From coercion to respectful care: women’s interactions with health care providers when planning a VBAC

Abstract

Background In many countries caesarean section rates are increasing and this impacts on choices made around mode of birth in subsequent pregnancies. Having a vaginal birth after caesarean (VBAC) can be a safe and empowering experience for women, yet most women have repeat caesareans. High caesarean section rates increase maternal and neonatal morbidity, health costs and burden on hospitals. Women can experience varied support from health care providers when planning a VBAC. The aim of this paper is to explore the nature and impact of the interactions between women planning a VBAC and health care providers from the women’s perspective. Methods A national Australian VBAC survey was undertaken in 2019. In total 559 women participated and provided 721 open-ended responses to six questions. Content analysis was used to categorise respondents’ answers to the open-ended questions. Results Two main categories were found capturing the positive and negative interactions women had with health care providers. The first main category, ‘Someone in my corner’, included the sub-categories ‘belief in women birthing’, ‘supported my decisions’ and ‘respectful maternity care’. The negative main category ‘Fighting for my birthing rights’ included the sub-categories ‘the odds were against me’, ‘lack of belief in women giving birth’ and ‘coercion’. Negative interactions included the use of coercive comments such as threats and demeaning language. Positive interactions included showing support for VBAC and demonstrating respectful maternity care. Conclusions In this study women who planned a VBAC experienced a variety of positive and negative interactions. Individualised care and continuity of care are strategies that support the provision of positive respectful maternity care.

Obstetric violence in the United States and other high-income countries: an integrative review

“…Women who are Black, ethnic minorities, adolescents, poor, with low education levels, drug users, without housing, without prenatal care, and without a companion are more vulnerable to obstetric violence. Keedle et al 49 n = 559 Australian women who planned a vaginal birth after cesarean: n = 171 pregnant and currently planning, and n = 388 following birth Qualitative, open-ended survey/Level III The category of negative interactions between participants and healthcare providers was identified as “Fighting for my birthing rights.” Intensity varied across the sub-categories: the odds were against me, lack of belief in women birthing, and coercion. Obstetric violence was most clearly present in coercion to accept a repeat cesarean.…”

“…Examples of obstetric violence were most clearly present in negative interactions as verbal coercion to have a repeat caesarean, threatening, and overt examples of unconsented procedures and having physical force used against the birthing person. 49 Co-researchers from Sweden found that interview participants had experienced psychological and physical abuse during childbirth that was considered obstetric violence. Results included accounts of higher-intensity experiences of obstetric violence that were compared to rape.…”

What women want if they were to have another baby: the Australian Birth Experience Study (BESt) cross-sectional national survey

“…In the maternity environment too many women experience coercion, obstetric violence and disrespectful care and are subject to victim blaming 10 11 37. An example of this is healthcare providers dismissive attitudes to birth plans 43 44.…”

“…This can lead to assumptions about the wishes and needs of women, such as increased rates of maternal requested caesarean 7 8. International and Australian research has found women often receive mistreatment and disrespectful and abusive care from healthcare providers,9–11 particularly for women of colour 12. Internationally around a third of women identify their previous birth as a traumatic experience,13 14 which can lead to increased rates of psychosocial issues such as post-traumatic stress disorder 15 16…”

Inequities in quality perinatal care in the United States during pregnancy and birth after cesarean

“…Women who desired a VBAC, but were unable to plan one, were less likely to experience respectful maternity care or to have autonomy in their decision making for their maternity care than women who planned a VBAC [ 9 ]. Recent studies found that individuals who reported a difference of opinion with their providers about the right care for themselves or their baby were significantly more likely to report mistreatment or to feel disrespected and coerced by their provider [ 7 , 9 , 10 ].…”