Factors That Impact Access to Vaginal Birth After Cesarean: Perceptions of Obstetric Nurses
BACKGROUND: Despite evidence demonstrating the safety of a trial of labor for women with a history of cesarean, nearly half of California's birth hospitals do not support vaginal birth after cesarean (VBAC). Increasing access to VBAC can contribute to a reduction in cesarean birth and the optimization of perinatal health outcomes.
METHODS: Thematic analysis was used to identify key themes in 157 comments volunteered by obstetric nurses during a structured survey of all civilian hospitals with perinatal units in California.
RESULTS: Nurses described significant efforts of specific providers, or change agents, required to support VBAC at their institutions. A sense of pride was evident in comments from nurses who associated VBAC support with high quality care. Nurses identified insufficient anesthesia coverage, the influence of professional organizations, and lack of provider willingness as barriers to VBAC.
CONCLUSION: Clinical data support increased access to VBAC. However, many non-clinical factors at the institutional and individual level function as barriers to VBAC. More studies are needed that: 1) demonstrate the safety of VBAC in smaller community hospitals; and, 2) investigate the perceptions of emergency obstetric providers with regard to VBAC. Maternal health providers who care for women with a history of cesarean should discuss the risks and benefits associated with a trial of labor and elective repeat cesarean to support informed choice and refer patients to centers that support VBAC if their institution does not.