‘Just opt for caesarean section and pick the birthdate’: a qualitative study exploring women’s delivery preferences after caesarean section in urban Tanzania

Objectives To explore perspectives, preferences and decision-making regarding mode of delivery after a previous caesarean section among women in urban Tanzania. Design A descriptive qualitative study using semi-structured in-depth interviews. Data were analysed using thematic analysis. Setting A private tertiary hospital in Dar es Salaam, Tanzania. Participants 11 women with one previous caesarean section who delivered at the study site were interviewed on the third day after delivery. Participants were purposively sampled to include both modes of delivery: five women underwent repeat caesarean section and six attempted a trial of labour after caesarean (TOLAC). Results Thematic analysis identified four key themes: (1) social and cultural influences, (2) physical and emotional experiences, (3) desire for emotional support and relief from labour pain and (4) balancing medical advice with personal beliefs. Misinformation, inconsistent counselling and strong social influences were prominent factors that often led women to prefer repeat caesarean section even when vaginal birth after caesarean (VBAC) was medically feasible. Conclusions Women’s delivery preferences after caesarean section are shaped by social influences, personal experiences and inconsistent healthcare counselling. While findings suggest opportunities to improve patient-centred communication, broader implementation of VBAC requires alignment across multiple levels of the healthcare system, including provider training, institutional protocols and supportive infrastructure which were beyond the scope of this study. Further research incorporating healthcare provider perspectives and diverse settings is needed.