University of Minnesota School of Public Health, Minneapolis, MN, USA.
School of Nursing, Yale University, Orange, CT, USA.
Birth. 2021 Jun;48(2):164-177. doi: 10.1111/birt.12513. Epub 2020 Dec 3.
Vaginal birth after cesarean (VBAC) is safe, cost-effective, and beneficial. Despite professional recommendations supporting VBAC and high success rates, VBAC rates in the United States (US) have remained below 15% since 2002. Very little has been written about access to VBAC in the United States from the perspectives of birthing people. We describe findings from a mixed methods study examining experiences seeking a VBAC in the United States.
Individuals with a history of cesarean and recent subsequent birth were recruited through social media groups. Using an online questionnaire, we collected sociodemographic and birth history information, qualitative accounts of participants' experiences, and scores on the Mothers on Respect Index, the Mothers Autonomy in Decision Making Scale, and the Generalized Self-Efficacy Scale.
Participants (N = 1711) representing all 50 states completed the questionnaire; 1151 provided qualitative data. Participants who planned a VBAC reported significantly greater decision-making autonomy and respectful treatment in their maternity care compared with those who did not. The qualitative theme: "I had to fight for my VBAC" describes participants' accounts of navigating obstacles to VBAC, including finding a supportive provider and traveling long distances to locate a clinician and/or hospital willing to provide care. Participants cited support from providers, doulas, and peers as critical to their ability to acquire the requisite knowledge and power to effectively self-advocate.
Findings highlight the difficulties individuals face accessing VBAC within the context of a complex health system and help to explain why rates of attempted VBAC remain low.
剖宫产后阴道分娩（VBAC）是安全、具有成本效益且有益的。尽管专业建议支持 VBAC 且成功率很高，但自 2002 年以来，美国（US）的 VBAC 率仍低于 15%。从产妇的角度来看，关于美国 VBAC 可及性的研究很少。我们描述了一项混合方法研究的结果，该研究检查了在美国寻求 VBAC 的经验。
通过社交媒体群组招募有剖宫产史和近期后续分娩的个人。我们使用在线问卷收集社会人口统计学和分娩史信息、参与者体验的定性描述以及母亲尊重指数、母亲决策自主权量表和一般自我效能感量表的得分。
代表所有 50 个州的参与者（N=1711）完成了问卷；1151 人提供了定性数据。计划 VBAC 的参与者在其产妇护理中报告的决策自主权和尊重待遇明显更高，而不计划 VBAC 的参与者则不然。定性主题为：“我必须争取 VBAC”，描述了参与者在 VBAC 方面遇到的障碍，包括寻找支持性提供者以及长途跋涉寻找愿意提供护理的临床医生和/或医院。参与者引用提供者、导乐和同行的支持，对于他们获得必要的知识和权力以有效地自我倡导至关重要。
研究结果强调了个人在复杂医疗体系背景下获取 VBAC 所面临的困难，并有助于解释为什么尝试 VBAC 的比率仍然很低。
