Women's reasons for and experiences of having a homebirth following a previous caesarean experience

Abstract

Background - The rates of caesarean section are rising across the developed world yet the vaginal birth after caesarean (VBAC) rate remains low. Caesarean section is related to increased morbidity for both women and babies, including higher rates of infection, increased need for blood products, operative trauma and neonatal intensive care admissions. Qualitative research suggests that there are women who prefer vaginal births after caesarean if this is supported and dislike unnecessary interventions. VBAC success rates are higher out of hospital than in hospital. A small number of women in Australia choose to have a homebirth after caesarean (HBAC). The reasons women choose to have a HBAC and their experiences have not been explored in research. Aims and methods - This study aimed to explore women's reasons for and experiences of choosing a homebirth following a caesarean section, by undertaking qualitative semi-structured interviews with 12 women who had a HBAC in the previous five years in Australia. A feminist theoretical framework was used to underpin the research and understand the power relations influencing the emerging themes. Eight privately practising midwives (PPMs) participated in a focus group to enhance and provide extra depth and meaning to the study. Thematic analysis was used to analyse the data. Results - The overarching theme was 'It's never happening again' with two associated themes of 'why it's never happening again' and 'how it's never happening again'. In the theme 'why it's never happening again' the women described their previous caesarean experience and identified episodes of bullying, intimidation and unnecessary interventions, resulting in what many of the women described as a traumatic birthing experience. With their next pregnancy the majority of women approached the hospital with the wish to have a VBAC but often found bullying and intimidation was repeated with no apparent room for negotiation. In this context, women sought other options and homebirth emerged as a valid one. In the theme 'How it's never happening again', the importance of support from a variety of sources, gaining knowledge about natural birth and employing the services of a PPM emerged as important factors. In this theme women also reported on the positive effect of a HBAC. Discussion - A previous experience of birth trauma, the over-medicalisation of childbirth and disrespectful and abusive attitudes of health care providers were the major influences for women pursuing a more positive birth option and choosing to have a HBAC. Gathering support and the close and continuous relationship with a PPM were factors that helped the women achieve their HBAC. Conclusion - Maternity care services often contribute to women having disempowering and traumatic birthing experiences and some appear to provide little support for women who wish to avoid over-medicalisation. Research is needed to explore ways for maternity providers working in the mainstream maternity care system to become more flexible in their guidelines and approach so they can meet the needs of these women within the hospital environment rather than turning them away. Homebirth can be a healing and empowering experience for women and is a valid option for women seeking a VBAC.

Date of Award	2015
Original language	English