Up to 25% of primigravid women in the United Kingdom deliver by caesarean section (CS). In their next pregnancy, many face a choice between repeat CS or attempting vaginal birth after CS (VBAC). The aim of this study was to explore influences on preferred birth route after CS by synthesising the findings of primary qualitative studies.Methods
A systematic search of Medline, Embase, Cinahl, Assia and Psycinfo (1996–2013) was performed and meta-ethnography, a systematic evidence-based approach to qualitative synthesis, was undertaken.Results
Of 1211 titles identified, 20 papers arising from 16 qualitative studies were included. The most powerful influences on women’s preference for ERCS were psychological sequelae of previous birth experience (such as fear and lack of self-belief) and the opinions of health professionals, friends, family and patient stories in the media. Women who preferred VBAC did so because of their inherent values regarding childbirth and their anticipation of a quicker recovery, but felt that coercive language used by clinicians engendered a sense of guilt. Few women discussed specific risks of either mode of delivery in the context of influence upon their decision.Conclusion
In contrast to a sense of ownership of choice demonstrated by women wishing VBAC, those preferring ERCS were influenced by previous birth experience and opinions of health professionals and social contacts. There is an opportunity for providing targeted information and clinician-delivered postnatal interventions to improve women’s understanding of the indication for their primary CS, inform women’s attitude towards future childbirth and encourage joint decision making.