BACKGROUND:
Globally, 21% of deliveries are performed by caesarean section (CS), despite WHO and PAHO recommendations to keep rates below 10-15%. Most are repeat CS. While lifesaving, CS is associated with risks such as hemorrhage, infection, and surgical complications. Trial of labour after cesarean (TOLAC) offers an opportunity for vaginal birth after cesarean (VBAC), but uptake remains low in many settings.

OBJECTIVES:
This study aimed to identify factors influencing women’s decisions regarding mode of delivery following a previous CS.

METHODS:
A cross-sectional study was conducted at Pumwani Maternity Hospital and Aga Khan University Hospital in Nairobi County. A total of 384 postnatal women with a history of CS were proportionally recruited using consecutive sampling. Data were collected using structured questionnaires. Descriptive, univariable, and multivariable logistic regression analyses were conducted using SPSS v22 and Stata v13 to determine predictors of TOLAC preference. Ethical approval was obtained from ISERC, NACOSTI, Nairobi County, and hospital research committees. Informed consent was secured from all participants.

RESULTS:
Among participants, 15.6% opted for TOLAC, with a VBAC success rate of 57.3%. The strongest predictors for preferring TOLAC at term were hospital policy (AOR = 5.13, 95% CI: 1.55–10.04), information received from healthcare providers (AOR = 5.59, 95% CI: 2.13–13.88), and personal preference (AOR = 3.59, 95% CI: 1.28–10.19).

CONCLUSIONS:
Hospital policy, provider communication, and personal preferences significantly influenced women’s decision to attempt TOLAC. These findings emphasize the importance of supportive policies and woman-centred counselling to facilitate informed decision-making after cesarean birth.

KEY MESSAGE:
To promote safe and informed birth choices after cesarean, health systems must support midwives and providers in offering respectful, evidence-based counselling aligned with women’s values. Poster session 2 (Group A)