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There is a paucity of information regarding Australian nurses' sleep and fatigue levels, and whether they result in impairment. Forty-one Australian hospital nurses completed daily logbooks for one month recording work hours, sleep, sleepiness, stress, errors, near errors and observed errors (made by others). Nurses reported exhaustion, stress and struggling to remain (STR) awake at work during one in three shifts. Sleep was significantly reduced on workdays in general, and workdays when an error was reported relative to days off. The primary predictor of error was STR, followed by stress. The primary predictor of extreme drowsiness during the commute was also STR awake, followed by exhaustion, and consecutive shifts. In turn, STR awake was predicted by exhaustion, prior sleep and shift length. Findings highlight the need for further attention to these issues to optimise the safety of nurses and patients in our hospitals, and the community at large on our roads. Keywords: Sleep loss; Work hours; Nursing

Abstract Background Exclusive breast milk provides complete nutrition for a baby's first six months of life. In Australia, breastfeeding initiation rates are high, however duration rates are low. Although numerous studies have explored the reasons behind low levels of breastfeeding, few have examined the experiences of women who maintain exclusive breastfeeding for the recommended six-month duration. Aim This paper will present an in-depth, idiographic interpretation of first-time mothers' experience of exclusive breastfeeding for six months in Australia. Method Interpretative phenomenological analysis was used to explore how five new mothers understood their six-month exclusive breastfeeding journey. Face-to-face, semi-structured interviews were conducted retrospectively, transcribed in full, and analysed using the flexible seven-step approach of interpretative phenomenological analysis. Findings Three higher-order themes were identified: (1) exclusive breastfeeding is a personal choice, (2) exclusive breastfeeding is harder than expected, and (3) everyone has something to say about breastfeeding. Conclusion The mothers were not prepared for public debates around infant feeding methods, where mothers judge each other and give advice that supports their own goals, both of which create an unnecessary divide between mothers. Despite these issues, the findings highlight the personal and social meanings aligned with exclusive breastfeeding and point to the significance in fostering determination as a means to achieve exclusive breastfeeding goals. This qualitative reflection contributes a nuanced understanding of mothers' lived experience of exclusive breastfeeding, deepening our understanding and enabling appropriate strategies and support for the longevity of exclusive breastfeeding, as well as direction for continued research. [ABSTRACT FROM AUTHOR]

Objective to investigate the personal, social, cultural and institutional influences on women making decisions about using epidural analgesia in labour. In this article we discuss the findings that describe practices around the gaining of consent for an epidural in labour, which we juxtapose with similar processes relating to use of water for labour and/or birth. Design ethnography. Setting tertiary hospital in Australian city. Participants sequential interviews were conducted with 16 women; hospital staff (primarily midwives and doctors) participated during six months of participatory observation fieldwork. Findings women were not given full disclosure of either practice and midwives tailored the information they gave according to the institutional policies rather than evidence. Key conclusions informed consent is an oft-cited human right in health care, yet in maternity care the micro-politics of how informed consent is gained is difficult to ascertain, leading to a situation whereby the concept of informed consent is more robust than the reality of practice; an illusion of informed consent exists, yet information is often biased towards medicalised birth practices. Implications for practice as primary maternity care-givers, midwives have a role in providing unbiased information to women; however it appears that hospital culture and policy affect the way that this information is presented. It is arguable whether women in such instances are giving true informed consent, and for this reason, the ethics of these hidden practices are questioned. [ABSTRACT FROM AUTHOR]

Background Given the significant benefits of breastfeeding, the World Health Organization (WHO) recommend exclusive breastfeeding for six months. Despite numerous strategies aimed at increasing the percentage of babies who are exclusively breastfed, Australia currently has one of the lowest six-month exclusive breastfeeding rates in the developed world. Notably, most research focuses on the early postnatal period (birth-two months) yet the largest decline in exclusive breastfeeding rates is observed between two and six months. Aim This study aimed to understand what enabled a first-time mother to continue exclusively breastfeeding between two and six months in Australia. Methods The qualitative approach known as interpretative phenomenological analysis (IPA) was used to explore how the new mother understood her exclusive breastfeeding journey. Data was collected retrospectively through a face-to-face, semi-structured interview, then transcribed in full and analyzed using IPA’s approach to data analysis. Findings Three main themes were identified as self-determination to achieve exclusive breastfeeding, the influence of social norms in Australian culture, and the impact social supports have on maintaining exclusive breastfeeding. Conclusion For this mother, her self-determination to exclusively breastfeed, along with positive social support, outweighed the impact of perceived social norms and negative pressure from significant others to stop exclusive breastfeeding. This qualitative reflection contributes to an understanding of the individual in the breastfeeding journey, uncovering nuances around exclusive breastfeeding that may be helpful in providing support for mothers and direction for further research. [ABSTRACT FROM AUTHOR]

