Responses to Vaginal Birth After Cesarean Section



    Corresponding author
    1. Jacqueline Fawcett, RN, PhD, FAAN, is a professor at the University of Pennsylvania School of Nursing in Philadelphia.
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    1. Lorraine Tulman, RN, DNSc, FAAN, is an associate professor at the University of Pennsylvania School of Nursing in Philadelphia.
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    1. Jane Perry Spedden, RN, is a staff nurse at Lancaster General Hospital in Lancaster, Pennsylvania.
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Address for correspondence: Jacqueline Fawcett, RN, PhD, FAAN, 720 Middle Turnpike, Storrs, CT 06268.


Objectives: To compare women's reactions to their experiences of vaginal birth after cesarean (VBAC) with their reactions to their previous cesarean birth experiences, to identify the factors that influenced the women's decision to attempt VBAC, and to describe the causes the women ascribed to the outcome of their birth experiences.

Design: An exploratory descriptive study derived from the Roy Adaptation Model of Nursing.

Setting: Hospital postpartum unit.

Participants: Thirty-two women who had experienced a VBAC.

Main outcome measures: The Perception of the Birth Scale and an investigator-developed questionnaire.

Results: The women reported moderately positive perceptions of the VBAC experience. However, the mean score was lower than previously reported means for vaginally delivered women. A statistically significant association (χ2=22.70, p<0.0005) was found between type of delivery and adaptive and ineffective responses within the Roy Adaptation Model modes, with a greater proportion of adaptive responses to the VBAC than the previous cesarean. Information from Obstetricians, nurses, family members, and print media influenced women's decisions to attempt the vaginal birth. Most causes ascribed to the successful VBAC came from external sources, were particular to a given pregnancy, and were beyond the woman's control.

Conclusions: The women reported both positive and negative aspects of childbearing, regardless of mode of delivery. The results indicate a need for a high quality of nursing and obstetric care for all women, with an emphasis on relief of pain and the provision of support and information.