Clinicians' and Midwives' Views of Factors Influencing Decision-making for Vaginal Birth after Caesarean Section: A Qualitative Study

Clinicians' and Midwives' Views of Factors Influencing Decision-making for Vaginal Birth after Caesarean Section: A Qualitative Study
Roghieh Bayrami,¹ Roksana Janghorban ,^2,*
1. Department of Midwifery, School of Nursing and Midwifery, Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
2. Department of Midwifery, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Introduction: Caesarean section (CS) rates are increasing in both developed and developing countries. Vaginal birth after cesarean (VBAC) is an important option for reducing the CS rate.The purpose of this study is to explore clinicians' and midwives' views of factors influencing decision-making for VBAC based on the theory of planned behavior.
Methods: This qualitative study was carried out in Urmia- Iran, during 2017-2018. Data were collected using in-depth semi-structured interviews with 21 obstetricians and midwives. Participants were selected among governmental hospitals through purposeful sampling until data saturation was reached. Data were analyzed through a directed content analysis approach using the MAXQDA software version 10.
Results: Three themes and seven sub-themes including 1. "attitude toward VBAC": positive attitude and negative attitude; 2. "control belief": organizational support, fear, and self-efficacy; and 3. "subjective norms": peer recommendation and maternal perceived pressure were emerged from data analysis.
Conclusion: Clinicians' and midwives' positive attitude and clinicians' self-efficacy could reinforce their intentions to select VBAC and support the mother. Insufficient organization support, clinicians' and midwives' negative attitude, clinicians' and women's fear, clinicians' peer recommendation and pressure of outside sources, which is perceived by mothers, could be barrier factors for VBAC.
Keywords: Vaginal birth after cesarean, cesarean section, clinicians, midwives, delivery, qualitative research