title: Vaginal birth after caesarean section: why is uptake so low? Insights from a meta-ethnographic synthesis of women's accounts of their birth choices.
abstract: OBJECTIVE
  To identify what women report influences their preferred mode of birth after caesarean section.
  
  
  METHODS
  Systematic review of qualitative literature using meta-ethnography.
  
  
  METHODS
  Medline, EMBASE, ASSIA, CINAHL and PsycINFO (1996 until April 2013; updated September 2015). Hand-searched journals, reference lists and abstract authors.
  
  
  METHODS
  Primary qualitative studies reporting women's accounts of what influenced their preferred mode of birth after caesarean section.
  
  
  METHODS
  Primary data (quotations from study participants) and authors' interpretations of these were extracted, compared and contrasted between studies, and grouped into themes to support the development of a 'line of argument' synthesis.
  
  
  RESULTS
  20 papers reporting the views of 507 women from four countries were included. Distinctive clusters of influences were identified for each of three groups of women. Women who confidently sought vaginal birth after a caesarean section were typically driven by a long-standing anticipation of vaginal birth. Women who sought a repeat caesarean section were strongly influenced by distressing previous birth experiences, and at times, by encouragement from social contacts. Women who were more open to information and professional guidance had fewer strong preconceptions and concerns, and viewed a range of considerations as potentially important.
  
  
  CONCLUSIONS
  Women's attitudes towards birth after caesarean section appear to be shaped by distinct clusters of influences, suggesting that opportunities exist for clinicians to stratify and personalise decision support by addressing relevant ideas, concerns and experiences from the first caesarean section birth onwards.
authors.affiliation: Division of Applied Health Sciences, University of Aberdeen, Aberdeen Maternity Hospital, Aberdeen, UK.
authors.forename: Mairead
authors.initials: M
authors.lastname: Black
authors.affiliation: Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: Vikki A
authors.initials: VA
authors.lastname: Entwistle
authors.affiliation: Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: Siladitya
authors.initials: S
authors.lastname: Bhattacharya
authors.affiliation: Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: Katie
authors.initials: K
authors.lastname: Gillies
mesh_terms: D000884:Anthropology, Cultural / Q000706:statistics & numerical data*; D001315:Australia; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D002681:China; D005260:Female; D006801:Humans; D010358:Patient Participation / Q000523:psychology / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data*; D011247:Pregnancy; D036301:Qualitative Research; D006113:United Kingdom; D014481:United States; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*
keywords: OBSTETRICS; PERINATOLOGY; PUBLIC HEALTH