Background: The most common reason for caesarean section (CS) is repeat CS following previous CS. Vaginal birth after caesarean section (VBAC) rates vary widely in different healthcare settings and countries. Obtaining deeper knowledge of clinicians’ views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Interview studies with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of ‘OptiBIRTH’, an ongoing research project. The study reported here is based on interviews in high VBAC countries. The aim of the study was to investigate the views of clinicians working in countries with high VBAC rates on factors of importance for improving VBAC rates. Methods: Individual (face-to-face or telephone) interviews and focus group interviews with clinicians (in different maternity care settings) in three countries with high VBAC rates were conducted during 2012–2013. In total, 44 clinicians participated: 26 midwives and 18 obstetricians. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country. Results: The findings are presented in four main categories with subcategories. First, a common approach is needed, including: feeling confident with VBAC, considering VBAC as the first alternative, communicating well, working in a team, working in accordance with a model and making agreements with the woman. Second, obstetricians need to make the final decision on the mode of delivery while involving women in counselling towards VBAC. Third, a woman who has a previous CS has a similar need for support as other labouring women, but with some extra precautions and additional recommendations for her care. Finally, clinicians should help strengthen women’s trust in VBAC, including building their trust in giving birth vaginally, recognising that giving birth naturally is an empowering experience for women, alleviating fear and offering extra visits to discuss the previous CS, and joining with the woman in a dialogue while leaving the decision about the mode of birth open. Conclusions: This study shows that, according to midwives and obstetricians from countries with high VBAC rates, the important factors for improving the VBAC rate are related to the structure of the maternity care system in the country, to the cooperation between midwives and obstetricians, and to the care offered during pregnancy and birth. More research on clinicians’ perspectives is needed from countries with low, as well as high, VBAC rates.
MULTIFILE
In ons dagelijkse leven hebben we veel met technologie te maken, vaak met interactieve, informatie-gerichte technologie: als consument doen we online boodschappen – zeker in deze pandemische tijd; als reiziger in het openbaar vervoer plannen en betalen we onze reis met interactieve technologie – nu weliswaar even wat minder; als weggebruiker navigeren we op basis van technologie; en ons energieverbruik in huis wordt ‘smart’ gemeten en geadministreerd. Als burger staan we steeds vaker middels technologie in contact met overheden. Denk aan alle online communicatie met de overheid, zo als de belastingdienst en gemeenten die middels apps, websites en de ‘Berichtenbox’ van ‘MijnOverheid’ met burgers communiceren. En er wordt over burgers en ons gedrag al heel wat data verzameld, door gemeenten, de politie, door bijvoorbeeld de zorgsector. En ook in de publieke ruimte wordt data verzameld – met smart city technologie, zoals camera’s en sensoren – met als doel om de stad veiliger, efficiënter en leefbaarder te maken. Al die ‘big data’ maakt het mogelijk om inzichten te genereren – al dan niet met kunstmatige intelligentie – en besluiten te nemen. We gebruiken technologie ook om als burger zelf actie te ondernemen. Bij de overheid kunnen we met apps melden wat er op straat verbeterd of onderhouden moet worden. Met onze buren zitten we in een WhatsApp groep of NextDoor, om bij te dragen aan de leefbaarheid en veiligheid van de buurt. We kunnen met smart home tools of citizen science kits de luchtkwaliteit meten, binnenshuis, maar ook buitenshuis. We tekenen petities, doen mee aan peilingen en enquêtes. En social networking sites (SNS) worden intensief gebruikt, voor sociale en professionele relaties, maar ook om maatschappelijk actief te zijn, voor het organiseren van het samenleven in een buurt. We weten inmiddels dat social media ook een effectief kanaal zijn om de democratie te beïnvloeden. Burgers komen dus in aanraking met veel verschillende technologieën, met verschillende doelstellingen, resultaten en bijeffecten, en waaraan mensen in allerlei functies en rollen deelnemen. Wat centraal staat in het vakgebied Civic Technology is dat de technologie in dienst staat van het burgerschap.
The obser-view is a method to generate data and create a learning space for both researcher and participants in qualitative research. It includes reflection between the two after the researcher has observed the participant. This article aims to reveal the benefits and challenges encountered when using the obser-view in two different research projects. In a Dutch project whose aim was to empower residents with dementia, in nursing homes the obser-view was used to generate data and create space for reflection which included residents and the family members. It showed that the obser-view cannot be finished when reflection does not happen. A Danish project with the aim to map the practice for inmates’ opportunities for education and job guidance highlighted that it made participants—educational prison leaders and teachers—aware they were doing their jobs by rote and showed the difficulties the researcher had trying to reflect with some participants. In both projects the obser-view created a learning space for participants. A benefit of the obser-view is that it can be used in dissimilar settings with different research purposes and with vulnerable and stigmatized people often excluded from the research. A challenge is for the researcher to reflect with participants, which is more likely to be successful if they have had time to develop a trusting relationship. Although the obser-view is a novel method in qualitative research, it has proved useful in different settings. It is a valuable method and we recommend developing it further in additional different settings with different populations.
