Journal ArticleDOI
Do Women Have a Choice? Care Providers' and Decision Makers' Perspectives on Barriers to Access of Health Services for Birth after a Previous Cesarean.
Sarah Munro,Sarah Munro,Jude Kornelsen,Kitty K. Corbett,Elizabeth Wilcox,Nick Bansback,Patricia A. Janssen +6 more
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TLDR
This study sought to explore maternity care providers' and decision makers' attitudes toward and experiences with providing and planning services for women with a previous cesarean and found that the factors influencing decisions resulted from interactions between the clinical, organizational, and policy levels of the health care system.Abstract:
Background
Repeat cesarean delivery is the single largest contributor to the escalating cesarean rate worldwide. Approximately 80 percent of women with a past cesarean are candidates for vaginal birth after a cesarean (VBAC), but in Canada less than one-third plan VBAC. Emerging evidence suggests that these trends may be due in part to nonclinical factors, including care provider practice patterns and delays in access to surgical and anesthesia services. This study sought to explore maternity care providers’ and decision makers’ attitudes toward and experiences with providing and planning services for women with a previous cesarean.
Methods
In-depth, semi-structured interviews were conducted with family physicians, midwives, obstetricians, nurses, anesthetists, and health service decision makers recruited from three rural and two urban Canadian communities. Constructivist grounded theory informed iterative data collection and analysis.
Results
Analysis of interviews (n = 35) revealed that the factors influencing decisions resulted from interactions between the clinical, organizational, and policy levels of the health care system. Physicians acted as information providers of clinical risks and benefits, with limited discussion of patient preferences. Decision makers serving large hospitals revealed concerns related to liability and patient safety. These stemmed from competing access to surgical resources.
Conclusions
To facilitate women's increased access to planned VBAC, it is necessary to address the barriers perceived by care providers and decision makers. Strategies to mitigate concerns include initiating decision support immediately after the primary cesarean, addressing the social risks that influence women's preferences, and managing perceptions of patient and litigation risks through shared decision making.read more
Citations
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Constructing Grounded Theory: A Practical Guide through Qualitative Analysis
TL;DR: The Grounded Theory: A Practical Guide through Qualitative Analysis as mentioned in this paper, a practical guide through qualitative analysis through quantitative analysis, is a good starting point for such a study.
Journal ArticleDOI
Planned private homebirth in Victoria 2000–2015: a retrospective cohort study of Victorian perinatal data
TL;DR: A population based cohort study of all births in Victoria, Australia 2000–2015 found that planned homebirth was associated with significantly lower rates of all obstetric interventions and combined overall maternal and perinatal morbidities.
Journal ArticleDOI
Interventions targeted at health professionals to reduce unnecessary caesarean sections: a qualitative evidence synthesis
TL;DR: There is a synergistic relationship between maternity care health professionals' underpinning philosophy of birth, the social and cultural context they are working within and the extent to which they were prepared to negotiate within health system resources to reduce caesarean rates.
Journal ArticleDOI
Cultural perspectives on vaginal birth after previous caesarean section in countries with high and low rates - A hermeneutic study.
TL;DR: In order to improve VBac rates both maternity care settings and individual professionals need to reflect on their VBAC culture, and make make changes to develop a 'pro-VBAC culture'.
Journal ArticleDOI
Making shared decisions in relation to planned caesarean sections: What are we up to?
TL;DR: To map the literature in relation to shared decision making (SDM) for planned caesarean section (CS), particularly women's experiences in receiving the information they need to make informed decisions, their knowledge of the risks and benefits of CS, the experiences and attitudes of clinicians in connection to SDM, and interventions that support women to makeinformed decisions.
References
More filters
Constructing Grounded Theory: A Practical Guide through Qualitative Analysis
TL;DR: The Grounded Theory: A Practical Guide through Qualitative Analysis as mentioned in this paper, a practical guide through qualitative analysis through quantitative analysis, is a good starting point for such a study.
Journal ArticleDOI
Shared Decision Making: Examining Key Elements And Barriers To Adoption Into Routine Clinical Practice
Légaré F,Holly O. Witteman +1 more
TL;DR: The three essential elements of shared decision making are described: recognizing and acknowledging that a decision is required; knowing and understanding the best available evidence; and incorporating the patient's values and preferences into the decision.
Vaginal Birth After Cesarean: New Insights
Jeanne Marie Guise,Karen Eden,Cathy Emeis,Mary Anna Denman,Nicole Marshall,Rongwei Rochelle Fu,Rosalind Janik,Peggy Nygren,Miranda Walker,Marian McDonagh +9 more
TL;DR: This report adds stronger evidence that VBAC is a reasonable and safe choice for the majority of women with prior cesarean, and there is emerging evidence of serious harms relating to multiple cESareans.
Journal ArticleDOI
Vaginal Birth After Cesarean: New Insights on Maternal and Neonatal Outcomes
Jeanne Marie Guise,Mary Anna Denman,Cathy Emeis,Nicole Marshall,Miranda Walker,Rongwei Fu,Rosalind Janik,Peggy Nygren,Karen Eden,Marian S McDonagh +9 more
TL;DR: Overall the best evidence suggests that VBAC is a reasonable choice for the majority of women and definitive studies are lacking to identify patients who are at greatest risk for adverse outcomes.
Journal ArticleDOI
Guidelines for vaginal birth after previous caesarean birth
TL;DR: The Society o Obstetricians and Gynecologists of Canad offers the SOGC Guidelines without restric tions to interested associations and indiv duals; the publications may be reproduced printed or modified and adapted to clinical environments, without charge, an without the need to seek prior approva from the SogC.