Exploring the decision-making process for trial of labour after caesarean: A qualitative study from a high-volume maternity care setting in Puducherry, South India

Rising caesarean section rates, particularly repeat procedures, pose clinical and ethical concerns in low- and middle-income countries. Vaginal birth after caesarean (VBAC) presents a safe and viable choice for many women. However, decisions regarding trial of labour after caesarean (TOLAC) are influenced by more than just clinical criteria; personal experiences, social contexts, and the availability of information deeply shape them.it wa aimed to explore the perceptions, experiences, and decision-making processes of women considering TOLAC in a high-volume maternity care setting in Puducherry, South India. A qualitative study was conducted using in-depth interviews with 17 postpartum women who had been evaluated for TOLAC. Thematic analysis was employed to identify the key domains that shape decision-making. Data were coded inductively and thematically framed through the lens of autonomy and informational agency. Five interconnected themes emerged: (1) Embodied Experience and Medical Memory; (2) Fear, Resolve, and Emotional Negotiation; (3) Cultural Scripts and Social Endorsements; (4) Provider Interactions and Health System Navigation; and (5) Digital and Peer-Based Information Seeking. Women navigated TOLAC decisions by reframing risk, interpreting medical advice, and balancing cultural and familial expectations. Their agency was influenced by social media, peer networks, and trust in healthcare institutions. Women’s decisions on VBAC reflect clinical considerations and emotional, cultural, and digital influences. Supporting person-centred maternity care in LMICs requires respectful dialogue, early counselling, and acknowledgement of women’s evolving information environments and autonomy.