title: Seeking control in the midst of uncertainty: Women's experiences of choosing mode of birth after caesarean.
abstract: OBJECTIVE
  Clinical practice guidelines indicate that over 80% of women with a previous caesarean should be offered a planned vaginal birth after caesarean (VBAC), however only one third of eligible women choose to plan a VBAC. To support informed choices for birth after caesarean, it is necessary to understand the factors that influence women's decision-making.
  
  
  OBJECTIVE
  The goal of this study was to explore attitudes towards and experiences with decision-making for mode of delivery after caesarean from the perspectives of Canadian women.
  
  
  METHODS
  In-depth, semi-structured interviews were conducted with 23 women eligible for VBAC in three rural and two urban communities in British Columbia, Canada, during summer 2015. Constructivist grounded theory informed iterative data collection and analysis.
  
  
  RESULTS
  Women's decision-making experiences were a process of "seeking control in the midst of uncertainty." Women formed early preferences for mode of delivery after their primary caesareans and engaged in careful deliberation during their inter-pregnancy interval, consisting of: reflecting on their birth, clarifying their values, becoming informed, considering the feasibility of options, deliberating with the care team, and making an actual choice. Women struggled to make trade-offs between having a healthy baby and social attributes of delivery, such as uninterrupted bonding with their newborn.
  
  
  CONCLUSIONS
  Women begin decision-making for birth after caesarean earlier than previously reported and their choices are influenced by personal experience and psychosocial concerns. Future interventions to support choice of mode of delivery should begin early after the primary caesarean, to reflect when women begin to form preferences.
authors.affiliation: Department of Family Practice, University of British Columbia, Vancouver, Canada; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, United States. Electronic address: sarah.munro@ubc.ca.
authors.forename: Sarah
authors.initials: S
authors.lastname: Munro
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Janssen
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
authors.forename: Kitty
authors.initials: K
authors.lastname: Corbett
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wilcox
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Nick
authors.initials: N
authors.lastname: Bansback
authors.affiliation: Department of Family Practice, University of British Columbia, Vancouver, Canada.
authors.forename: Jude
authors.initials: J
authors.lastname: Kornelsen
mesh_terms: D000328:Adult; D002170:Canada; D002755:Choice Behavior; D003657:Decision Making; D036861:Delivery, Obstetric / Q000523:psychology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D016064:Vaginal Birth after Cesarean / Q000523:psychology*; D055815:Young Adult
keywords: Caesarean section; Decision making; Obstetrics; Qualitative research; Vaginal birth after caesarean