Healthcare providers' perspectives on vaginal birth after caesarean section at Mwananyamala Hospital in Dar es salaam, Tanzania

Abstract

ABSTRACT Background: In Tanzania, the rate of cesarean section (CS) rose from 6% in 2016 to 11% in 2022 often due to repeated unnecessary CS that increases the risk of maternal and neonatal morbidity and mortality.Vaginal Birth after Cesarean (VBAC) offers a safer alternative and reduce the rate of unnecessary CS. Aim: This study explored healthcare providers' perspectives on VBAC at Mwananyamala Hospital to identify barriers, facilitators, and recommendations made by HCPs to improve VBAC practices. Methods and materials: The research used a descriptive qualitative study design with purposive sampling of 15 healthcare providers at Mwananyamala Hospital, Dar es Salaam, Tanzania. In-depth, semi-structured interviews were conducted, recorded, and transcribed to capture perspectives on VBAC. Thematic analysis was applied to the data, involving coding and identification of emerging patterns. Ethical considerations included informed consent, confidentiality, and adherence to ethical guidelines for research involving human subjects. Results: The data revealed four main themes, each with several subthemes. Participants demonstrated an understanding of VBAC, including its meaning, criteria, benefits, and complications. Facilitators included individual and facility-related facilitators. Participants highlighted Individual, interpersonal, facility and patient related barriers to implement VBAC. Recommendations emphasized the need for guidelines and SOPs promoting VBAC, on-the-job training, enhanced staffing and motivation, comprehensive education for mothers and the community, and improved interdisciplinary teamwork for VBAC management. Conclusion and recommendations: HCPs showed understanding of VBAC criteria, benefits and complications, focusing on thorough patient evaluation for safe outcomes. Facilitators included individual and facility related facilitators. The identified barriers included individual, interpersonal facility and patient related barriers. Recommendations included enhancing teamwork, addressing staffing, and ongoing training to improve VBAC outcomes. Tailored interventions like teamwork and vi education are crucial to overcoming universal challenges in VBAC implementation and improving outcomes. Future research should evaluate these strategies to refine VBAC practices. Keywords: Caesarean Section Rates; Experience; Healthcare Providers; Perspectives; Tanzania; Vaginal Birth after Caesarean Section