“Can’t Save Yourself Alone”: a metasynthesis of clinicians’ experiences on Vaginal birth after Caesarean section

Abstract

Introduction: Increasing the rate of vaginal births after cesarean sections (VBAC) is crucial for addressing the rising prevalence of cesarean sections (CS). Despite its potential benefits, the rate of VBAC remains low, and progress in increasing these rates over time has been minimal. Promoting VBAC is a key intervention to reduce CS rates, yet it is underutilized. Clinicians' perspectives on VBAC play a significant role in this context, but there is a scarcity of qualitative studies exploring their views. This review article aims to explore and interpret qualitative evidence from clinicians' views and experiences regarding VBAC.

Methods: A meta-synthesis based on the interpretative meta-ethnography method was conducted. The inclusion criteria were peer-reviewed qualitative articles from various disciplines examining clinicians' perspectives on VBAC. Seven articles met the inclusion criteria.

Results: The included studies explored clinicians' attitudes towards VBAC concerning different aspects of the phenomenon. The main results are encapsulated in the metaphor "Can’t save yourself alone." Clinicians perceive themselves as key influencers in the woman's journey to choosing VBAC while acknowledging their challenges and need for support. The findings are further presented through four themes: “Feeling like the playmaker”, “Looking at women's desires with the eye of responsibility”, “Carrying your own personal and professional stances”, “Is it really worth it?”.

Discussion: To promote VBAC, clinicians need to remain united, prioritize effective communication, view each other with compassion, and share responsibilities with supportive healthcare organizations. More studies are necessary to explore local contexts and identify effective interventions to improve VBAC rates.