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Einleitung: Die Raten der Sectio caesarea (Sectio) steigen in der Schweiz seit Jahren. Viele Frauen mit einer vorausgegangenen Sectio erhalten beim nächsten Kind wieder eine Sectio. Das, obwohl die Vaginalgeburt nach Sectio eine gute Alternative darstellt und die elektive Sectio mit vielen Komplikationen verbunden ist. Ziel: Das Ziel dieser Arbeit ist es, Variablen zu identifizieren, welche Frauen in ihrem Entscheidungsprozess über das Geburtsprocedere als massgebend betrachten. Dadurch soll es ermöglicht werden, bei der Beratung zum Geburtsprocedere speziell auf diese Gründe einzugehen, sodass die Schwangeren eine unabhängige und evidenzbasierte Entscheidung treffen können. Methode: Die Literaturrecherche wird mithilfe der Ein- und Ausschlusskriterien auf bekannten Datenbanken durchgeführt. Sechs gefundene Studien werden zur Analyse und kritischen Würdigung ausgewählt. Ergebnisse: Die Ergebnisse zeigen, dass Frauen im Prozess der Entscheidungsfindung viele verschiedene Aspekte bedenken. So gibt es keine Einflussfaktoren, die zwangsläufig zu einer bestimmten Geburtsentscheidung führen, sondern es findet eine Abwägung, zugeschnitten auf die jeweils individuelle Situation statt. Trotzdem gibt es einige Faktoren, die eine Korrelation zu einer der Geburtsoptionen aufweisen. Schlussfolgerung: In Zukunft sollte vermehrt Wert darauf gelegt werden, welche Vorstellungen und Wünsche die Frauen haben. Um die gemeinsame Entscheidungsfindung übersichtlicher zu gestalten, kann eine Entscheidungshilfe zum Einsatz kommen. Weiterer Forschungsbedarf besteht.

Einleitung: Die Raten der Sectio caesarea (Sectio) steigen in der Schweiz seit Jahren. Viele Frauen mit einer vorausgegangenen Sectio erhalten beim nächsten Kind wieder eine Sectio. Das, obwohl die Vaginalgeburt nach Sectio eine gute Alternative darstellt und die elektive Sectio mit vielen Komplikationen verbunden ist. Ziel: Das Ziel dieser Arbeit ist es, Variablen zu identifizieren, welche Frauen in ihrem Entscheidungsprozess über das Geburtsprocedere als massgebend betrachten. Dadurch soll es ermöglicht werden, bei der Beratung zum Geburtsprocedere speziell auf diese Gründe einzugehen, sodass die Schwangeren eine unabhängige und evidenzbasierte Entscheidung treffen können. Methode: Die Literaturrecherche wird mithilfe der Ein- und Ausschlusskriterien auf bekannten Datenbanken durchgeführt. Sechs gefundene Studien werden zur Analyse und kritischen Würdigung ausgewählt. Ergebnisse: Die Ergebnisse zeigen, dass Frauen im Prozess der Entscheidungsfindung viele verschiedene Aspekte bedenken. So gibt es keine Einflussfaktoren, die zwangsläufig zu einer bestimmten Geburtsentscheidung führen, sondern es findet eine Abwägung, zugeschnitten auf die jeweils individuelle Situation statt. Trotzdem gibt es einige Faktoren, die eine Korrelation zu einer der Geburtsoptionen aufweisen. Schlussfolgerung: In Zukunft sollte vermehrt Wert darauf gelegt werden, welche Vorstellungen und Wünsche die Frauen haben. Um die gemeinsame Entscheidungsfindung übersichtlicher zu gestalten, kann eine Entscheidungshilfe zum Einsatz kommen. Weiterer Forschungsbedarf besteht.

Purpose: There is a need to gain deeper knowledge about women’s experience of vaginal birth after caesarean section (VBAC). Considerable research has been conducted on VBAC; however, only a few qualitative studies focus on women’s experiences. Therefore, the aim of this study was to describe the lived experiences of VBAC among women resident in Sweden, a country with a high VBAC rate. Method: This studywas performed in accordance with a phenomenological reflective lifeworld approach. Interviews were conducted with nine women in an urban region of Sweden one year after their VBAC birth. Results: The essential meaning of the studied phenomenon is “to challenge oneself as a childbearing woman”, which is further described by its four constituents: “striving for support from professionals”, “desiring the experience”, “contrasting and comparing memories of two different births” and “being part of the birthing culture”. Conclusions: The experience of VBAC meant regained trust in the ability to give birth vaginally. The women lacked follow-up and support after the caesarean section (CS), during the subsequent pregnancy and the forthcoming VBAC. Enhanced support could be a key factor in helping women meeting the challenge and feel confident about giving birth vaginally despite their previous experiences of CS.

