, remains challenging.AIM: This study aimed to explore organizational factors, including barriers and possible solutions that may impact on the successful application of the midwife psychoeducation intervention in practice.METHODS: Mixed methods data collection included a self-administered survey (n = 62), clinician-led focus groups (n = 28), and interviews with key stakeholders (n = 5). Simple descriptive statistics were used to analyze the quantitative data. Latent content analysis was used to analyze the qualitative data.RESULTS: Midwives were perceived to be best placed to deliver psychoeducation to women fearful of birth. Support for normal birth was high. There was, however, disparity between positive attitudes toward evidence-based practice in theory and its clinical application. Similarly, although the workplace learning culture was generally assessed as positive, many participants believed changing practice was difficult and reported a low sense of agency for challenging or facilitating change. Participants reported that barriers to implementing the evidence included time constraints and heavy workloads. There was a lack of awareness and confidence to implement evidence-based practice (EBP) with participants identifying that resistance to change was often the result of clinician fear and self-interest. The way services were routinely structured was considered problematic as fragmentation actively worked against midwives forming meaningful relationships with women. Enablers included organizational support, education, local champions, and continuity of midwifery care.CONCLUSION: The study identified the clinicians’ readiness, barriers, and possible solutions to the widespread implementation of an evidence-based psychoeducation intervention delivered by midwives for women fearful of birth at one maternity facility in South East Queensland, Australia. Many of the identified barriers were commensurate with the international literature on translating evidence into practice.

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