Midwives' views on vaginal birth after a previous caesarean section

Abstract

A vaginal birth after Caesarean section refers to a vaginal delivery following a previous delivery by Caesarean section. The aim of this study was to explore midwives’ perceptions on vaginal birth after Caesarean section. The objectives were; to enquire into how midwives perceive vaginal birth after a previous Caesarean section, to explore their thoughts about maternal choice in determining their preferred birth method, and to explore the physical and psychological intrapartum care provided to women attempting a vaginal birth after a Caesarean section. A qualitative approach was adopted, using semi-structured, one-to-one interviews, conducted with a purposive sample of six midwives working at the Central Delivery Suite at Malta’s main general hospital. A 100% response rate was achieved. The interviews were audio-recorded, and then transcribed verbatim. Data was analysed using thematic analysis. The findings revealed that midwives had a positive attitude towards vaginal birth after Caesarean section, and encouraged eligible women to opt for this alternative. However, they also believed in promoting informed decision making, and respecting women’s choices. Midwives felt that women were primarily influenced by the advice of obstetricians, as well as by their own previous experiences of birth and postpartum recovery. The opinions of other women within their close social network, were also found to have an impact on maternal decision. Participants claimed that effective communication and psychological support were needed throughout the experience, especially if women required an emergency Caesarean section, following an unsuccessful trial of labour, which often left women feeling downhearted. The study concluded that choosing the optimal mode of birth after a previous operative delivery is often a complex decision for expectant mothers. The study suggests the need for all eligible expectant mothers to receive unbiased information about vaginal birth after Caesarean section. The main recommendations of the study entail the need for further research exploring obstetricians’ attitudes towards vaginal birth after Caesarean section. This would provide a deeper insight into how these professionals may be influencing women in their decisions. This study also recommends training for all healthcare professionals providing intrapartum care, to continuously keep them informed regarding updated evidence-based guidelines on vaginal birth after Caesarean section.