Purpose: There is a need to gain deeper knowledge about women’s experience of vaginal birth after caesarean section (VBAC). Considerable research has been conducted on VBAC; however, only a few qualitative studies focus on women’s experiences. Therefore, the aim of this study was to describe the lived experiences of VBAC among women resident in Sweden, a country with a high VBAC rate. Method: This studywas performed in accordance with a phenomenological reflective lifeworld approach. Interviews were conducted with nine women in an urban region of Sweden one year after their VBAC birth. Results: The essential meaning of the studied phenomenon is “to challenge oneself as a childbearing woman”, which is further described by its four constituents: “striving for support from professionals”, “desiring the experience”, “contrasting and comparing memories of two different births” and “being part of the birthing culture”. Conclusions: The experience of VBAC meant regained trust in the ability to give birth vaginally. The women lacked follow-up and support after the caesarean section (CS), during the subsequent pregnancy and the forthcoming VBAC. Enhanced support could be a key factor in helping women meeting the challenge and feel confident about giving birth vaginally despite their previous experiences of CS.

Objective: Knowledge about labour characteristics of women achieving successful vaginal birth after caesarean section (VBAC) might be used to improve labour and birth management. This study examined sociodemographic and labour process-related factors regarding a) differences between countries, b) the comparison of successful VBAC with unplanned caesarean section, and c) predictors for the success of planned VBAC in three European countries. Design: We analysed observational data collected within the OptiBIRTH trial, a cluster-randomised controlled trial. Setting: Fifteen study sites in Ireland, Italy and Germany, five in each country. Participants: 790 participants going into labour for planned VBAC. Measurements: Descriptive statistics and random-effects logistic regression models were applied. Findings: The pooled successful VBAC-rate was 74.6%. Italy had the highest proportion of women receiving none of the four intrapartum interventions amniotomy (ARM), oxytocin, epidural or opioids (42.5% vs Ireland: 26.8% and Germany: 25.3%, p < 0.001). Earlier performance of ARM was associated with successful VBAC (3.50 hrs vs 6.08 hrs, p = 0.004). A positive predictor for successful vaginal birth was a previous vaginal birth (OR=3.73, 95% CI [2.17, 6.44], p < 0.001). The effect of ARM increased with longer labour duration (OR for interaction term=1.06, 95% CI [1.004, 1.12], p = 0.035). Higher infant birthweight (OR per kg=0.34, 95% CI [0.23, 0.50], p < 0.001), ARM (reference spontaneous rupture of membranes (SROM), OR=0.20, 95% CI [0.11, 0.37], p < 0.001) and a longer labour duration (OR per hour=0.93, 95% CI [0.90, 0.97], p < 0.001) decreased the odds of a vaginal birth. Key Conclusion: Women with a previous vaginal birth, an infant with a lower birth weight, SROM and a shorter labour duration were most likely to have a successful vaginal birth. If SROM did not occur, an earlier ARM increased the odds of a vaginal birth. Implication for Practice: Labour progress should be a

Objective: This study investigated how health care provider communication of risk information, and women's role in decision-making, influenced women's preferences for mode of birth after a previous caesarean birth. Methods: Women (N = 669) were randomised to one of eight conditions in a 2 (selectivity of risk information) × 2 (format of risk information) × 2 (role in decision making) experimental design. After exposure to a hypothetical decision scenario that varied information communicated by an obstetrician to a pregnant woman with a previous caesarean birth across the three factors, women were asked to decide their preferred hypothetical childbirth preference. Results: Women provided with selective information (incomplete/biased toward repeat caesarean) and relative risk formats (ratio of incidence being compared e.g. 2.5 times higher), perceived lower risk for caesarean and were significantly more likely to prefer repeat caesarean birth than those provided with non-selective information (complete/unbiased) and absolute risk formats (incidence rate e.g. 0.01 per 100). Role in decision-making did not significantly influence childbirth preferences Conclusions: Modifiable aspects of healthcare provider communication may influence women's decision-making about childbirth preferences Practice implications: Optimised communication about risks of all options may have an impact on over-use of repeat CS.

