Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Across Canada, caesarean section (CS) rates have exceeded optimal levels, exposing mothers to increased morbidity. As CS delivery costs significantly more than vaginal delivery, the increase in CS also creates strain on health care system funding and resources. In British Columbia, 83.4% of women with a previous CS undergo a repeat CS. Best evidence indicates, however, that most women with a previous CS are good candidates for a vaginal birth after caesarean (VBAC) and 70% who try have successful VBACs. In this context, we have a limited understanding of why women and their care providers choose elective repeat CS and what information they use in making decisions for mode of delivery. Understanding women's health information needs is essential to educate women on the risks and benefits of VBAC and repeat CS, enhance women's self-confidence around vaginal birth, and to support women to make informed, shared decisions for mode of delivery. This study builds on existing initiatives to optimize the caesarean rate in British Columbia and aims to 1) explore multiparous women and care providers' decision-making for mode of delivery after a previous CS; and 2) identify communication strategies that improve health literacy around CS and VBAC and enhance women's informed choice for mode of delivery. Using qualitative research methods, I will interview mothers and maternity care providers to explore their decision-making and communication around mode of delivery. Integrated knowledge translation with key stakeholders in provincial maternity services will enhance the relevance of the recommendations and their application to existing quality improvement initiatives to optimize the CS rate. Best practices in mode of delivery can decrease the rate of elective CS, thereby reducing health risks to mothers and infants and accruing significant health care system savings.