Repeat CS or VBAC? A systematic review of the factors influencing pregnant women’s decision-making processes

Background. Recent guidance from NICE (2011) has underlined the importance of facilitating informed decision-making for pregnant women with respect to planned repeat caesarean section (CS) and planned vaginal birth after CS (VBAC). The facilitation of informed decision-making requires midwives, obstetricians and other healthcare professionals to have a holistic understanding of the factors influencing women’s decisions.Aim. To undertake a mixed studies systematic review of the factors influencing pregnant women’s decisions with respect to planned repeat CS and planned VBAC.Methods. Pope et al’s (2007) guidelines were used to structure the review. Eight electronic databases (from October 2001 to October 2011) were searched. Research studies and systematic reviews that examined decision-making from the perspective of pregnant women and/or healthcare professionals were included. Procedures were systematically applied for quality appraisal anddata extraction. Thematic analysis and narrative summary techniques were used.Findings. A total of 25 studies were included in the review. Analysis highlighted the complexity of women’s decision-making yielding five broad themes namely; facilitating woman-centred care; organisation of maternity care and the influence of healthcare professionals; women’s knowledge and perceptions of risk; education and counselling programmes, and use of decision aids; andwomen’s responsibilities.Conclusion. Attention needs to be directed to the accurate assessment of women’s decisional needs, and the development and evaluation of decision-support interventions.Key words: Pregnant women, caesarean section (CS), vaginal birth after caesarean (VBAC), decision-making, literature review, systematic review, evidence-based midwifery