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Health Care System Barriers to Vaginal Birth after Cesarean Section: A Qualitative Study

BACKGROUND: Approximately half of mothers give birth by cesarean section in Iran and two-thirds of them are repeated cesareans. Repeated cesarean is threatening for the mothers and newborns and not compatible with fertility policies in Iran. Vaginal Birth After Cesarean (VBAC) is a reasonable strate...

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Autores principales: Firoozi, Mahboobeh, Tara, Fatemeh, Ahanchian, Mohammad Robab, Latifnejad Roudsari, Robab
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299419/
https://www.ncbi.nlm.nih.gov/pubmed/32724765
http://dx.doi.org/10.4103/ijnmr.IJNMR_150_19
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author Firoozi, Mahboobeh
Tara, Fatemeh
Ahanchian, Mohammad Robab
Latifnejad Roudsari, Robab
author_facet Firoozi, Mahboobeh
Tara, Fatemeh
Ahanchian, Mohammad Robab
Latifnejad Roudsari, Robab
author_sort Firoozi, Mahboobeh
collection PubMed
description BACKGROUND: Approximately half of mothers give birth by cesarean section in Iran and two-thirds of them are repeated cesareans. Repeated cesarean is threatening for the mothers and newborns and not compatible with fertility policies in Iran. Vaginal Birth After Cesarean (VBAC) is a reasonable strategy but its prevalence is very low due to some barriers. The aim of this study was to explore barriers to VBAC in health care system. MATERIALS AND METHODS: In this qualitative study, 26 semi-structured individual interviews with maternity care providers and mothers with prior cesarean section as well as one focus group discussion with maternity care providers were conducted. Interviews and focus group discussions were tape-recorded, transcribed verbatim and analyzed with conventional content analysis developed by Graneheim and Lundman using MXQDA10 software. RESULTS: Barriers to VBAC in health care system identified in the main category of “the climate of restriction, fear and discourage” and eight subcategories including: “defective access to specialized services,” “insufficient encouragement system,” “modeling in cesarean section,” “physician-centeredness in VBAC,” “fear of legal responsibilities,” “imposed policies,” “marginalization of midwives,” and “unsupportive birth team.” CONCLUSIONS: To remove barriers of VBAC in health care system, appropriate strategies including establishment of specialized VBAC counseling centers, performance-based incentive policies, cultural development and promotion of natural childbirth, promoting of teamwork culture, shared decision making, improvement of knowledge and skills of maternal care providers and implementation of clinical guidelines, should be considered. Future research could be focused on the effect of implementing these strategies to decrease repeat cesarean section rate.
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spelling pubmed-72994192020-07-27 Health Care System Barriers to Vaginal Birth after Cesarean Section: A Qualitative Study Firoozi, Mahboobeh Tara, Fatemeh Ahanchian, Mohammad Robab Latifnejad Roudsari, Robab Iran J Nurs Midwifery Res Original Article BACKGROUND: Approximately half of mothers give birth by cesarean section in Iran and two-thirds of them are repeated cesareans. Repeated cesarean is threatening for the mothers and newborns and not compatible with fertility policies in Iran. Vaginal Birth After Cesarean (VBAC) is a reasonable strategy but its prevalence is very low due to some barriers. The aim of this study was to explore barriers to VBAC in health care system. MATERIALS AND METHODS: In this qualitative study, 26 semi-structured individual interviews with maternity care providers and mothers with prior cesarean section as well as one focus group discussion with maternity care providers were conducted. Interviews and focus group discussions were tape-recorded, transcribed verbatim and analyzed with conventional content analysis developed by Graneheim and Lundman using MXQDA10 software. RESULTS: Barriers to VBAC in health care system identified in the main category of “the climate of restriction, fear and discourage” and eight subcategories including: “defective access to specialized services,” “insufficient encouragement system,” “modeling in cesarean section,” “physician-centeredness in VBAC,” “fear of legal responsibilities,” “imposed policies,” “marginalization of midwives,” and “unsupportive birth team.” CONCLUSIONS: To remove barriers of VBAC in health care system, appropriate strategies including establishment of specialized VBAC counseling centers, performance-based incentive policies, cultural development and promotion of natural childbirth, promoting of teamwork culture, shared decision making, improvement of knowledge and skills of maternal care providers and implementation of clinical guidelines, should be considered. Future research could be focused on the effect of implementing these strategies to decrease repeat cesarean section rate. Wolters Kluwer - Medknow 2020-04-18 /pmc/articles/PMC7299419/ /pubmed/32724765 http://dx.doi.org/10.4103/ijnmr.IJNMR_150_19 Text en Copyright: © 2020 Iranian Journal of Nursing and Midwifery Research http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Firoozi, Mahboobeh
Tara, Fatemeh
Ahanchian, Mohammad Robab
Latifnejad Roudsari, Robab
Health Care System Barriers to Vaginal Birth after Cesarean Section: A Qualitative Study
title Health Care System Barriers to Vaginal Birth after Cesarean Section: A Qualitative Study
title_full Health Care System Barriers to Vaginal Birth after Cesarean Section: A Qualitative Study
title_fullStr Health Care System Barriers to Vaginal Birth after Cesarean Section: A Qualitative Study
title_full_unstemmed Health Care System Barriers to Vaginal Birth after Cesarean Section: A Qualitative Study
title_short Health Care System Barriers to Vaginal Birth after Cesarean Section: A Qualitative Study
title_sort health care system barriers to vaginal birth after cesarean section: a qualitative study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299419/
https://www.ncbi.nlm.nih.gov/pubmed/32724765
http://dx.doi.org/10.4103/ijnmr.IJNMR_150_19
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