Purpose: There is a need to gain deeper knowledge about women’s experience of vaginal birth after caesarean section (VBAC). Considerable research has been conducted on VBAC; however, only a few qualitative studies focus on women’s experiences. Therefore, the aim of this study was to describe the lived experiences of VBAC among women resident in Sweden, a country with a high VBAC rate. Method: This studywas performed in accordance with a phenomenological reflective lifeworld approach. Interviews were conducted with nine women in an urban region of Sweden one year after their VBAC birth. Results: The essential meaning of the studied phenomenon is “to challenge oneself as a childbearing woman”, which is further described by its four constituents: “striving for support from professionals”, “desiring the experience”, “contrasting and comparing memories of two different births” and “being part of the birthing culture”. Conclusions: The experience of VBAC meant regained trust in the ability to give birth vaginally. The women lacked follow-up and support after the caesarean section (CS), during the subsequent pregnancy and the forthcoming VBAC. Enhanced support could be a key factor in helping women meeting the challenge and feel confident about giving birth vaginally despite their previous experiences of CS.

Objective: Knowledge about labour characteristics of women achieving successful vaginal birth after caesarean section (VBAC) might be used to improve labour and birth management. This study examined sociodemographic and labour process-related factors regarding a) differences between countries, b) the comparison of successful VBAC with unplanned caesarean section, and c) predictors for the success of planned VBAC in three European countries. Design: We analysed observational data collected within the OptiBIRTH trial, a cluster-randomised controlled trial. Setting: Fifteen study sites in Ireland, Italy and Germany, five in each country. Participants: 790 participants going into labour for planned VBAC. Measurements: Descriptive statistics and random-effects logistic regression models were applied. Findings: The pooled successful VBAC-rate was 74.6%. Italy had the highest proportion of women receiving none of the four intrapartum interventions amniotomy (ARM), oxytocin, epidural or opioids (42.5% vs Ireland: 26.8% and Germany: 25.3%, p < 0.001). Earlier performance of ARM was associated with successful VBAC (3.50 hrs vs 6.08 hrs, p = 0.004). A positive predictor for successful vaginal birth was a previous vaginal birth (OR=3.73, 95% CI [2.17, 6.44], p < 0.001). The effect of ARM increased with longer labour duration (OR for interaction term=1.06, 95% CI [1.004, 1.12], p = 0.035). Higher infant birthweight (OR per kg=0.34, 95% CI [0.23, 0.50], p < 0.001), ARM (reference spontaneous rupture of membranes (SROM), OR=0.20, 95% CI [0.11, 0.37], p < 0.001) and a longer labour duration (OR per hour=0.93, 95% CI [0.90, 0.97], p < 0.001) decreased the odds of a vaginal birth. Key Conclusion: Women with a previous vaginal birth, an infant with a lower birth weight, SROM and a shorter labour duration were most likely to have a successful vaginal birth. If SROM did not occur, an earlier ARM increased the odds of a vaginal birth. Implication for Practice: Labour progress should be a

Background: Caesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians’ views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of “OptiBIRTH”, an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates. Methods: Focus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country. Results: The findings are presented in four main categories with several sub-categories: 1) “prameters for VBAC”, including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) “organisational support and resources for women undergoing a VBAC”, meaning a successful VBAC requires clinical expertise and resources during labour; 3) “fear as a key inhibitor of successful VBAC”, including understanding women’s fear of childbirth, clinicians’ fear of VBAC and the ways that clinicians’ fear can be transferred to women; and 4) “shared decision making – rapport, knowledge and confidence”, meaning ensuring consistent, realistic and unbiased

Complex interventions encompassing several interconnecting and interacting components can be challenging to evaluate. Examining the underlying trial processes while an intervention is being tested can assist in explaining why an intervention was effective (or not). This paper describes a process evaluation of a pan-European cluster randomised controlled trial, OptiBIRTH (undertaken in Ireland, Italy and Germany), that successfully used both quantitative and qualitative methods to enhance understanding of the underlying trial mechanisms and their effect on the trial outcome.

Complex interventions encompassing several interconnecting and interacting components can be challenging to evaluate. Examining the underlying trial processes while an intervention is being tested can assist in explaining why an intervention was effective (or not). This paper describes a process evaluation of a pan-European cluster randomised controlled trial, OptiBIRTH (undertaken in Ireland, Italy and Germany), that successfully used both quantitative and qualitative methods to enhance understanding of the underlying trial mechanisms and their effect on the trial outcome.

