Clinician’s and women s perceptions of individual barriers for achieving a vaginal birth after cesarean (VBAC) in Iran: A qualitative content analysis

Background and Aim : High rate of repeated cesarean and its complications are the results of cesareantsunami in the last two decades in Iran and VBAC is an important strategy instead of repeated cesarean.Currently, rate of VBAC in health care system of Iran is very low and severely depended on individualperformance. The purpose of this study is identifying the clinician’s and women s perceptions of individualbarriers for achieving a VBAC.Methods : In this conventional content analysis, data collection was conducted with semi-structuredinterviews and one focus group discussion with health care providers and prior cesarean section mothers.The place of research was Mashhad University of Medical Sciences in 2017. 28 numbers of maternal healthprofessionals including gynecologists, midwives and family physicians at various professional positionsincluding clinical, managerial and executive, as well as previous cesarean mothers at different stagesincluding pregnancy, postpartum, and non-pregnancy entered in this study. All the interviews and focusgroup discussion were first recorded and then transcribed verbatim by the first researcher. Data analyzedby Graneheim and Lundman(2004) method and by the MAXQDA.10 software.Results : Individual barriers to VBAC were identified in five sub-categories: sense of danger , indolence , negative attitude , passive decision making and inefficiency of financial incentive .Conclusion : Planning to remove individual barriers including: To inform mothers about choice of birthmode and empowering them in shared decision making, improving maternity care and create supportiveenvironment, report of VBAC outcomes in health system, organization of VBAC care team and strategieslike these can help to promote VBAC rate and decrease the cesarean section rate.

Keywords:

Vaginal birth after cesarean section , VBAC , barriers , individual