In many countries, cesarean section is routinely used if the woman previously gave birth by cesarean section. Doctors and midwives in countries with a high rate of vaginal births after cesarean sections have for the first time been asked in a study to give their views on how to increase the percentage of vaginal births.
The summarized research shows that a vaginal birth is preferable in the next childbirth for most women who have given birth by cesarean section. In spite of this, cesarean section is routinely used in many countries.
The on-going EU project OptiBirth seeks to increase the rate of vaginal births in three countries with high cesarean section rates: Germany, Ireland and Italy. In these countries, a woman-centred intervention is now tested that targets the women and their partners as well as doctors and midwives.
Views of Obstetricians and Midwives
Professor Ingela Lundgren at Sahlgrenska Academy is leading the research group that as a base of the intervention, interviewed doctors and midwives in the participating countries. Focus groups and individual interviews were held with 18 obstetricians and 26 midwives from countries with a high rate of vaginal births after cesarean sections – Finland, Sweden and the Netherlands – to gather their views of how the rate of vaginal births can be increased.
“The results show that there must first and foremost be a common approach where vaginal birth is the first alternative if there are no complications or risk factors. The staff must feel secure in a vaginal birth, and work in teams and according to a model that everyone follows,” says Ingela Lundgren, Professor at Sahlgrenska Academy.
More factors that affect the proportion of cesarean sections, according to the doctors and midwives in the study, are the attitude in the society to childbirth, how the decision about mode of delivery is made and by who, the collaboration between doctors and midwives and between the women and the staff, and what the follow-up after the first cesarean section looked like.
The woman should be involved, for example, by a plan being prepared before the delivery. The staff needs to strengthen the woman’s faith in the delivery, provide support in the event of fear of childbirth and offer time to discuss the earlier cesarean section. It is important to not decide between cesarean section or vaginal birth too early and there should be time to process the earlier birth experience.
“The woman should be involved in making decisions on mode of delivery, but the final decision on a cesarean section or vaginal birth must be made by a doctor with expertise, according to the doctors and midwives in the study”, says Ingela Lundgren.