Abstract
BACKGROUND: Australia has a low uptake of vaginal birth after cesarean despite the evidence that this is best practice. A new midwifery-led service was introduced with the overall goal to improve the quality of care offered to women and their families that have experienced a cesarean section. The postnatal arm of the service targeted women who had experienced their first cesarean section. The service included an early hospital postnatal visit from the next birth after cesarean (NBAC) midwives whereby women were given an opportunity to share their experiences. Women were subsequently given an evidence-based resource on birth after cesarean as well as the midwives' contact details should they wish to contact them anytime during the first 6 weeks after birth.
AIM: To evaluate the effectiveness the postnatal arm of the service on women's birth mode intentions in a subsequent pregnancy and their levels of childbirth fear and self-efficacy at 12 weeks postpartum.
METHOD: Comparative descriptive design (pre-/posttest). Fifty-three women receiving standard care (comparison group) and 50 women receiving the NBAC postnatal service completed a childbirth fear measure (Wijma Delivery Expectancy/Experience Questionnaire Version B), a self-efficacy scale (New General Self-Efficacy Scale [NGSE]), and were asked their preferred birth mode for a subsequent pregnancy. Data was collected at 3-5 days and 12 weeks postpartum. Descriptive statistics and chi-square analysis were used to test several formulated hypotheses.
RESULTS: Although women who received a visit from the NBAC midwives were more likely to state they intended to birth vaginally in a next pregnancy, compared to women receiving standard care, the finding was not significant (p = 272). Likewise, there was no difference in childbirth fear with both groups of women having high levels of childbirth fear (comparison [86.27] and NBAC group [84.67]). Comparison of self-efficacy items between groups at 12 weeks were not significant aside from NBAC women feeling more confident with their ability to complete tasks well (p = .005).
CONCLUSION: Although the findings of this small study were not statistically significant, the simple and timely nature of the intervention seems worthy of further consideration and investigation. In addition, research needs to continue to focus on how midwives can better meet women's emotional needs in the postpartum period helping to ameliorate women's fear and build confidence for their next pregnancy and birth experience.
