A Qualitative Inquiry to Explore Why Women with Previous Cesarean-Section Do Not Choose Vaginal Birth after Cesarean

Abstract

Background and Aim: Complications of cesarean-section are many times more than vaginal birth and increase with repeat it, despite mothers don’t choose vaginal birth after CS. Aim: The aim of the present study is to explain why previous cesarean section mothers not to choose VBAC? Methods: A conventional content analysis performed by 25 participants from previous CS mothers (pregnant/non-pregnant) and maternal health care  providers through semi-structured individual interviews and two focus group sessions in Om-Albanin hospital in Mashhad, Iran. The interviews lasted 30 - 90 minutes and their content was recorded, transcribed and analyzed using Graneheim & Lundman’s method (2004). Data validity was verified by Lincoln and Guba criteria. Results: The main category of "loneliness, weakness, fear in VBAC" emerged from three subcategories: "non-supportive individual-social perspective", " inefficient care "and "psychological fear of childbirth". Sub-subcategories identified as: First sub-subcategory: " opposite beliefs to VBAC" ,  "non-supportive community" and " non-supportive individual-social perspective". second includes: " inadequate provision of optimal care "," inadequate knowledge and awareness "," Weakness in decision self-efficacy "and" Weakness in effective counseling " and third  includes: " negative experiences of vaginal birth " , "feeling of danger" and "fear" . Conclusion: The mothers are conflict in choosing VBAC in three aspects: social, care system and individual dimensions. Comprehensive support including: cultural interventions for vaginal birth, planning a supportive  and special care system for previous CS mothers, increasing knowledge and correcting beliefs will help them in decision  self-efficacy. It is proposed planning of these strategies and assess their effectiveness.