The women described that they had their own personal responsibility in relation to giving birth vaginally after a previous CS 13 18 19 30 31 . This responsibility could be related to the women themselves and their attitudes to birth, expressed as being strongly, deeply and highly motivated 18 .

Oh yes, deeply motivated. … I didn't feel like, if I wasn't deeply motivated it wouldn't have happened 18 , p.81.

The women described how they had to seek information to gain knowledge of how to facilitate normal birth 2 13 18 19 30 31 , which could sometimes be found by accessing their own medical record from the first delivery 31 . Individual responsibility also means an openness to try a vaginal birth, wanting a natural birth and positive self-talk 18 , and experiencing that it is their decision if they want to try a VBAC or not 30 .

(The consultant) said that it was absolutely up to me because there was no particular reason why my last one turned out to be a Caesarean, that it was 50/50 probably that I would need another one again and it was totally up to me if I wanted to try or not 30 , p 8.

Individual responsibility also means a responsibility to communicate with the health professionals 18 with a determined approach 13 18 19 . For some women this can be experienced as being in a bit of a fight 18 .

So I knew that I needed something just to relax me for that interim time. Very prepared, yes. I had to be to do this because I did feel like I was in for a bit of fight near the end 18 , p. 81.

In almost all studies women describe how they predominantly have been informed about the risks involved in giving birth vaginally 2 13 18 19 30 31 . For some women these risks meant that they did not have a choice to give birth vaginally 29 . The risks that the women were informed about were uterine rupture 2 13 , death of the child or mother or both 13 19 , the risk of ending up having another CS 2 13 , and being irresponsible and putting the baby at risk 19 30 .

All those horrible things could be wrong, you could lose your baby, your uterus could rupture, you could bleed to death 19 , p.1565.

The women had to confront serious risks in relation to their decision whether to give birth vaginally or by CS 2 31 , in a context of high childbirth intervention rates and a risk focus 19 . Information about risk was mediated by physicians and midwives 2 13 18 19 30 31 , but could also be in the form of materials such as a CDROM 31 . The women describe how they were informed about success rates of delivering vaginally, mediated by different percentages (20 -70%) in relation to their individual risks 18 30 , and as ‘odds’ being against them 18 . Therefore, for some women, at the back of their mind they were thinking that they probably were not going to be able to give birth vaginally 30 .

They examined me and they said it was entirely up to me but they reckoned I didn't have a good chance of having him myself, em, 30%, they said I would probably end up having to have an emergency Caesarean 30 , p.8.

The information sheet noted that only 20% of women give birth naturally successfully after a Caesarean so I realized that the odds were against me but I was determined anyway 18 , p.81.

When health professionals are explaining the risks involved with VBAC, the women were reflecting the fact that no information was given about the benefits of vaginal birth 2 13 30 , only the downside and risk 13 , which may be experienced as strange 2 . The hospital was experienced as more anxious than the women 2 . For some women, guilt was involved if they wished to have a vaginal birth and were thereby accepting the risks 30 . The women may find some good stories about vaginal birth but miss being given concrete information 30 .

I could insist on trying for a normal delivery but there's the guilt that you're being irresponsible and putting the baby at risk 30 , p.9.

You know there might be one in a hundred chances that I have a uterine rupture, but they kept focusing on the fact that I might be that. Might be that one person that has it. Me, I was thinking ‘look, I'm most likely going to be one of the 99’ 13 , p. 278.

Because vaginal birth may be seen as a risky project by health professionals, women may feel that they are not supported if they state that they want a vaginal birth 2 13 19 30 . Support was lacking both from midwives and doctors 2 13 30 . From the perspective of the hospital, vaginal birth is seen as a risky project 13 . Some women feel considerable pressure from their doctors for CS, which was intensified with comments about being selfish, and putting oneself at risk of uterine rupture and bleeding to death 19 . Powerful medical recommendations could also be made during the birth that influences women, sometimes leading to CS. Some women felt that doctors would let them try but that they would intercede quite quickly 30 . Some women experienced that, although the hospital purported to be pro VBAC, the subliminal messages they were being given all suggested that vaginal birth was unlikely 30 .

I feel every time I go and see the doctor or the midwife they keep talking about elective Caesareans…they keep finding reasons why I'll probably need an elective Caesarean so yeah it feels like choice is a lot more limited this time 30 , p.8.

