BMid (hons), School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia.
The College of Health, Medicine and Wellbeing, School of Nursing and Midwifery (SONM) University of Newcastle, Callaghan, NSW, Australia.
Int J Community Based Nurs Midwifery. 2023 Jul;11(3):152-168. doi: 10.30476/IJCBNM.2023.97229.2171.
Caesarean section (CS) rates are continuing to rise worldwide. Elective repeat CS (ERCS) greatly contribute to the rising rate which increases unnecessary risks of maternal and neonatal morbidity and mortality. Vaginal birth after caesarean (VBAC) is a safe mode of birth for most women; however, uptake remains low. Our objective is to find the factors that influence women's decision-making to support informed choices for the mode of next birth after caesarean section (NBAC).
A literature search was conducted in CINAHL, Maternity and Infant Care, Embase, EmCare, Cochrane Library and Medline databases. Primary, qualitative, peer reviewed, English language research articles were assessed according to inclusion/exclusion criteria. Articles were systematically assessed for inclusion or exclusion. Included studies were assessed using the Critical Appraisal Skills Programme qualitative studies checklist, Noblit and Hare's seven-step meta-ethnography approach synthesised themes.
Fourteen primary research articles were included. Six studies on 287 women focused on VBAC, and eight studies examined both VBAC and ERCS with 1861 women and 311 blogs. Thematic analysis yielded four primary themes: Influence of health professionals, impact of previous birth experience, optimal experience, and being in control.
This meta-ethnography highlights health professionals' influence on women's decision making. To assist in decision-making, women need supportive health professionals who provide the current evidence-informed information about risks and benefits of each mode of birth. Health professionals need skills to provide supportive shared decision-making, debrief women regarding indications for their primary caesarean, and address issues of safety, fear, and expectations of childbirth.
剖宫产率在全球范围内持续上升。择期再次剖宫产（ERCS）极大地促成了这一上升趋势，增加了产妇和新生儿发病率和死亡率的不必要风险。剖宫产后阴道分娩（VBAC）是大多数女性安全的分娩方式；然而，接受率仍然很低。我们的目的是寻找影响女性决策的因素，以支持对剖宫产术后下一次分娩方式的知情选择。
在 CINAHL、Maternity and Infant Care、Embase、EmCare、Cochrane Library 和 Medline 数据库中进行了文献检索。根据纳入/排除标准评估了主要的、定性的、同行评审的、英语语言的研究文章。对文章进行了系统的纳入或排除评估。使用批判性评估技能计划定性研究检查表、Noblit 和 Hare 的七步元分析方法对纳入的研究进行评估，综合主题。
纳入了 14 篇原始研究文章。有 6 项针对 287 名女性的研究侧重于 VBAC，8 项研究同时研究了 VBAC 和 ERCS，涉及 1861 名女性和 311 篇博客。主题分析产生了四个主要主题：卫生专业人员的影响、先前分娩经历的影响、最佳体验和控制感。
这项元分析强调了卫生专业人员对女性决策的影响。为了协助决策，女性需要得到支持的卫生专业人员，他们提供关于每种分娩方式的风险和益处的当前循证信息。卫生专业人员需要提供支持性的共同决策技能，为女性提供关于其主要剖宫产的适应症的反馈，并解决安全、恐惧和分娩期望等问题。
