Hospitalizations related to childbirth, Notably the cohort studies conducted by Hanley et al. Namely, one third of maternity care for birth after caesarean is provided by family physicians in Canada, while in the UK care is provided mainly by 38 obstetricians and midwives, and in the US largely by obstetricians. The current study offers such knowledge by using an iKT framework to explore attitudes toward and experiences with decision-making for birth after caesarean in the context 25 of British Columbia. They expressed confidence in their current access to surgical services, experience in working with limited resources, and no professional competition with other surgical specialties for access to the operating room. Avoidance was the most common strategy.

The phenomenon of decision-making after a previous caesarean emphasizes the importance of understanding how patterns evolve within systems, how these systems self-organize, and the interaction between system elements. They took place in a variety of settings, including provider offices, hospital call rooms, and restaurants. I have presented them in this way as both the data analysis and the development of the findings was a concurrent process. Care providers and decision makers see their role as information providers and support women to make the choice for birth after caesarean. Because once they actually go to the c-section part, once I actually got into surgery, it was so hectic right? Support Center Support Center.

N Engl J Med. All feared the uncertainty of a vaginal delivery and consequently leaned toward repeating the caesarean experience.

midwifery dissertation vbac

The system self organized in response to interaction of diverse local agents, not from external design. Angela, however, Grace was not inclined to change her practice based on fear of a lawsuit:.

She described the encounter as unnecessary and irritating: Kitty Corbett University of Waterloo I, Sarah Munro, designed and conducted the study and wrote disertation the chapters in this dissertation.

The ethnography was conducted over a period of 16 months, with interviews conducted with the key stakeholders of the intervention; that is the women, clinicians, and Opinion Leaders OLs who are part of the intervention.


In health services research, one of dissfrtation overarching disciplines, a literature review aims to identify gaps in the research, clarify unanswered questions, and critique the existing literature. In my approach for theoretical sampling I anticipated that these activities might include expanding the initial sample criteria to include other participants e.

Pooling resources and increasing interprofessional communication were innovations that appeared to flourish in these isolated rural communities. Negative feedback from other overlapping systems e. Zweifler and colleagues [ 19 ] also discovered a decline in the uptake of a trial of labor in a population-based study in California. Bangal showed that uterine rupture happened in women attempted to have VBAC before 2 years interval from previous C-section These considerations emerge before any future pregnancies, and are based on her personal experiences.

For Hannah, the risk of experiencing a traumatic repeat caesarean during a planned VBAC loomed larger than the likelihood that she would have a successful VBAC as planned. Rural was defined as populations living miwdifery the commuting zones of larger urban centres with 78 populations of 10, or more. These rules may look illogical to another agent. They really do need to express an interest in it.

Thank you to the School of Population and Public Health for being my home department and to the faculty who provided feedback on my research proposal.

Although participants had the opportunity to ask their physician questions, many described feeling rushed. These are evidence-based tools that aim to supplement not replace the shared decision-making process between patient and care provider. The micro-level of the health system dissertatiln individuals in clinical and social encounters, including patients, their families, and care providers.

Cesarean delivery resources need to be available during VBAC trial of labor. The findings from this research provide insights cissertation the factors that are associated with cultural change during the implementation of the OptiBIRTH study.


It stresses the importance of having researchers engage with the stakeholders who will use research results and leverage their different perspectives to create knowledge that is more relevant, useful, and usable. History and research evidence function as attractor patterns influencing whether the system will change or mmidwifery.

Another group was able to maintain the option of VBAC by committing to remain in-house during a trial of labor. A key strategy for supporting change in a complex system has been outlined by Jordan et al in a theoretical debate piece on the role of conversation in health care interventions: Experiential knowledge helped women to gain certainty with their choice and was a therapeutic process for the eight women who experienced postpartum depression and anxiety.

Thus, birth centers in Florida vba unable to offer VBAC legally, and midwives are concerned that women’s choices are declining as a result. Applying complexity theory illustrates that the evidence-to-action gap cannot be understood by decomposing the problem into individual barriers, facilitators, and outcomes.

midwifery dissertation vbac

What are the factors that influence implementation of SDM in maternity care? Given the national mandate to increase access, it is important to explore the factors that either enable providers to offer or constrain them from offering VBAC.

Such care provider attitudes and experiences may effect the uptake of midwifwry practices and decision-making for mode of delivery after caesarean.

There is evidence from the United States that access to VBAC services has been restricted due to malpractice concerns.