VBAC or elective CS? An exploration of decision-making process employed by women on their mode of birth following a previous lower segment caesarean section

Roisin Ailbhe Lennon; Karlene Kearns; Siobhan O'Dowd; Linda Biesty

doi:10.1016/j.wombi.2023.05.011

VBAC or elective CS? An exploration of decision-making process employed by women on their mode of birth following a previous lower segment caesarean section

Women Birth. 2023 Nov;36(6):e623-e630. doi: 10.1016/j.wombi.2023.05.011. Epub 2023 Jun 11.

Authors

Roisin Ailbhe Lennon¹, Karlene Kearns², Siobhan O'Dowd³, Linda Biesty⁴

Affiliations

¹ Master of Health Sciences (Advanced Practice with Prescribing), Women and Infants' Services, Sligo University Hospital, Sligo, Republic of Ireland. Electronic address: roisin.l@hotmail.com.
² Master Health Science, Clinical Placement coordinator, Sligo University Hospital, Sligo, Republic of Ireland.
³ Department of Nursing, Health Sciences and Disability Studies. St Angela's College, Sligo, Republic of Ireland.
⁴ School of Nursing & Midwifery, University of Galway, Galway, Republic of Ireland.

PMID: 37308355
DOI: 10.1016/j.wombi.2023.05.011

Abstract

Background: Part of the caseload of an Advanced Midwife Practitioner (AMP) service in a Northwest of Ireland maternity unit includes vaginal birth after caesarean section (VBAC) women. Despite evidence about VBAC being a safe option for women, the numbers attempting a VBAC remain small. This research was undertaken to give an insight into how VBAC eligible women opt for an elective repeat CS (ERCS) or VBAC birth.

Methods: Forty-four postnatal women with one previous CS who birthed between August 2021 and March 2022 were invited to participate in a qualitative study. Thirteen semi-structured interviews were undertaken in 2022. Thematic Analysis guided the analysis of the data and the findings are framed using the domains of the Socio-Ecological Model.

Findings: Decision making in relation to ERCS and VBAC is complex. Women want accurate VBAC information and time for discussions. Decisions are influenced by the woman's own confidence to birth naturally, family size, rite of passage to motherhood, control, previous birth experience, postnatal recovery and friends and family.

Discussion: Previous experience can influence but not predict the next mode of birth. However, there is no one script that healthcare professionals (HCP) can use for this decision making given the various factors that influence this. To meet women's individual needs, HCPs should discuss VBAC suitability postnatally, offer VBAC antenatal clinics and specific VBAC classes.

Conclusion: Discussions about suitability for VBAC should occur following the primary CS. Continuity of care (COC), time for discussions and VBAC supportive HCP should be an option for all of this cohort.

Keywords: Caesarean section; Continuity of carer; Decision making; Vaginal birth after caesarean section; Women’s experiences.