Background: Caesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians’ views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of “OptiBIRTH”, an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates. Methods: Focus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country. Results: The findings are presented in four main categories with several sub-categories: 1) “prameters for VBAC”, including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) “organisational support and resources for women undergoing a VBAC”, meaning a successful VBAC requires clinical expertise and resources during labour; 3) “fear as a key inhibitor of successful VBAC”, including understanding women’s fear of childbirth, clinicians’ fear of VBAC and the ways that clinicians’ fear can be transferred to women; and 4) “shared decision making – rapport, knowledge and confidence”, meaning ensuring consistent, realistic and unbiased

Bakgrund: Antalet kejsarsnitt har ökat i världen. En orsak till ökningen beror på kejsarsnitt till följd av ett tidigare kejsarsnitt, vilket i många länder anses vara ett hinder för en vaginal förlossning. Aktuell forskning visar dock att vaginal förlossning till följd av ett tidigare kejsarsnitt är ett säkert alternativ för de flesta kvinnor. Syfte: Att belysa kvinnors upplevelse kring att föda vaginalt efter ett tidigare kejsarsnitt. Metod: En kvalitativ intervjustudie med induktiv ansats. Materialet analyserades med innehållsanalys enligt Graneheim och Lundman. Resultat: Fyra kategorier påträffades; behov av verktyg inför den vaginala förlossningen, ett tidigare kejsarsnitt ger ett annat perspektiv på förlossningen, två separata upplevelser av att föda samt skillnader i perioden efter förlossningen. Konklusion: Till stor del upplevde kvinnorna det som positivt att få möjligheten att föda vaginalt efter ett tidigare kejsarsnitt. Det är därför viktigt att kvinnor ges denna möjlighet även i framtiden.

Darstellung des Themas: Eine vaginale Geburt nach Sectio im ausserklinischen Bereich wird momentan kontrovers diskutiert. In der Literatur und aktuellen Empfehlungen der Ärzte werden verschiedene Aspekte dagegen beschrieben. Neuere Studien und Erfahrungswerte der Hebammen im ausserklinischen Bereich zeigen jedoch ein anderes Bild. Ziel: Das Hauptziel der Arbeit ist aufzuzeigen, wie das mütterliche und kindliche Outcome bei VBAC im ausserklinischen Setting ist. Aus den gewonnenen Erkenntnissen sollen Empfehlungen für die Praxis abgeleitet werden. Methode: In diversen medizinischen Datenbanken wurden nach wissenschaftlicher Literatur gesucht. Es wurden sechs quantitative Studien zur Bearbeitung selektioniert und anhand vom EMED-Bewertungsraster auf ihre Evidenz geprüft. Resultate: Das mütterliche Outcome wurde anhand der Anzahl intrapartalen und postpartalen Verlegungen, erfolgreicher Vaginalgeburten und Uterusrupturen gemessen. Meist wurden keine signifikanten Unterschiede zwischen den Vergleichsgruppen gezeigt. Das kindliche Outcome wurde anhand der Verlegungsrate, den Apgarwerten und der Mortalitätsrate gemessen, wobei sich keine signifikanten Unterschiede zwischen den Vergleichsgruppen zeigten. Schlussfolgerung: Aufgrund der Studienauswertungen, Sichtung von Sekundärliteratur und persönlichen Erfahrungen als Hebammen, kann gesagt werden, dass ein ausserklinischer VBAC nicht für alle Frauen ausgeschlossen werden muss. Eine individuelle Beratung ist notwendig.

Darstellung des Themas: Eine vaginale Geburt nach Sectio im ausserklinischen Bereich wird momentan kontrovers diskutiert. In der Literatur und aktuellen Empfehlungen der Ärzte werden verschiedene Aspekte dagegen beschrieben. Neuere Studien und Erfahrungswerte der Hebammen im ausserklinischen Bereich zeigen jedoch ein anderes Bild. Ziel: Das Hauptziel der Arbeit ist aufzuzeigen, wie das mütterliche und kindliche Outcome bei VBAC im ausserklinischen Setting ist. Aus den gewonnenen Erkenntnissen sollen Empfehlungen für die Praxis abgeleitet werden. Methode: In diversen medizinischen Datenbanken wurden nach wissenschaftlicher Literatur gesucht. Es wurden sechs quantitative Studien zur Bearbeitung selektioniert und anhand vom EMED-Bewertungsraster auf ihre Evidenz geprüft. Resultate: Das mütterliche Outcome wurde anhand der Anzahl intrapartalen und postpartalen Verlegungen, erfolgreicher Vaginalgeburten und Uterusrupturen gemessen. Meist wurden keine signifikanten Unterschiede zwischen den Vergleichsgruppen gezeigt. Das kindliche Outcome wurde anhand der Verlegungsrate, den Apgarwerten und der Mortalitätsrate gemessen, wobei sich keine signifikanten Unterschiede zwischen den Vergleichsgruppen zeigten. Schlussfolgerung: Aufgrund der Studienauswertungen, Sichtung von Sekundärliteratur und persönlichen Erfahrungen als Hebammen, kann gesagt werden, dass ein ausserklinischer VBAC nicht für alle Frauen ausgeschlossen werden muss. Eine individuelle Beratung ist notwendig.

