Clinician’s and women\'s perceptions of individual barriers for achieving a vaginal birth after cesarean (VBAC) in Iran: A qualitative content analysis

Background: High rate of repeat cesarean section and its complications are the results of cesarean tsunami in the last two decades in Iran. Vaginal birth after cesarean (VBAC) is an important alternative for repeat cesarean. However, the rate of VBAC in Iran is very low subject to some organizational and individual barriers. This study explored the clinician’s and women's perceptions of individual barriers to achieve VBAC. Methods: In this conventional content analysis, 28 semi-structured interviews and one focus group discussion was conducted with health care providers including gynecologists, midwives and family physicians as well as  prior  cesarean section mothers in Mashhad in 2017. Participants were selected through purposive sampling considering the strategy of maximum variation. Data analyzed according to Graneheim and Lundman (2004) method using MAXQDA.10 software. Results: The theme of “obstacles to acceptance and committed actions” emerged from two categories of “psychological barriers” and “operational barriers and five sub-categories labeled as: 'sense of danger”, “financial displeasure",  "negative attitude", "barriers to decision making" and "indolence". Conclusions: Attitude improvement by maternity care promotion and create supportive environment, informing mothers about choice of birth mode and empowering them in shared decision making, organization of VBAC care team and create motivation in persons and hospitals through report of research projects outcomes on safety and benefits of VBAC will be affected the VBAC rate and cesarean section rate.