School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
Amsterdam University Medical Centers, Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
BMC Pregnancy Childbirth. 2020 Jun 30;20(1):381. doi: 10.1186/s12884-020-03075-8.
Vaginal birth after caesarean (VBAC) is a safe mode of birth for most women but internationally VBAC rates remain low. In Australia women planning a VBAC may experience different models of care including continuity of care (CoC). There are a limited number of studies exploring the impact and influence of CoC on women's experiences of planning a VBAC. Continuity of care (CoC) with a midwife has been found to increase spontaneous vaginal birth and decrease some interventions. Women planning a VBAC prefer and benefit from CoC with a known care provider. This study aimed to explore the influence, and impact, of continuity of care on women's experiences when planning a VBAC in Australia.
The Australian VBAC survey was designed and distributed via social media. Outcomes and experiences of women who had planned a VBAC in the past 5 years were compared by model of care. Standard fragmented maternity care was compared to continuity of care with a midwife or doctor.
In total, 490 women completed the survey and respondents came from every State and Territory in Australia. Women who had CoC with a midwife were more likely to feel in control of their decision making and feel their health care provider positively supported their decision to have a VBAC. Women who had CoC with a midwife were more likely to have been active in labour, experience water immersion and have an upright birthing position. Women who received fragmented care experienced lower autonomy and lower respect compared to CoC.
This study recruited a non-probability based, self-selected, sample of women using social media. Women found having a VBAC less traumatic than their previous caesarean and women planning a VBAC benefited from CoC models, particularly midwifery continuity of care. Women seeking VBAC are often excluded from these models as they are considered to have risk factors. There needs to be a focus on increasing shared belief and confidence in VBAC across professions and an expansion of midwifery led continuity of care models for women seeking a VBAC.
对于大多数女性来说，剖宫产后阴道分娩（VBAC）是一种安全的分娩方式，但国际上 VBAC 率仍然较低。在澳大利亚，计划 VBAC 的女性可能会经历不同的护理模式，包括连续性护理（CoC）。只有少数研究探讨了 CoC 对女性计划 VBAC 体验的影响和影响。与助产士的连续性护理（CoC）已被发现增加自然阴道分娩，并减少一些干预措施。计划 VBAC 的女性更喜欢并受益于与已知护理提供者的 CoC。本研究旨在探讨连续性护理对澳大利亚女性计划 VBAC 时体验的影响和影响。
澳大利亚 VBAC 调查是通过社交媒体设计和分发的。通过护理模式比较过去 5 年计划 VBAC 的女性的结局和体验。标准的碎片化产妇护理与助产士或医生的连续性护理进行比较。
共有 490 名女性完成了调查，受访者来自澳大利亚的每个州和地区。与接受助产士连续性护理的女性相比，接受碎片化护理的女性更有可能感到对自己的决策有掌控感，并感到她们的医疗保健提供者积极支持她们进行 VBAC 的决定。接受助产士连续性护理的女性更有可能积极参与分娩，体验水中浸泡，并采用直立的分娩姿势。与 CoC 相比，接受碎片化护理的女性体验到较低的自主权和较低的尊重。
本研究使用社交媒体招募了基于概率的、自我选择的女性非概率样本。与前一次剖宫产相比，女性发现 VBAC 的创伤性较小，计划 VBAC 的女性受益于 CoC 模式，尤其是助产士连续性护理。寻求 VBAC 的女性经常被排除在这些模式之外，因为她们被认为有风险因素。需要在整个专业领域中增加对 VBAC 的共同信念和信心，并扩大助产士主导的连续性护理模式，以满足寻求 VBAC 的女性的需求。
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