BACKGROUND: Caesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of "OptiBIRTH", an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates. METHODS: Focus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country. RESULTS: The findings are presented in four main categories with several sub-categories: 1) "prameters for VBAC", including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) "organisational support and resources for women undergoing a VBAC", meaning a successful VBAC requires clinical expertise and resources during labour; 3) "fear as a key inhibitor of successful VBAC", including understanding women's fear of childbirth, clinicians' fear of VBAC and the ways that clinicians' fear can be transferred to women; and 4) "shared decision making - rapport, knowledge and confidence", meaning ensuring consistent, realistic and unbiased

BACKGROUND: Caesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of "OptiBIRTH", an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates. METHODS: Focus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country. RESULTS: The findings are presented in four main categories with several sub-categories: 1) "prameters for VBAC", including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) "organisational support and resources for women undergoing a VBAC", meaning a successful VBAC requires clinical expertise and resources during labour; 3) "fear as a key inhibitor of successful VBAC", including understanding women's fear of childbirth, clinicians' fear of VBAC and the ways that clinicians' fear can be transferred to women; and 4) "shared decision making - rapport, knowledge and confidence", meaning ensuring consistent, realistic and unbiased

Aim: In 2008, a Western Australian maternity hospital began a next birth after caesarean (NBAC) service to improve the quality of care offered to pregnant women who had experienced a caesarean section (CS) in a previous pregnancy. The aim of this study was to evaluate the NBAC service at three time points (booking visit, 36 weeks’ gestation and six weeks postnatal) to determine changes in childbirth fear, confidence, knowledge and intention to pursue a vaginal birth after caesarean (VBAC) in a current pregnancy, compared to those women receiving standard antenatal care. Method: A comparative descriptive study design was implemented following receipt of ethical approval from the study hospital. A total of 47 women who attended the NBAC service for their antenatal care and a comparison group of 45 women who attended the main hospital clinic were recruited. Descriptive statistics, chi-square and t-test analyses were used. Women provided additional qualitative comments at 36 weeks and six weeks postnatal regarding their perceptions of care, which were analysed using content analysis.Results: At recruitment, the comparison and NBAC groups were comparable for demographic variables and birth intention. Birth outcomes were not different with 15 out of 25 comparison women (60%) achieving their desired VBAC, compared to 20 out of 34 NBAC women (58.8%). At 36 weeks’ gestation, NBAC women had increased knowledge of behavioural techniques to assist with labour and birth (p=0.0004) and higher self-efficacy (confidence) scores (p=0.011). There were no differences in terms of childbirth fear with both groups reporting high mean childbirth fear scores. Content analysis highlighted the positive and negative aspects of women’s antenatal care experiences. Implications: Findings suggest that providing pregnant women who had experienced a previous CS with evidence-based information about birth options did increase their knowledge, confidence and satisfaction with care. Childbirth fear le

BACKGROUND: With cesarean rates around the world escalating, concern is growing around why women wanting a vaginal birth after cesarean (VBAC) are not achieving their goal. AIM: To gain an understanding of women’s perceptions of factors they felt contributed to not achieving a VBAC. SETTING AND PARTICIPANTS: Fifteen women were interviewed following a nonelective repeat cesarean section (NERCS). They had attended a Western Australian midwifery-led service, next birth after cesarean (NBAC), and labored but were not successful in achieving a VBAC because of reasons around delayed progress. Interview transcripts were analyzed using Colaizzi’s method of thematic analysis. FINDINGS: Five themes emerged: “Tentative commitment with lingering doubts,” “My body failed me,” “Compromised by a longer than tolerable labor,” “Unable to effectively self-advocate in a climate of power struggling and poor support,” and “The inflexibility of hospital processes.” The final theme included two subthemes: “Restrictive policies” on labor and use of the cardiotocography, “The CTG.” CONCLUSIONS: When labor did not progress as envisaged and hospital processes adversely affected how women were supported, women’s doubts around being able to achieve a VBAC were reinforced with a NERCS. Maternity services need to ensure clinical practice reflects best evidence while assuring staff are supportive of women’s choice.

