Caesarean section (CS) rates are increasing worldwide, an increase that is multifactorial and not well understood. There is considerable variation in the rates of vaginal birth after previous Caesarean section (VBAC). Cultural differences could be one explanation of the varying rates.
To interpret cultural perspectives on VBAC.
A hermeneutic approach for analysing findings from four published qualitative studies that were part of the OptiBIRTH study, focusing on clinicians and women’s views of important factors for improving the rate of VBAC. 115 clinicians and 73 women participated in individual interviews and focus group interviews in countries with low rates (Germany, Italy and Ireland) and countries with high rates (Sweden, Finland and the Netherlands), in the original studies.
Three themes demonstrated how the culture differs between the high and low VBAC rate countries; from being an obvious first alternative to an issue dependent on many factors; from something included in the ordinary care to something special; and from obstetrician making the final decision to a choice by the woman. The fourth theme, preparing for a new birth by early follow-up and leaving the last birth behind, reflects coherence between the cultures.
The findings deepen our understanding of why the VBAC rates vary across countries and healthcare settings, and can be used for improving the care for women.
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’.
Problem or issue
The impact of culture on CS rates is an under researched area and may be a factor that is contributing to the low uptake in VBAC rates.
What is already known
Worldwide, CS rates are increasing and vary between countries. VBAC is an important mechanism for reducing the CS rates. However, the rates of VBAC also vary between countries.
What this paper adds
Evidence on different cultural perspectives on VBAC and their influence on women, professionals and the decision-making process.
- Vaginal birth after previous caesarean sectionHermeneuticCaesarean sectionCulture
- Caesarean section
- Vaginal birth after previous caesarean section