Influences on vaginal birth after caesarean section: A qualitative study of Taiwanese women.
BACKGROUND
Vaginal birth is a safe mode of birth for most women who have had a prior caesarean with a transverse incision. Despite the evidence, most Taiwanese women who have had a previous caesarean are rarely offered the opportunity to consider any possibility other than a repeat caesarean.


OBJECTIVE
This study explored factors affecting Taiwanese women's decisionmaking regarding vaginal birth after cesarean.


METHODS
Ajzen's Theory of Planned Behaviour provided the theoretical framework to underpin the study, which adopted an interpretive descriptive methodology. Sequential semi-structured interviews were conducted with 29 women who had a previous caesarean and were pregnant between 34 and 38 weeks gestation, ten women who attempted vaginal birth in the third to fifth day postpartum, and 25 women in the fourth week postpartum. Boyatzis' method of thematic analysis was used to identify themes and codes.


RESULTS
This paper reports the findings of the prenatal interviews with 29 participants. The major factor influencing women's decision-making was to avoid negative outcomes for themselves and their babies. Three thematic codes describe influences on the women's decisions: 'past experience of childbirth', 'anticipating the next experience of normal birth' and 'contemplation on the process of childbirth'.


CONCLUSIONS
Women who have had a previous caesarean section are prepared to have a vaginal birth but are not always supported to carry out this decision. Changing the models of antenatal care is recommended as a strategy to overcome this difficulty therefore empowering women to make a meaningful choice about VBAC after a CS.
Chang Gung University of Science and Technology, 2, Chia-Pu Rd., West Sec., Pu-tz, Chiayi, Taiwan. Electronic address: mmchen@mail.cgust.edu.tw.
Mei-Man
MM
Chen
School of Nursing and Midwifery, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia. Electronic address: Lois.McKellar@unisa.edu.au.
Lois
L
McKellar
School of Nursing and Midwifery, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia. Electronic address: Jan.Pincombe@unisa.edu.au.
Jan
J
Pincombe
D000328:Adult; D002585:Cesarean Section / Q000523:psychology*; D002755:Choice Behavior; D003657:Decision Making; D036861:Delivery, Obstetric / Q000523:psychology*; D005260:Female; D006801:Humans; D036801:Parturition / Q000523:psychology*; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000523:psychology*; D036301:Qualitative Research; D013624:Taiwan; D016064:Vaginal Birth after Cesarean / Q000523:psychology*
Caesarean section; Decision-making; Qi; Theory of Planned Behaviour; Vaginal birth after cesarean