Women's Perceptions of Contributory Factors for Not Achieving a Vaginal Birth After Cesarean (VBAC)

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.