Exploring cultural changes about vaginal birth after caesarean section (VBAC): an Italian follow-up on the OptiBIRTH study

Abstract Background: Increasing the rate of vaginal births after caesarean sections (VBAC) is crucial to address the rising prevalence of caesarean sections (CS). Despite its benefits, VBAC rates remain low. Promoting VBAC is key to reducing CS rates, yet it is underutilized. Clinicians' perspectives and their evolution over time are pivotal in this context, but qualitative studies on their views are limited. Aim: This thesis aimed to explore and interpret changes in clinicians' perspectives on VBAC since the OptiBIRTH study, which was a complex intervention aimed at increasing VBAC rates. Additionally, it sought to interpret these changes from a cultural perspective. Methods: Study I: A meta-synthesis based on interpretative meta-ethnography, including peer-reviewed qualitative articles from various disciplines examining clinicians' perspectives on VBAC between 2016 and 2020. Study II: A national multicentre qualitative field research on current clinicians' perceptions and attitudes towards VBAC, using focus group interviews. Study III: Comparison of emerging results from Study II with previous qualitative knowledge, interpreted from a cultural perspective using a hermeneutic approach.