PARTO VAGINALE DOPO TAGLIO CESAREO: RICERCA FENOMENOLOGICA ERMENEUTICA

Background: Contextually to the actual increase in the percentage of worldwide caesarian section, the topic of VBAC (Vaginal Birth after Caesarean) assumes a specific significance. In the literature a large number of articles estimates the quantitative features of the problem, taking into consideration the risks and the benefits, the predictive success factors, the inclusion and exclusion criteria, the guidelines about the pregnancy and childbirth support. There are, however, only few qualitative studies about woman past during the previous caesarian, about the reason leading to the VBAC choice and the vaginal birth experience. Aim of the Study: Finding the reason why a previous caesarian delivery woman chooses to give birth through a vaginal way, instead of repeating a caesarian section, analyzing at the meantime the previous caesarian section past, the difficulties in the relationships with health professionals and with the relatives during the choice, the perceived advantages and disadvantages due to the fact of having given birth through a vaginal way. The secondary purpose is the analysis and the comparison between the procedures used in two third level hospitals in the Lombardia area but also considering the Evidence Based Practice. Methods: The women, who have taken part in the report, have been identified through a retrospective analysis of the nosological report at Clinica Ostetrica L.Mangiagalli and at ICP Buzzi. The analysis is based on the fact that these women are all characterized by a physiological or operative vaginal birth after caesarean section and by an alive and vital newborn, in a period which goes from 4 weeks to 6 months from the birth date. Among these, 16 women have answered to a semi-structured questionnaire that they have filled in at the telephone or by e-mail. At a later stage, the results have been examined by means of a fenomenologic - ermeneutic approach, which has led to identify 20 categories referable to five themes. The valuation of the helpful procedures at both ward is based on the observation of the intra-hospital records devoted to VBAC, on informative and supporting materials, which consent the participation in the VBAC.Results: The women responses highlight the topics: “the women past after previous caesarian section”, “the explanation of the women choice”, “the vaginal birth women past after caesarian”, “people around me..”, “the comparison between the experiences”. In this particular case, women often do not accept and are not pleased with their caesarean experience (with differences between planned and compelling caesarean); meanwhile the VBAC is appraised because of the emotional intensity, even though it is physically difficult for the pain suffered. It is extremely important for women to feel active and birth key player, also to have the opportunity to choose natural childbirth and, at the same time, the convenience of the childbirth. Mother desires and fears emerge together with the pain and the postpartum topic (an analysis about the main difficulties of the two different kind of birth is present). The main reasons leading to the choice of a VBAC are the curiosity of natural vaginal birth emotions, the need to be more active and live better the postpartum, the necessity to share the experience with the husband and the newborn. All the interviewed women feel well liked by professionals during pregnancy, meanwhile during labor 3 women have been frustrated, criticized and they remained lonely. The husband is always a help and an optimal fellow. In contrast with the clinical practice it is highlighted how counseling is not always good realized, how reports are partially consisted with the international guidelines, how professionals show an insufficient application of these reports using a medicalized and interventionist support, sometimes based on defensive medicine. Conclusion: Related to VBAC it is always necessary to consider women experience along with best practice, in order to guarantee a safe and custom assistance during pregnancy (in particular for counseling, which should start fromthe women desires and from the women experience), childbirth and postpartum. Practical Relevance: In order to encourage the VBAC practice and to reduce unessential caesarean, it is important to work for informing women, for conveying about this opportunity and increasing people’s awareness about decisions, for training and updating the professional knowledge, and for a more custom, natural and continuous assistance during pregnancy, childbirth and postnatal period.