The experiences of women planning a vaginal birth after caesarean (VBAC) in Australia

Abstract

Women in Australia who have had a caesarean section for a previous birth have the option of planning a repeat caesarean or a vaginal birth after caesarean (VBAC) for the next birth. Women who plan a VBAC will either achieve this or have a repeat caesarean. Research indicates that 60–80% of women who plan a VBAC will reach their goal, but rates are influenced by model of care and birth location. In Australia 84% of women have a repeat caesarean and these rates are higher in private hospitals. There is currently no formal data collection which captures whether women plan to have a VBAC or not. There is an ongoing debate about the safety and risk of repeat elective caesarean, compared to possible emergency repeat caesarean, when women choose to have a VBAC. There are several factors that appear to influence women’s decision-making process about the next birth after caesarean section (NBAC), such as feelings around the previous birth, cultural expectations around birth and the attitudes and values towards VBAC held by health care providers. There is limited research exploring the impact of health care providers’ attitudes and behaviours on women’s experiences of planning a VBAC or the impact of different birth locations and models of care in Australia. Studies exploring women’s plans for a VBAC predominantly use qualitative data collection methods in the postnatal period and there is currently no research where women give real-time accounts of their experiences. The aim of this study was to explore the experiences of women planning a VBAC in Australia. This study was a sequential exploratory mixed-methods study comprised of three phases. This is a PhD by published papers and includes four publications and a book chapter. Findings from this study indicate that women who have had a previous caesarean go on a journey during their next pregnancy with both positive and negative experiences. Four factors influence how resolved or disappointed women felt at the end of their journey and after their birthing experience. The factor ‘having a relationship’ was found to be pivotal to the factors ‘having control’, ‘having confidence’ and ‘having an active labour’. Continuity of care from a midwife positively influenced the four factors and women’s overall experiences of planning a VBAC. This study highlights that women planning a VBAC should be supported by health care providers and facilities who use the four factors framework. Examples of relevant practices include using individualised birth plans, accessing active birth courses antenatally, facilitating active labour and birth and providing continuity of care with a midwife.

Date of Award	2020
Original language	English
Awarding Institution	Western Sydney University
Supervisor	Hannah Dahlen (Supervisor)