The decision-making process in the choice of VBAC: Facilitators and barriers from women’s perception, a systematic review

INTRODUCTION Vaginal birth after cesarean (VBAC) is associated with a lower risk of maternal morbidity, fewer complications in future pregnancies, and a reduced overall cesarean section (C-section) rate at the population level. Despite these benefits, a woman's decision for VBAC is shaped by multiple factors. This review aims to identify elements perceived by women as influential in the VBAC decision-making process. METHODS We conducted a systematic review between 1 June and 12 July 2024, using PubMed, CINAHL, Embase and PsycINFO. We included English-language studies (2014-2024) on women eligible for VBAC with >= 1 previous C-sections. Study quality was appraised using CASP. Findings were narratively and thematically synthesized. RESULTS Twenty-one studies met the inclusion criteria. Fifteen recurring factors were identified. 'Facilitators' of VBAC included: mother-newborn bonding; support from partner and family; desire for vaginal birth; previous VBAC experience; shorter postpartum recovery; partner and family support; social support from other women; healthcare professionals' attitudes; communication and respectful maternity care; and counseling. 'Barriers' included: anxiety and fear of the unknown; healthcare professional's misinformation and attitudes; coercive counseling; pain related to labor; loss of control; and perceived risk to mother or newborn. CONCLUSIONS VBAC decision-making is influenced by past birth experiences, perceived support, and current concerns. Healthcare professionals' attitudes and high-quality counseling are key to informed, unbiased choices. Continuity of care, midwifery care and education can empower women and reduce unnecessary C-sections. However, as most studies are from high-income, English-speaking countries, findings may not generalize globally.