OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren,...
-
Upload
kelly-lambert -
Category
Documents
-
view
218 -
download
1
Transcript of OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren,...
![Page 1: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/1.jpg)
OptiBIRTHOptiBIRTHWG2:Development of the women-centred interventionLeader: Ingela Lundgren, University of Gothenburg, Sweden
![Page 2: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/2.jpg)
WG2: Intervention development
Focus groups interviews with women, their partners (if desired), physicians and midwives Countries with high VBAC-rates 45-55% - Finland, Sweden and the Netherlands 2 groups with 6-8 women (one urban and one rural) and 2 with 6-8 professionals in each country, total 12 groups Countries with low VBAC-rates 29-36 % - Italy, Germany, and Ireland 1 groups with 6-8 women and 1 with 6-8 professionals (in each of 7-8 maternity units allocated randomly to the experimental group), total 14-16 groups
![Page 3: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/3.jpg)
OptiBIRTHOptiBIRTH
Questions to the focus groups Five major questions will be asked: 1) In your opinion, what are the important factors for a successful VBAC?; 2) What are the barriers to successful VBAC?; 3) What was/is important to you as a birth-giving woman/professional?; 4)What is your view on shared clinical decision-making (i.e. making decisions on aspects of your/women’s/ partner’s care and sharing decision-making with others)?; 5) How can you support women to be confident with VBAC (for example women with fear of childbirth).
![Page 4: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/4.jpg)
Data analysis: Conduct month 3 (in countries with low VBAC randomized) Analysis complete month 5
Data analysis: Content analysis based on the 5 questions, analysed in main categories and sub- categories; one for women and one for professionals
Data analysis first level in different countries (5-10 subcategories/ question in English) Skype meeting analyse in whole group WG-leader next step analyse all text New Skype meeting for feed-back Completed January 2013
![Page 5: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/5.jpg)
Status – focus groups Ethical approval in October Finland: ethical approval in process, Kuopio and Helsinki or
Tampere Sweden: ethical approval in process, Gothenburg and
Borås/Skövde The Netherlands: ethical approval in process Ireland: ??? Italy: ethical approval for Genoa, other regions in process Germany: ethical approval in process, Hannover and ??
Interviews with women postpartum and during pregnancy (Ireland) Interviews with obstetricians and midwives in one group or different groups
![Page 6: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/6.jpg)
Systematic reviews 1. Women-centred antenatal interventions for increasing VBAC
rates and reducing fear of childbirth
2. Clinician-centred interventions for increasing VBAC rates and reducing fear of childbirth in women and apprehension in clinicians
Keywords VBAC, vaginal birth after caesarean section (spelling)
women-centred (spelling), interventions, clinician-centred (spelling), experiences, decision-making, success, barriers, professionals, health care professionals, midwives, obstetricians., preferences, fear of childbirth, choice, options, tocophobia, anxiety, PTSD, traumatic birth, TOL, medical litigation
Complete Month 4
![Page 7: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/7.jpg)
Background
‘Groping through the fog’: a metasynthesis of women´s experiences on VBAC (Vaginal birth after Caesarean section)Ingela Lundgren, Cecily Begley, Mechthild M Gross and Terese BondasBMC Pregnancy and Childbirth 2012, 12:85 (21 August 2012)
The objective of this metasynthesis is to integrate the findings and deepen the understanding of women’s experiences of VBAC.
![Page 8: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/8.jpg)
1981 articles (VBAC) ↓ 142 articles (Keywords VBAC, vaginal birth after caesarean section,
qualitative study, experiences, qualitative and women´s experiences in various combinations)
Exclusion: quantitative studies, studies about health care professionals’ experiences
↓ 22 articles (read) Exclusion: not focusing women´s experiences, only focusing experiences
of CS in relation to VBAC ↓ 11 articles Exclusion: Quality check by 45-items based by COREQ 32-item [27] and
Walsh and Downe [28]. ↓ 8 articles included in the metasynthesis Figure 1. Flow chart summarizing search strategy.
![Page 9: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/9.jpg)
ResultsStudies from UK (1), US (3) and Australia
(4)Metaphor; groping through the foggiving birth vaginally after a previous CS
is experienced as paradoxical Four main themes and sub-themes
![Page 10: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/10.jpg)
Own strong responsibility for giving birth vaginally
In relation to the women themselves In relation to information In relation to health-professionals
![Page 11: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/11.jpg)
Vaginal birth after CS is a risky project To have to confront serious risks mediated by health-
professionals Lack of information about the benefits of vaginal birth Not supported if you want a VBAC
![Page 12: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/12.jpg)
Vaginal birth has several positive aspects mainly described by women
Good for the baby and the mother- baby relationship A meaningful experience of importance for them as women An easier birth in relation to recovery afterwards Some health professionals are pro VBAC
![Page 13: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/13.jpg)
To be involved in decision about mode of delivery is difficult but important
Not being informed enoughConflicting information Important to have a choiceUncertainty in relation to choice Information/support from others not the hospitalSupport from professionalsExperiences from the last birth influence the choice
![Page 14: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/14.jpg)
Questions:Language for transcriptions?Data-analysis in the different countries to
which level?Last step by the responsible scientific person
(IL)?Involvement by IL in the different countries?Analysis in two steps?
![Page 15: OptiBIRTH OptiBIRTH WG2:Development of the women-centred intervention Leader: Ingela Lundgren, University of Gothenburg, Sweden.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cdc5503460f949a6ceb/html5/thumbnails/15.jpg)
Questions for Cecily:Pregnancy or after birth CS?Different groups in low and high VBAC-
countries?New questions from the groupsIs it OK with individual interviews; Ireland
the Netherlands.Randomization low VBAC countries Focus groups as part of the intervention?