OptiBIRTH
WG2:Development of the women-centred intervention
Leader: Ingela Lundgren, University of Gothenburg, Sweden
WG2: Intervention development
Focus groups interviews with women, their partners (if
desired), physicians and midwives
Countries with high VBAC-rates 45-55% - Finland, Sweden and
the Netherlands
2 groups with 6-8 women (one urban and one rural)
and 2 with 6-8 professionals in each country, total 12 groups
Countries with low VBAC-rates 29-36 % - Italy, Germany, and
Ireland
1 groups with 6-8 women and 1 with 6-8 professionals (in each
of 7-8 maternity units allocated randomly to the experimental
group), total 14-16 groups
Questions to the focus groups
Five major questions will be asked:
1) In your opinion, what are the important factors for a
successful VBAC?;
2) What are the barriers to successful VBAC?;
3) What was/is important to you as a birth-giving
woman/professional?;
4)What is your view on shared clinical decision-making
(i.e. making decisions on aspects of your/women’s/
partner’s care and sharing decision-making with others)?;
5) How can you support women to be confident with VBAC
(for example women with fear of childbirth).
OptiBIRTH
Data analysis:
Conduct month 3 (in countries with low VBAC randomized)
Analysis complete month 5
Data analysis:
Content analysis based on the 5 questions,
analysed in main categories and sub- categories; one for women
and one for professionals
Data analysis first level in different countries (5-10 subcategories/
question in English)
Skype meeting analyse in whole group
WG-leader next step analyse all text
New Skype meeting for feed-back
Completed January 2013
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Status – focus groups
Ethical approval in October
Finland: ethical approval in process, Kuopio and Helsinki or
Tampere
Sweden: ethical approval in process, Gothenburg and
Borås/Skövde
The Netherlands: ethical approval in process
Ireland: ???
Italy: ethical approval for Genoa, other regions in process
Germany: ethical approval in process, Hannover and ??
Interviews with women postpartum and during
pregnancy (Ireland)
Interviews with obstetricians and midwives in one
group or different groups
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Systematic reviews
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1. Women-centred antenatal interventions for increasing VBAC
rates and reducing fear of childbirth
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2. Clinician-centred interventions for increasing VBAC rates and
reducing fear of childbirth in women and apprehension in
clinicians
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Keywords VBAC, vaginal birth after caesarean section (spelling)
women-centred (spelling), interventions, clinician-centred
(spelling), experiences, decision-making, success, barriers,
professionals, health care professionals, midwives, obstetricians.,
preferences, fear of childbirth, choice, options, tocophobia,
anxiety, PTSD, traumatic birth, TOL, medical litigation
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Complete Month 4
Background
‘Groping through the fog’: a metasynthesis of women´s
experiences on VBAC (Vaginal birth after Caesarean section)
Ingela Lundgren, Cecily Begley, Mechthild M Gross and Terese Bondas
BMC Pregnancy and Childbirth 2012, 12:85 (21 August 2012)
The objective of this metasynthesis is to integrate the
findings and deepen the understanding of women’s
experiences of VBAC.
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1981 articles (VBAC)
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142 articles (Keywords VBAC, vaginal birth after caesarean
section, qualitative study, experiences, qualitative and women´s
experiences in various combinations)
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Exclusion: quantitative studies, studies about health care
professionals’ experiences
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22 articles (read)
Exclusion: not focusing women´s experiences, only focusing
experiences of CS in relation to VBAC
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11 articles
Exclusion: Quality check by 45-items based by COREQ 32-item
[27] and Walsh and Downe [28].
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 8 articles included in the metasynthesis
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Figure 1. Flow chart summarizing search strategy.
 Results
Studies from UK (1), US (3) and Australia
(4)
 Metaphor; groping through the fog
 giving birth vaginally after a previous CS
is experienced as paradoxical
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Four main themes
and sub-themes
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Own strong responsibility for giving birth
vaginally
In relation to the women themselves
In relation to information
In relation to health-professionals
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Vaginal birth after CS is a risky project
To have to confront serious risks mediated by healthprofessionals
Lack of information about the benefits of vaginal birth
Not supported if you want a VBAC
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Vaginal birth has several positive aspects
mainly described by women
Good for the baby and the mother- baby relationship
A meaningful experience of importance for them as women
An easier birth in relation to recovery afterwards
Some health professionals are pro VBAC
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To be involved in decision about mode of
delivery is difficult but important
Not being informed enough
Conflicting information
Important to have a choice
Uncertainty in relation to choice
Information/support from others not the hospital
Support from professionals
Experiences from the last birth influence the choice
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Questions:
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Language for transcriptions?
Data-analysis in the different countries to
which level?
Last step by the responsible scientific person
(IL)?
Involvement by IL in the different countries?
Analysis in two steps?
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Questions for Cecily:
Pregnancy or after birth CS?
Different groups in low and high VBACcountries?
New questions from the groups
Is it OK with individual interviews; Ireland
the Netherlands.
Randomization low VBAC countries
Focus groups as part of the intervention?