Factors Influencing Preference for Repeat Elective Cesarean Section among Low-Risk Women with Previous Unplanned Cesarean Delivery at Kijabe Hospital in Kenya

Cesarean section (CS) 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 contributed substantially to this increase. For low-risk women, vaginal birth after CS is a safe and cost-effective alternative that can reduce cesarean-related morbidity and ease the burden of higher rates placed on the healthcare system. Despite these benefits, many women in Kenya still prefer to repeat elective cesarean delivery in subsequent pregnancies. This study investigated the factors influencing this preference among low-risk women attending Kijabe Hospital. 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 CS 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 choices of delivery modes. Traumatic vaginal interventions, an expressed low confidence in a 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 are key to encouraging safer, evidence-based birth practices.