RESEARCH. Caesarian sections (CS) are becoming more common in Europe, but how common they are depends greatly on which country the woman is in. Research indicates that it is not women’s own wishes that are behind this increase, but rather the attitudes of the professionals that pregnant women encounter – something that has been confirmed by a new study that interviewed midwives and obstetricians from Ireland, Germany and Italy.
The EU’s OptiBIRTH project, which received several years of funding from the EU’s seventh framework program, was wrapped up recently at a meeting in Brussels. The project was coordinated by Professor Cecily Begley from Trinity College Dublin, who is also a visiting professor at the University of Gothenburg. The aim of the project was to increase the percentage of vaginal births among women with a previously CS (VBAC). The existing knowledge that provided the basis for OptiBIRTH shows that vaginal birth is the safest option for most women who have previously delivered a child via CS.
Ingela Lundgren, a professor in reproductive and perinatal health at the University of Gothenburg, took on the role of scientific leader for the work group who developed the project’s intervention. Christina Nilsson, a postdoctoral student, also contributed to the project.
“The intervention that was trialed in Germany, Ireland and Italy involved a special woman-centred program for pregnant. Training for doctors and midwives also formed part of the interventions, partly developed based on the studies of professionals done during the project,” Ingela Lundgren tells us.
The focus groups consisted of 71 doctors and midwives in Ireland, Germany and Italy, which are all countries in which a low proportion of VBAC. The results of the studies show that a positive attitude is required from everyone involved, as are sufficient childbirth-related resources, in order to increase the percentage of vaginal births.
“It is important for the professionals to have sufficient clinical expertise so that they feel confident handling vaginal births. With CS becoming more common, there is a major risk that clinical expertise will get lost – something we learnt in particular from information given by professionals in Italy,” says Ingela Lundgren.
The research also reveals that fear is a major barrier not only for women, but also for professionals, from choosing vaginal birth. Another factor is the decision-making process, which has also been described as problematic:
“The women need accurate and balanced information, and the relationship between her and the professionals needs to be built on trust. It is important to follow up on the first CS at an early stage and to give them the opportunity to ask questions and discuss the event before the next birth. Women need to be able to leave the first birth behind to be able to move on to the next one,” Ingela Lundgren continues.
Some of these findings are consistent with another research project conducted in Sweden, Finland and the Netherlands, countries in which there is a higher proportion of VBAC. Forty-four doctors and midwives were interviewed as part of this research, which also highlighted the importance of trust between the professionals and the woman, a positive attitude among everyone involved, early follow-up after the first CS, and of reducing the amount of fear. The research done in Sweden, Finland and the Netherlands did, however, reveal other factors that encourage vaginal birth, such as sharing the same views, a good working relationship between doctors and midwives, strengthen the woman’s confidence to give birth vaginally, and that the doctor make the final decision about vaginal birth or CS while involving the woman.
“These factors encouraging vaginal birth did not emerge from the second study, which indicates that there are considerable differences in attitudes, organization of healthcare and decision-making between countries with high and low VBAC rates.” says Ingela Lundgren.
The main OptiBIRTH study is expected to be published soon. A meeting catering specifically for women is also scheduled to take place in Gothenburg on January 31: http://130.241.135.136/2016/12/37160/.
