Health care system barriers to vaginal birth after cesarean section (VBAC). A qualitative study

Background and Aim : Approximately half of mothers give birth by cesarean section in Iran and twothirdsof them are repeated cesareans. Repeated cesarean is threatening for the mothers and newborns andnot compatible with fertility policies in Iran. Vaginal Birth After Cesarean (VBAC) is a reasonable strategybut its prevalence is very low due to some barriers. The aim of this study was to explore barriers to VBACin health care system.Methods : In this qualitative study, 26 semi-structured individual interviews with maternity care providersand mothers with prior cesarean section as well as one focus group discussion with maternity care providerswere conducted. Interviews and focus group session were tape-recorded, transcribed verbatim and analyzedwith conventional content analysis developed by Graneheim & Lundman (2004) using MXQDA10softwareResults : : Barriers to VBAC in health care system identified in the main category of the climate ofrestriction, fear and discourage and eight sub-categories including: Defective access to specializedservices , insufficient encouragement system , modeling in cesarean section , Physician-centerednessin VBAC , Fear of legal responsibilities , Imposed policies , marginalization of midwives and unsupportive birth team .Conclusion : To remove barriers of VBAC in health care system, appropriate strategies including:establishment of specialized VBAC counseling centers, performance-based incentive policies, culturaldevelopment 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.Future research could be focused on the effect of implementing these strategies to decrease repeat cesareansection rate.

Keywords:

Vaginal birth after cesarean section , VBAC , barriers , health care system , qualitative study