'Constructing identity' - An ethnography of women's participation in antenatal classes within a randomised trial (OptiBIRTH) aimed at increasing vaginal birth after caesarean section

Background: The OptiBIRTH trial aims to improve maternal health service delivery, and optimise childbirth, by increasing vaginal birth after caesarean section (VBAC) through enhanced patient-centred maternity care across... [ view full abstract ]

Background: The OptiBIRTH trial aims to improve maternal health service delivery, and optimise childbirth, by increasing vaginal birth after caesarean section (VBAC) through enhanced patient-centred maternity care across Europe. Embedded within this trial is an ethnography of cultural change surrounding the OptiBIRTH intervention, with the focus of this presentation on one aspect of this, the antenatal classes.

Aims and objectives: To present the findings of an ethnography of one component of the OptiBIRTH trial complex intervention, the antenatal classes.

Methods: Using an ethnographic approach, encompassing both participant and non-participant observation, in addition to field-notes, data were collected and analysed on women and clinicians attending and participating in the antenatal class component of the OptiBIRTH trial intervention. The analysis provides interpretations and understandings of the cultural context within which these classes are held and emergent changes as the classes and the trial progresses. Ethical approval for the ethnography has also been granted by the HSE Mid-Western Regional Hospital Research Ethics Committee and by the Faculty of Health Sciences Ethics Committee, Trinity College Dublin.

Findings: The findings of this aspect of the ethnography demonstrate that identity, largely influenced by clinicians’ (that is ‘Opinion Leaders’) through positive communication and language on VBAC, and personal success stories of women who have achieved a birth that they wanted, is constructed during participation in the OptiBIRTH antenatal class. This social construction includes both the collective identity that is created in the class by participants sharing their stories of previous birth experiences, to personal identity, centred on becoming a woman who is trying to have a natural birth.

Implications: The OptiBIRTH antenatal classes facilitate the construction of a new identity, for women who have undergone one previous caesarean section, by positively framing VBAC as achievable in the context of natural birth aspirations and desire.