Women’s experiences of planning a vaginal birth after caesarean in different models of maternity care in Australia

Keedle, Hazel; Peters, Lilian L.; Schmied, Virginia; Burns, Elaine; Keedle, Warren; Dahlen, Hannah

doi:10.1186/s12884-020-03075-8

Cited by 35 publications

(38 citation statements)

References 65 publications

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“…The study's focus on health equity in maternal health corresponds to the latest priorities of the US Surgeon General and Department of Health and Human Services 48,49 . Although the experiences of our participants occurred during a global health crisis, their mean scores on the MADM and MOR were slightly higher than in a comparable pre‐COVID‐19 US national sample, 39 and median scores were higher than pre‐COVID‐19 Australian and German samples 50,51 …”

Section: Discussioncontrasting

confidence: 58%

Experiences of Quality Perinatal Care During the US COVID‐19 Pandemic

Ibrahim

Kennedy

Combellick

2021

J Midwife Womens Health

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Introduction Quality perinatal care is recognized as an important birth process and outcome. During the coronavirus disease 2019 (COVID‐19) pandemic, quality of perinatal care was compromised as the health care system grappled with adapting to an ever‐changing, uncertain, and unprecedented public health crisis. Methods The aim of this study was to explore the quality of perinatal care received during the COVID‐19 pandemic in the United States. Data were collected via an online questionnaire completed by people who gave birth in the United States after March 15, 2020. The questionnaire included the Mothers on Respect Index and the Mothers Autonomy in Decision Making validated measures. Low‐quality perinatal care was defined as decreased respect and/or autonomy in the perinatal care received. Responses were geocoded by zip code to determine COVID‐19 case‐load in the county on the date of birth. Multivariate regression analyses described associations between respect and autonomy in decision‐making for perinatal care and levels of COVID‐19 outbreak across the United States. Results Participants (N = 707) from 46 states and the District of Columbia completed the questionnaire. As COVID‐19 cases increased, participants’ experiences of autonomy in decision‐making for perinatal care decreased significantly (P = .04). Participants who identified as Black, Indigenous, and people of color, those who had an obstetrician provider, and those who gave birth in a hospital were more likely to experience low‐quality perinatal care. Those with a midwife provider or who had a home birth were more likely to experience high‐quality perinatal care in adjusted models. Discussion Variability in experiences of high‐quality perinatal care by sociodemographic characteristics, birth setting, and provider type may relate to implicit bias, structural racism, and inequities in maternal health and COVID‐19 outcomes for birthing people from marginalized communities.

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Section: Discussioncontrasting

confidence: 58%

Experiences of Quality Perinatal Care During the US COVID‐19 Pandemic

Ibrahim

Kennedy

Combellick

2021

J Midwife Womens Health

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“…Vedam and colleagues found that improved access to midwives was associated with higher rates of VBAC and lower rates of cesarean in the United States 55 . Similarly, a continuity of care model of care, common in midwifery practices, has been shown to increase experiences of respect and autonomy 56 . Our sample trended in this direction; nearly 40% of participants who planned a VBAC had a midwife provider for their second birth, a rate that is significantly higher than the United States as a whole where only about 10% of people give birth with a midwife 57 .…”

Section: Discussionmentioning

confidence: 99%

“I had to fight for my VBAC”: A mixed methods exploration of women’s experiences of pregnancy and vaginal birth after cesarean in the United States

Ibrahim

Shorten

Vedam

et al. 2020

Birth

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Background Vaginal birth after cesarean (VBAC) is safe, cost‐effective, and beneficial. Despite professional recommendations supporting VBAC and high success rates, VBAC rates in the United States (US) have remained below 15% since 2002. Very little has been written about access to VBAC in the United States from the perspectives of birthing people. We describe findings from a mixed methods study examining experiences seeking a VBAC in the United States. Methods Individuals with a history of cesarean and recent subsequent birth were recruited through social media groups. Using an online questionnaire, we collected sociodemographic and birth history information, qualitative accounts of participants’ experiences, and scores on the Mothers on Respect Index, the Mothers Autonomy in Decision Making Scale, and the Generalized Self‐Efficacy Scale. Results Participants (N = 1711) representing all 50 states completed the questionnaire; 1151 provided qualitative data. Participants who planned a VBAC reported significantly greater decision‐making autonomy and respectful treatment in their maternity care compared with those who did not. The qualitative theme: “I had to fight for my VBAC” describes participants’ accounts of navigating obstacles to VBAC, including finding a supportive provider and traveling long distances to locate a clinician and/or hospital willing to provide care. Participants cited support from providers, doulas, and peers as critical to their ability to acquire the requisite knowledge and power to effectively self‐advocate. Discussion Findings highlight the difficulties individuals face accessing VBAC within the context of a complex health system and help to explain why rates of attempted VBAC remain low.

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“…The survey development and pilot testing has previously been published [ 22 ]. The survey included 114 items that contained demographic, yes/no, Likert scales, open ended questions and validated tools grouped around the four factors.…”

Section: Methodsmentioning

confidence: 99%

“…The qualitative findings were integrated into the next phase of the study which was a national survey. The quantitative results of the experiences of women who had planned a VBAC in the previous five years in different models of maternity care has been published [ 22 ]. 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 women’s perspectives.…”

Section: Introductionmentioning

confidence: 99%

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

Keedle

Schmied

Burns

et al. 2022

BMC Pregnancy Childbirth

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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.

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Women’s experiences of planning a vaginal birth after caesarean in different models of maternity care in Australia

Cited by 35 publications

References 65 publications

Experiences of Quality Perinatal Care During the US COVID‐19 Pandemic

Experiences of Quality Perinatal Care During the US COVID‐19 Pandemic

“I had to fight for my VBAC”: A mixed methods exploration of women’s experiences of pregnancy and vaginal birth after cesarean in the United States

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

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