'Motherbirth or childbirth'? : a prospective analysis of vaginal birth after caesarean blogs

Objective: vaginal birth after caesarean (VBAC) is a controversial issue with strong opinions for and against. The means in which women work through the different opinions and options using the internet should be of interest to midwives, obstetricians and policy makers. The aim of this study was to examine how women use English language internet blog sites to discuss the option of VBAC and what factors influence these women's decision to have a VBAC or repeat caesarean section. Design: a qualitative study using internet blog sites as the source of data was undertaken. Google alerts were created to search for the term VBAC in internet blogs. These alerts were sent to the first author's email account daily for a one-year period (November 2007 to October 2008) and downloaded. The content was analysed using thematic analysis. Findings: there were 311 blogs mentioning the word VBAC in the one-year period. Most of the blog sites and discussion originated from the USA. There were more blogs written during the Northern Hemisphere winter months than during other seasons. The main theme identified was a dichotomy in philosophical framework women held about birth; that is a 'motherbirth' or 'childbirth' framework. Whether women eventually wrote that they chose a VBAC or repeat caesarean or the extent to which they pursued their birth choice depended on whether they came from a perspective that a 'good parent sacrifices themselves for their baby (prioritises the baby) and takes no risks' (childbirth) or that 'giving birth matters to the woman and a happy, healthy mother is a happy healthy baby (mother and baby have equal priority)' (motherbirth). Several themes were identified including: surviving the damage; inadequate bodies; choice and control; fearing and trusting birth; negotiating the system; and minimising or overestimating risk. Key conclusion: women filtered their decision making regarding VBAC through a belief system that prioritises according to their personal approaches. Implications for clinical practice: blogging may be providing a valuable insight into factors that inform decision making and may provide a forum of information and support for women who have experienced a caesarean section