In almost all studies, positive aspects of giving birth vaginally are described by the women 2 18 19 20 29 30 31 . Natural birth is described as good for the baby 18 19 20 31 , exemplified with bonding 19 20 , the best start for baby 18 , for maternal infant-relationship and well-being 19 29 , and breast-feeding 20 . Vaginal birth was believed to provide bonding to a much greater extent than CS 19 . Women also said that it is important for the baby to pass through the vagina to aid lung expansion 19 . Vaginal birth was said to improve the emotional contact with the baby 19 , and women did not want professionals to take the baby after the birth 31 . Vaginal birth decreases the risk of anything happening to the baby 31 , and promotes health and well-being of both mother and baby, enhancing maternal interactions and the transition to motherhood 19 .

By doing the vaginal birth you were really giving your baby a better chance – certainly 18 , p.80.

I didn't hold her for a week and I didn't want that to happen (again) 31 , p.669.

Normal birth was preferred because it reduce the number of drugs 18 19 , and interventions such as epidurals and induction of labour 19 , had better delivery outcomes 31 , and was safer 31 . To deliver a baby was described as natural 18 19 29 , and considered to be a normal but significant life event 18 19 , and a feeling of failure was described if not being able to birth vaginally 29 .

To deliver a baby is so natural. That's what it was meant to be about. So when you get told: ‘you're not going to do that, you're going to have yours pulled out of your belly’, it does, it makes you feel ‘oh!’ 29 , p.29.

Giving birth vaginally was also described as good for the woman, expressed as satisfying and empowering 18 , important for women to reach their goals 19 , a meaningful maternal experience in life 18 29 , and as an integral part of being a mother and a woman 19 .

I felt very empowered. Even more passionate about it than before 18 , p.81.

The women describe that they wanted to experience a natural birth and the function of the female body 18 20 31 , by working with the body 19 , active participation 19 , and giving their body an opportunity to experience natural childbirth 19 . The process of birth was described as when one stage triggers something in the human body and mind to flow on to another stage 31 . Women's bodies were described as designed to give birth vaginally 19 30 .

You're built to have a baby naturally and I would just prefer to do it naturally 19 , p. 1565.

The women want to see what it is like to give birth vaginally 2 19 29 31 , which was described as the ultimate birth 29 31 , what birth is about 29 , and nature's way, the proper way and intended way 19 . The women express a strong maternal drive to give birth naturally 19 31 . Physical and emotional factors are important in relation to giving birth vaginally 31 . Belief systems such as religion could also influence the decision 19 . Some women who valued a vaginal birth but delivered by CS expressed that they would have loved having a vaginal delivery 2 19 29 , and regret that they did not try, and they are disappointed or even depressed 29 .

I knew that they would talk about a CS…I didn't want to have one…I wanted to have a vaginal, normal delivery if you want to say that…with a lot more of my input…I wanted to do it, plan it, and do it my way this time…I had a lot more input…a lot of it is control 31 , p.668.

But you know, like a cesarean ago I would have been: ‘oh, yeah, go for cesarean’. But now that I'm definitely looking down the barrel of not being able to ever have a natural birth now. Actually this is my last. I'm very disappointed 29 , p.30.

Vaginal birth was also preferred due to easier, shorter and quicker recovery after the birth 2 19 20 31 . It was experienced as easier with a small child at home compared to CS 31 . A vaginal birth was also described as less interrupting to daily life 19 . CS resulted in a more painful and longer recovery 20 . Vaginal birth was also easier in relation to family obligations 20 . Women describe that they can walk after VBAC and do not need to rest so much in the following 6–8 weeks 31 . The inability to drive immediately following CS was also felt as very prohibitive 19 20 .

I'm saying that it would be a lot of hassle after the event, and being in a state with stitches or whatever and being told you can't do this and you can't do that for six weeks…my little boy's at nursery and so it would be difficult if I can't drive to get him to the nursery and all that kind of thing 20 p.164.

Even if positive aspects of vaginal birth were mainly described by the women, some studies indicate that health professionals prefer VBAC but this was not explicitly stated, according to the women 2 13 20 . Trying for a normal birth is experienced as preferable 20 . A physician could also be perceived to be against CS 31 .

The doctor was very much against CS 31 , p.668.

Women describe lack of information from the health care system 2 13 19 20 30 , which negatively influences decision-making about mode of delivery. They describe that they were unprepared for labour 20 , ill-informed 2 , were lacking knowledge 30 , and that information after the first CS would have been helpful 2 . In relation to decision-making they need more facts in order to decide 2 30 , and need to know, and be brave enough to ask, the right questions 2 . They also needed more information based on the individual, not on routine 2 30 .

