FACTORS INFLUENCING PREFERENCE FOR REPEAT ELECTIVE CESAREAN SECTION AMONG LOW-RISK WOMEN WITH PREVIOUS UNPLANNED CESAREAN DELIVERY AT AIC KIJABE HOSPITAL

Abstract

Cesarean section rates have risen significantly over the past decade, with many countries surpassing the World Health Organization's standard of 10-15%. Women with a previous cesarean- Robson group 5- contribute substantially to this increase. For low-risk women, Vaginal Birth After Cesarean (VBAC) is a safe and cost-effective alternative that can reduce cesarean-related morbidity and ease the burden higher rates placed on the healthcare system. Despite these benefits, many women in Kenya still prefer repeat elective cesarean delivery in subsequent pregnancies. This study investigates the factors influencing this preference among low-risk women attending AIC Kijabe Hospital, exploring the influence of their previous birth experiences, and that of healthcare providers on their delivery decisions. This qualitative phenomenological study involved 18 women with prior cesarean delivery attending the hospital. Participants were selected through purposive sampling based on predefined inclusion and exclusion criteria. Data was collected through in-depth interviews using a semi-structured interview guide and analyzed using inductive thematic analysis with the Dedoose software. Maternal reasons for preferring repeat cesarean included fear, personal preference versus the influence of loved ones, the convenience of simultaneous bilateral tubal ligation, and the desire to experience a vaginal birth. Prior birth experiences also shaped maternal choice of delivery mode-- traumatic vaginal interventions, an expressed low confidence in successful vaginal birth and the considerations of risks over benefits were all influential. Participants also emphasized the importance of healthcare providers‟ recommendations, noting counseling gaps and facility preparedness to offer VBAC services. Ultimately, reducing repeat cesareans among low-risk women requires a comprehensive strategy: Strengthening the support for VBAC services, improving the quality of patient-provider communication, and addressing the emotional and psychological impacts of prior birth trauma. Institutional policies that encourage comprehensive counseling and shared decision-making will be key to encouraging safer, evidence-based birth practices.