Women’s experience of vaginal birth after caesarean

Australian researchers have published a review and meta-synthesis of twenty research papers exploring women’s experience of vaginal birth after caesarean in a variety of birth locations. This is an important and valuable piece of work because, although we know that vaginal birth after caesarean is safe and can be very healing for women, the rates of this remain low in some areas, and we are curious as to why this is. One way to approach this question is to look at women’s views and experiences, and such research can also help us better plan care for similar women in the future.

This kind of research doesn’t deal in numbers, though. A meta-synthesis is based on qualitative research, and the results are expressed as a rich description of the themes that emerged. In this case:

“The overarching theme was ‘the journey from pain to power’. The theme ‘the hurt me’ describes the previous caesarean experience and resulting feelings. Women experience a journey of ‘peaks and troughs’ moving from their previous caesarean to their vaginal birth after caesarean. Achieving a vaginal birth after caesarean was seen in the theme ‘the powerful me,’ and the resultant benefits are described in the theme ‘the ongoing journey’.” (Keedle et al 2017).

The paper includes a useful table of the 20 papers that were analysed, along with a summary of the research methods and the themes that arose from each. The authors also use quotes from the individual papers to illustrate the themes that emerged, and some of these are quite harrowing to read. But there are also positive stories of how women healed through their next birth. Crucially, “This journey from pain to power is strongly influenced by the type of support provided by health care professionals (both negative and positive). Positive support from health care professionals is more common in confident practitioners and where there is continuity of care relationship with a midwife.” (Keedle et al 2017).

 

The Research

Background: Vaginal birth after caesarean can be a safe and satisfying option for many women who have had a previous caesarean, yet rates of vaginal birth after caesarean remain low in the majority of countries. Exploring women’s experiences of vaginal birth after caesarean can improve health practitioners’ understanding of the factors that facilitate or hinder women in the journey to have a vaginal birth after caesarean.

Methods: This paper reports on a meta-ethnographic review of 20 research papers exploring women’s experience of vaginal birth after caesarean in a variety of birth locations. Meta-ethnography utilises a seven-stage process to synthesise qualitative research.

Results: The overarching theme was ‘the journey from pain to power’. The theme ‘the hurt me’ describes the previous caesarean experience and resulting feelings. Women experience a journey of ‘peaks and troughs’ moving from their previous caesarean to their vaginal birth after caesarean. Achieving a vaginal birth after caesarean was seen in the theme ‘the powerful me,’ and the resultant benefits are described in the theme ‘the ongoing journey’.

Conclusion: Women undergo a journey from their previous caesarean with different positive and negative experiences as they move towards their goal of achieving a vaginal birth after caesarean. This ‘journey from pain to power’ is strongly influenced by both negative and positive support provided by health care practitioners. Positive support from a health care professional is more common in confident practitioners and continuity of care with a midwife.

 

Keedle H, Schmied V, Burns E et al (2017). The journey from pain to power: A meta-ethnography on women’s experiences of vaginal birth after caesarean. Women and Birth  https://doi.org/10.1016/j.wombi.2017.06.008
 photo credit: MabyCakes Post-birth bliss! via photopin (license)

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