Table 2:
Woman-Experienced Factors Related to Accessing VBAC in the United States and Exemplary Quotes
| Specific Factor | Exemplary Quote |
|---|---|
| Lack of knowledge20,26,33,37,41 | “Women anticipating birth in a hospital prohibiting VBAC are often unaware of their right to refuse the surgery, or they do not know how to assert those rights.”41(pp117−118); author |
| Body: Body as inadequate29,33 | “Her reasoning is that because I’ve laboured before and dilated fully to 10 cm and was still unable to get my baby out that chances are my pelvis is either misshapen or too small.”29(p170) a; research participant |
| Psychological: Fear and concern about risk29,33,38 | “… most agree that the safest place for me is to VBAC in a hospital with a supportive staff. I am scared over these risks, no matter how small, and frightened of these doctors who would judge me harshly …”29(p171); research participant |
| Psychological: Concern about loss of control29,38 | “As much as I want to be in control, I’m not in control of that experience.”38(p90); research participant |
| Knowledge30,32–34,37,39 | “I was armed with all that information when I went in to talk to the doctor”32(p668); research participant |
| Body: Belief in birth/ trust in body20,29,30,32,34,38 | “I’m doing this, I know what my body’s doing, it can do this.”34(p774); research participant |
| Body: Expected easier recovery33,38 | “I always thought that there were so many advantages to doing the VBAC, and the biggest one in my mind was really the quicker recovery time.”38(p87); research participant |
| Body: Prior vaginal birth38 | “Both definitively stated that they had a superior experience with their [previous] vaginal birth: ‘I had a great birth experience with him. It was really good.’”38(p69); author and research participant |
| Psychological: VBAC as healing29,30,38 | “… I was in disbelief. My body had done this all on its own, my body wasn’t a failure … I used to cry whenever I talked about the birth of my oldest children. I felt empty and like something was stolen from me. But now I feel like I have healed…”30(p86); research participant |
| Psychological: Sense of control30,32,37,38 | “I had a lot more control over [the decision whether to attempt VBAC or have a repeat cesarean].…I had a lot more input … a lot of it is control.”32(p668); research participant |
| Psychological: Self-advocacy30,33,37 | “Unlike with my first pregnancy, I was educated about the different interventions and medications and was able to advocate for myself. I was confident and bold enough to say no when the doctors on call attempted to rush and intimidate me into breaking my water too early. I was bold enough to fire one doctor who was clearly not in support of my VBAC and was cocky and even rude …”30(p85); research participant |
| Psychological: Determination30,32,34,37 | “So you’re in this stigma that you can’t do it and obviously I wanted to prove everybody wrong that I can do it”37(p199); research participant |
| Support of other women29,30,37,39 | “In preparing for the birth of my second child and talking to many other women who were doing the same”29(p170); research participant |
| Family support33,37 | “We looked up research together, and we were trying to make the decision mutually but he kept saying this is your body…whatever you want to do it is your body…I’ll support you.”37(p194); research participant |
| Cultural factors38 | “I guess it’s [decision to plan VBAC] partly probably our generation is, like, big on the natural birth thing and breastfeeding. And as my friends have, like, started to have kids and the conversation about birth has happened, more and more people talk about midwives and trying to do it naturally.”38(p67); research participant |
| Unsupportive provider20,26,29–31,33,35–37,40,41 | “I was always told by my doctors that because I had my first c-section that I would have to keep having them, even though my first c-section was the result of an induction gone wrong. There was no medical reason that I couldn’t have a vaginal birth, so when I discovered other women were having vaginal births after c-sections I was angry. I felt lied to … manipulated.”30(p82); research participant |
| Health system barrier: VBAC bans20,21,26,29,33,36,38–41 | “Pregnant with her fourth child, [JZ] planned to give birth at her local hospital, as she had done with her first three children. However, just a few months short of her due date, her doctor informed her that due to a recent change in the hospital’s policies, she would have to schedule a cesarean. During her second pregnancy, [JZ] had a placental abruption and an emergency cesarean. Although she had a successful vaginal birth with her third pregnancy, the hospital is one of hundreds of hospitals that prohibit vaginal birth after cesarean (VBAC), and their new policy would require her to have a medically unnecessary cesarean that she did not want.”41(p105); author |
| Health system barrier: Distance20,21,26,31,36,41 | “I am having an impossible time finding a hospital that does VBACs in my state that isn’t over 2 hours away!”31(p279); research participant |
| Financial: Insurance38,40 | “Insurance would only cover delivery at [X] Hospital and she called every obstetrician with privileges there. Just one told her she would allow a vaginal birth, but she added that [she] was too far along to transfer care.”40(p142); author |
| Financial: Lack of resources21,41 | “Many other women have chosen repeat [cesarean] at our facility due to lack of resources rather than preferences. Half of our obstetric patients are [publicly] insured. They frequently do not have reliable transportation, family support, or education that would enable them to seek delivery in another city and hospital.21(p1001); author |
| VBAC supportive provider29,32,35,37,38 | “Sally is the fourth provider I’ve seen during this pregnancy and I just started with her at 28 weeks! It took me that long to find a provider AND a hospital that would be supportive in this endeavor [VBAC]!!”29(p171); research participant |
| VBAC supportive policies and procedures29,37 | “You could tell they [the birth unit nurses] were all rooting for me to have this baby vaginally…they all knew that I wanted to have the vaginal birth.”37(p200); research participant |
a
“Labour” is used instead of “labor” throughout the Dahlen et al study,29 likely because it was published in a UK-based journal. However, they noted that most of the blog posts were from US women.