Key influences on women's decisions for vaginal birth following a previous caesarean section: A qualitative study

There remains a steady increase in the caesarean section (CS) rate globally ranging from 5% in sub-Saharan Africa to 42.8% in the Caribbean and Latin America. Vaginal birth after CS (VBAC) is a proven way of increasing normality in childbirth for most women. This study aimed to explore the factors that influence women's decision-making for VBAC after previous CS.

A qualitative design was used. All women with experience of one previous CS, and eligible for VBAC were invited to participate in the study. Data for this study were collected using semi-structured individual interview with 10 women via Zoom following verbal and written consent between March and September 2023. Thematic analysis was employed, and the discussion of the findings was informed by Foucault's theory of power/knowledge.

Factors that influence women's decision-making are presented under two main themes - 'Self-determination,' and 'Self-confidence.' Knowledge, strong will, previous experience, and quest to feel better after birth contributed to women's determination to be in control of their decision. Self-belief, and support from the care providers had impact on women's confidence. Most of the participants demonstrated a sense of control and satisfaction with their decision regardless of subsequent mode of birth.

The findings highlight the intrinsic link between knowledge and power and the role of these constructs in decision-making. Therefore, women need to be well informed and feel empowered to take control of the decision about their mode of birth following previous caesarean section.