She’s got four children herself and she’s of the opinion . . . ‘Look, if the pain gets too bad, you’ve already had a Caesarean. All the female gynaecologists themselves would just opt straight in and have a Caesarean. That’s what they’re all doing . . . Why go and put yourself through that again if you had such a terrible experience the first time? . . . Look, I’m all for you wanting to try it. We’ll give it a go, if it gets too hard and too bad, straight in for a Caesarean. You don’t need to muck around.’ That was her opinion. I said, ‘Okay. I really want to do it though’ 13 , p.279.

Health-care professionals were seen as mediating between conflicting, and sometimes contradictory, information 2 13 20 30 . Women describe how individual doctors have different opinions 2 13 about what is the best choice. They feel that there is a lack of medical consensus as to whether induction should be attempted following a previous CS 2 20 . A personal choice for vaginal birth can be in conflict with clinician’s expectations 30 .

Every time you'd see a different doctor. I don't think I ever saw the same doctor. Some seem to be more towards the vaginal birth than the Caesarean and others the other way around. I think it is a bit of personal preference really 13 , p.277.

Women describe that it is of importance to have a choice about mode of delivery 2 18 19 20 30 31 . Health-professionals allowed the women to make decisions 2 18 20 30 31 , and it was important to have an opportunity for both vaginal birth and CS 18 29 30 31 . Involvement in decision-making gave confidence and increased the trust in the carers 20 , gave a sense of being active 31 , of having choice in relation to interventions 20 , and that the choice was completely up to the woman 30 . Being involved in decision-making also gave a sense of control 31 , which many women felt was important to retain 19 31 ; however, some women in one study felt relief when they relinquished control, as it avoided them feeling guilty over making the decision 18 . Women also expressed respect of others’ decisions 18 19 29 .

I knew I wanted to try it from the beginning and I knew that as soon as I got pregnant… When I went to the doctor's office the first time, I asked to see if I could try it, and they were all really supportive 31 , p.668-669.

Women felt uncertainty in relation to choice 2 19 20 30 31 . Uncertainty may lead to a ‘wait and see-policy’ 2 , being ‘back and forward’ 30 , and changing their mind several times before the birth 19 , and not being strong on standing up for what they really want 30 . Women expressed uncertainty in relation to labour 20 30 , particularly the second stage of labour 20 . Some women were anxious about the choice even after the birth 2 . Uncertainty could lead to changing specialist, hospitals and getting a second opinion 19 . For some women the solution was to rely on the professionals ‘who know best’ 20 30 .

I don't know what to think really. It's a bit daunting thinking about having a normal birth after a Caesarean section. I don't know what to expect 20 , p.164.

I was back and forward. I was quite, on a few occasions I said ‘right, I'll go for the section’ to both the consultant and the midwife. I'm the kind of person that I listen to people's advice. I'm not very strong on right this is what I want 30 , p.9.

Information and support from others, not the hospital, was of importance for the women 2 13 18 19 30 31 . They received information and opinions from their partner, family, friends and relatives 2 19 30 31 . Women read books and got information by internet and television 2 19 30 31 , which could be experienced as both helpful and non-helpful. Support also came from women with similar experiences of birth 19 .

I read all the research, read a lot of other women's experiences and I contacted a support group 19 , p.1565.

Support in relation to choice was mediated by doctors, and midwives working at hospitals and in the community 2 13 29 30 31 . Information was most commonly provided during hospital consultations 2 29 30 31 . Therefore the decision whether to give birth vaginally or by CS was mostly influenced by doctors 2 29 30 31 , who were experienced as supportive of the women's decision 2 29 30 31 .

I felt that the choice was mine completely and he just basically said to me there and then ‘we can set a date, the 15 ^th of May, how does that suit you, at 8 o'clock in the morning and I just felt completely flooded with relief 30 , p.9.

Previous birth experiences influenced women's choice 2 19 29 31 . The CS-experience was for some women connected to disempowerment, being powerless, helpless, angry and ‘ripped off’ 19 , and loss of confidence in their body’s ability to give birth 29 . Being separated from the baby was also a negative aspect of the previous birth 19 31 . Further, the birth environment 19 and the relationships with professionals were of importance 19 . Some women express that they will do it differently this time 31 , which could mean a vaginal birth or a CS. Some women would not try giving birth vaginally 29 , and do not like labour pain 29 . For some, the experience of CS has strengthened their desire to have a normal birth 19 , but for others a CS was the choice they must make, connected to a desire to have a healthy baby 19 30 , and not as an easy and weaker option 30 .

I think the way people handle that first one either builds confidence or takes away people's confidence 29 , p.29.