Bridget Basile Ibrahim
Yale University
Bridget is a first year PhD student at Yale School of Nursing. She received her BSN from the Johns Hopkins University School of Nursing, her Family Nurse Practitioner MSN from the University of California, Los Angeles. She also holds a BA and MA in Cultural Anthropology from Boson University. Prior to returning to school, she worked extensively with underserved populations at community health centers in the U.S. and Canada. Her research focus for her doctoral work is in access to vaginal birth after cesarean (VBAC), maternal child health, health policy, and health disparities.
Purpose: To analyze and synthesize the existing literature to study the nonmedical factors affecting the availability of and access to VBAC in the United States. Specifically, to identify factors influencing VBAC accessibility and clarify barriers and facilitators to VBAC access in the U.S. as perceived by women.
Background/ Significance: Despite strong birth-professional organization recommendations and a host of short and long term benefits to both mother and child, vaginal birth after cesarean (VBAC) rates in the U.S. have been ~ 10% for over 10 years. Nonmedical factors that influence the availability of safe VBAC in the U.S. need to be explored.
Method: An integrative review of the literature (IR) was carried out using Whittemore and Knafl’s (2005) methodology. The IR methodology was selected as it is the only method to synthesize the literature that allows for the use of resources with diverse methodologies (Whittemore & Knafl, 2005). A literature search was completed in November 2016 on Scopus and Pubmed data bases. Various types of data sources were utilized in the final data collection and analysis (n=18): five published qualitative studies, two published quantitative studies, four literature reviews, two unpublished dissertations describing qualitative studies, three editorial pieces, one book, and one article in a law journal.
Results:
Thirteen patient-experienced facilitators were identified: (1) supportive provider, (2) supportive system,
(3) knowledge, (4) belief in birth, (5) belief in VBAC as healing, (6)
perceived easier recovery, (7) history of vaginal delivery, (8) perceived sense
of control, (9) self-advocacy, (10) determination, (11) peer support, (12) family support, and (13) cultural factors. Eleven patient-experienced barriers were identified: (1) unsupportive provider, (2) unsupportive system, (3) insurance, (4) fear, (5) concern about loss of control and (6) risk, (7)psychological factors, (8) lack of knowledge, (9) distance, (10) lack of resources, and (11) cultural factors. The 13 facilitators and 11 barriers identified were categorized into four types: (a) personal factors, (b) social factors, (c) system factors, and (3) external factors
Conclusions: Personal factors (knowledge, self-advocacy, determination, and trust in birth and one’s body) are the most influential facilitators to women accessing VBAC. System factors (unsupportive provider, VBAC bans, and insurance issues) are the most commonly reported barrier to VBAC for women in the U.S. Many factors are on a continuum of barrier to facilitator. Interventions that target an improvement in these factors have the potential to increase the VBAC rates across the U.S.
1. Studies that integrate knowledge from a range of scientific approaches and/or perspecti , Studies of and contributions to practice and/or service organisation , Social and cultural precursors and consequences of optimal childbirth