BACKGROUND: In July 2008, a new midwife-led “Next Birth After Cesarean” (NBAC) service was launched at King Edward Memorial Hospital (KEMH) in Perth, Western Australia. Midwives from the NBAC service provide antenatal care, evidence-based information about birth choices, tailored birth preparation classes, and assistance with developing birth plans to pregnant women who have had a previous cesarean birth. OBJECTIVE: To determine the contributory factors that women who were cared for by the NBAC service and experienced a vaginal birth after cesarean (VBAC) perceived to be associated with achieving their desired mode of birth. METHODS: A qualitative descriptive approach was used for this study in which semistructured interviews were conducted with 13 participant women who have achieved a VBAC and were analyzed using a modified “constant comparison” technique. FINDINGS: Two key themes reflecting personal and professional factors comprising eight subthemes emerged from analysis of interview data. CONCLUSIONS: These findings offer a unique perspective on the phenomenon of achieving a VBAC and provide maternity care practitioners and policy makers around the world with valuable insights into how the care environment might be enhanced for women who would prefer a vaginal birth after their previous cesarean section.

This paper reports the findings of a small pilot study undertaken to identify women's perceptions of their Caesarean section and/or their experience of attempting to achieve a vaginal birth after Caesarean. Fifty-nine women replied to a survey designed and distributed by the consumer organisation Birthrites. The survey consisted of 22 closed and open-ended questions. Descriptive statistics and content analysis were used to analyse the data. Six major factors that impacted on women's perceptions of their birthing experience were identified: (i) ‘being supported’; (ii) ‘violated expectations’; (iii) ‘loss of control’; (iv) ‘health professionals’ language, attitudes and care practices’; (v) ‘the labour experience and the cascade of intervention’; and (vi) ’surgical birth and the separation from the baby’. The results support previous work in this area and demonstrate that some women suffer from psychological trauma following an emergency Caesarean section. The experiences of the women in this small study indicate a need for health professionals to not only better understand the distress that may occur but to also develop a greater understanding of the impact of their interactions with women. The study also provides a consumer ‘voice’ on current routine hospital policies surrounding vaginal birth after Caesarean and confirms the importance of choice, control and continuity of care for all women regardless of their ‘risk’ status.

Collagen IV and Iaminin play a key role in regulating stiffness, elasticity and flexibility of the vesico-uterine space (VUS) tissue. The neurotensin (NT), the neuropeptide tyrosine (NPY) and the protein gene product 9.5 (PGP 9.5) possessing vasorelaxation and tissue vascularization activities, play key roles in cervical ripening, scar innervations and pain control. We propose that the integrity of these substances in VUS tissue is compromised after Cesarean section (CS), since wound healing disturbances and pelvic pain, as well as pregnancy and delivery complications, are related with lower uterine segment dysfunctions after CS. Therefore, the contents of collagen IV, Iaminin, NT, NPY and PGP 9.5 nerve fibres from the VUS tissue samples obtained during the first CS and the repeated CS were comparatively studied. VUS specimens were collected from 104 patients during CS and evaluated by immunohistochemistry. Collagen IV and Iaminin were mostly found in the vascular membrane bounds and their images were quantitatively evaluated by Quantimet Leica analyzer software. Differences of collagen IV, Iaminin, NT, NPY and PGP 9.5 values in VUS tissue between the first CS and the repeat CS samples were calculated by Student's t-test. Reduced Iaminin and increased collagen IV values were observed in the VUS scar tissue after the repeated CS in comparison with those of VUS intact tissue obtained during the first CS. Significantly higher values of nerve fibres, containing NT, NPY and PGP 9.5 were registered in intact VUS tissue samples, respectively 5±0.7, 7±0.6 and 5±0.9 CU, than those of VUS scar tissue samples obtained during the repeated CS, respectively 3±0.6, 2±0.4 and 3±0.7 CU (p<0.05). The authors observed increased collagen IV and reduced Iaminin values after the repeated CS which might be the key signs of inflammatory damage of VUS scar tissue by CS. These findings were strengthened by the registration of decreased NT, NPY and PGP 9.5 values in the same samples, which ar