Having an open mind- clinician attitudes to vaginal birth after caesarean section in Ireland

Presenting author: Patricia Healy Co-authors: Carroll, M. Begley C. Lalor J. Aim of Study: To explore clinician’s attitudes to vaginal birth after caesarean (VBAC) in order to identify important factors for success. ... [ view full abstract ]

Presenting author: Patricia Healy
Co-authors: Carroll, M. Begley C. Lalor J.

Aim of Study: To explore clinician’s attitudes to vaginal birth after caesarean (VBAC) in order to identify important factors for success.

Background:
Concern has been expressed at the rising caesarean section rates across the world, as caesarean birth carries a higher risk of maternal mortality and morbidity. Clinical decision-making is complex and the attitudes of clinicians and pregnant women play a part in determining the number of caesarean sections conducted in any maternity care service.

Methods and Results: Three focus group interviews were conducted with midwives, obstetricians and neonatologists (n=31) from three sites in Ireland as part of a larger trial the OptiBIRTH study. Clinicians were asked to identify the important factors for success and the perceived barriers to increasing VBAC rates locally. A key theme that emerged was having an ‘open mind’ which included raising the issue of a VBAC with women before their discharge following the caesarean or at the first opportunity in a subsequent pregnancy. Strategies suggested to prepare women included targeted antenatal education, having a champion midwife to ensure consistency of information and to support women throughout pregnancy. However, concerns were raised as to the impact of others, particularly relatives and family doctors with a negative attitude to VBAC, on the woman’s willingness to consider this option. Clinicians were also concerned that to minimise the risks, labour wards required adequate staffing by obstetricians and midwives with experience of VBAC.

Conclusions: Few studies have explored clinicians’ attitudes to VBAC, in particular when background rates are low. This study demonstrates that, in Ireland, clinicians have an ‘open mind’ to VBAC and with appropriate education and information packages, continuity of care from experienced staff and careful selection of women based on their obstetric history, increasing VBAC rates in maternity care settings is Ireland is possible.