Lennon Roisin Ailbhe, Kearns Karlene, O'Dowd Siobhan, Biesty Linda
Master of Health Sciences (Advanced Practice with Prescribing), Women and Infants' Services, Sligo University Hospital, Sligo, Republic of Ireland.
Master Health Science, Clinical Placement coordinator, Sligo University Hospital, Sligo, Republic of Ireland.
Women Birth. 2023 Nov;36(6):e623-e630. doi: 10.1016/j.wombi.2023.05.011. Epub 2023 Jun 11.
Part of the caseload of an Advanced Midwife Practitioner (AMP) service in a Northwest of Ireland maternity unit includes vaginal birth after caesarean section (VBAC) women. Despite evidence about VBAC being a safe option for women, the numbers attempting a VBAC remain small. This research was undertaken to give an insight into how VBAC eligible women opt for an elective repeat CS (ERCS) or VBAC birth.
Forty-four postnatal women with one previous CS who birthed between August 2021 and March 2022 were invited to participate in a qualitative study. Thirteen semi-structured interviews were undertaken in 2022. Thematic Analysis guided the analysis of the data and the findings are framed using the domains of the Socio-Ecological Model.
Decision making in relation to ERCS and VBAC is complex. Women want accurate VBAC information and time for discussions. Decisions are influenced by the woman's own confidence to birth naturally, family size, rite of passage to motherhood, control, previous birth experience, postnatal recovery and friends and family.
Previous experience can influence but not predict the next mode of birth. However, there is no one script that healthcare professionals (HCP) can use for this decision making given the various factors that influence this. To meet women's individual needs, HCPs should discuss VBAC suitability postnatally, offer VBAC antenatal clinics and specific VBAC classes.
Discussions about suitability for VBAC should occur following the primary CS. Continuity of care (COC), time for discussions and VBAC supportive HCP should be an option for all of this cohort.
爱尔兰西北部一家产科单位的高级助产士从业者（AMP）服务的部分病例包括剖宫产术后阴道分娩（VBAC）的女性。尽管有证据表明VBAC对女性来说是一种安全的选择，但尝试VBAC的人数仍然很少。开展这项研究是为了深入了解符合VBAC条件的女性如何选择选择性再次剖宫产（ERCS）或VBAC分娩。
邀请了44名在2021年8月至2022年3月期间生育且此前有过一次剖宫产的产后女性参与一项定性研究。2022年进行了13次半结构化访谈。主题分析指导了数据的分析，研究结果依据社会生态模型的领域进行阐述。
关于ERCS和VBAC的决策很复杂。女性希望获得准确的VBAC信息并有时间进行讨论。决策受到女性自身自然分娩的信心、家庭规模、成为母亲的仪式、控制权、既往分娩经历、产后恢复以及朋友和家人的影响。
既往经历会产生影响，但无法预测下一次的分娩方式。然而，鉴于影响这一决策的各种因素，医疗保健专业人员（HCP）没有一个通用的脚本可用于此决策。为满足女性的个体需求，HCP应在产后讨论VBAC的适用性，提供VBAC产前诊所和特定的VBAC课程。
应在首次剖宫产之后讨论VBAC的适用性。连续护理（COC）、讨论时间以及支持VBAC的HCP应该是这一群体的选择。