Background Aboriginal and Torres Strait Islander women, hereafter called Indigenous women, can experience a lack of understanding of their cultural needs when accessing maternity care in the standard hospital care system. Aim To explore the lived experiences described by Indigenous women accessing labour and birth care in the standard hospital care system at a tertiary public hospital in South Australia. Methods An interpretive Heideggerian phenomenological approach was used. Indigenous women who accessed standard care voluntarily agreed to participate in semi-structured interviews with Indigenous interviewers. The interviews were transcribed and analysed informed by van Manen's approach. Findings Thematic analysis revealed six main themes: “knowing what is best and wanting the best for my baby”, “communicating my way”, “how they made me feel”, “all of my physical needs were met”, “we have resilience and strength despite our hardships” and “recognising my culture”. Conclusion Indigenous women in this study expressed and shared some of their cultural needs, identifying culturally unsafe practices. Recommendations to address these include the extension of current care planners to include cultural needs; Aboriginal Maternal Infant Care (AMIC) workers for women from rural and remote areas; AMIC workers on call to assist the women and midwives; increased education, employment and retention of Indigenous midwives; increased review into the women's experiences; removal of signs on the door restricting visitors in the birth suite; flexibility in the application of hospital rules and regulations; and changes to birthing services in rural and remote areas so women may not have to relocate for birth. [ABSTRACT FROM AUTHOR]

Background Aboriginal and Torres Strait islander 1 1 The term Aboriginal is inclusive of both Aboriginal and Torres Strait Islander peoples in this study. women face considerable health disparity in relation to their maternity health outcomes when compared to non-Aboriginal women. Culture and culturally appropriate care can contribute to positive health outcomes for Aboriginal women. How midwives provide culturally appropriate care and how the care is experienced by the women is central to this study. Aim To explore the lived experiences of midwives providing care in the standard hospital care system to Aboriginal women at a large tertiary teaching hospital. Methods An interpretive Heideggerian phenomenological approach was used. Semi-structured interviews were conducted with thirteen volunteer midwives which were transcribed, analysed and presented informed by van Manen's approach. Findings Thematic analysis revealed six main themes: “Finding ways to connect with the women”, “building support networks – supporting with and through Aboriginal cultural knowledge”, “managing the perceived barriers to effective care”, “perceived equity is treating women the same”, “understanding culture” and “assessing cultural needs – urban versus rural/remote Aboriginal cultural needs”. Conclusion The midwives in this study have shared their stories of caring for Aboriginal women. They have identified communication and building support with Aboriginal health workers and families as important. They have identified perceived barriers to the provision of care, and misunderstanding around the interpretation of cultural safety in practice was found. Suggestions are made to support midwives in their practice and improve the experiences for Aboriginal women. [ABSTRACT FROM AUTHOR]

Background Approximately 30% of Australian women use epidural analgesia for pain relief in labour, and its use is increasing. While epidural analgesia is considered a safe option from an anaesthetic point of view, its use transfers a labouring woman out of the category of ‘normal’ labour and increases her risk of intervention. Judicious use of epidural may be beneficial in particular situations, but its current common use needs to be assessed more closely. This has not yet been explored in the Australian context. Aim To examine personal, social, institutional and cultural influences on women in their decision to use epidural analgesia in labour. Examining this one event in depth illuminates other birth practices, which can also be analysed according to how they fit within prevailing cultural beliefs about birth. Methods Ethnography, underpinned by a critical medical anthropology methodology. Results These findings describe the influence of risk culture on labour ward practice; specifically, the policies and practices surrounding the use of epidural analgesia are contrasted with those on the use of water. Engaging with current risk theory, we identify the role of power in conceptualisations of risk, which are commonly perpetuated by authority rather than evidence. Conclusions As we move towards a risk-driven society, it is vital to identify both the conception and the consequences of promulgations of risk. The construction of waterbirth as a ‘risky’ practice had the effect of limiting midwifery practice and women's choices, despite evidence that points to the epidural as the more ‘dangerous’ option. [ABSTRACT FROM AUTHOR]

Abstract: Objective: to critically review literature related to the practice of antenatal breast expression (ABE) and the reasons for this practice. Method: a critical review of available literature was undertaken by accessing Internet and library resources. Articles were to be documented in English. No restrictions were placed on dates due to the important historical background of this topic. Keywords used to refine the search included antenatal breast expression, colostrum, antenatal breast-feeding education and midwives and International Board Certified Lactation Consultants (IBCLC). Findings: the literature search discovered ABE has been performed historically to prepare breasts for breast-feeding postnatally. It is presently being taught to store colostrum to prevent neonatal hypoglycaemia or hasten production of Lactogenesis 2. Studies relating to nipple stimulation were also critically appraised due to concerns of premature labour. Conclusions: the safety and efficacy of ABE has yet to be demonstrated. The three studies related to the benefits teaching of this skill were small in size with methodological flaws. Trials related to nipple stimulation were also found to have substantial limitations. The reasons for and physicality of performing ABE vs. nipple stimulation differed markedly. While recent teaching of ABE has been encouraged through available commentaries, case studies and policies (in view of the documented positive effects of early colostrum administration), the benefits of this practice are yet to be substantiated. Implications for practice: large, credible RCTs are needed to confirm efficacy and safety of this technique. A survey exploring the prevalence of ABE practices is also indicated and to explore the information currently provided by midwives to women in their care. [Copyright &y& Elsevier]

Abstract: Background: Antenatal breast expression (ABE) has been taught in the past as breast preparation. Now some authorities are advising ABE and storage of colostrum for the feeding the newborn in the treatment and/or prevention of hypoglycaemia in the immediate postnatal period (thus avoiding the need for formula supplementation). The actual incidence of ABE teaching amongst International Board Certified Lactation Consultant (IBCLC) Midwives is unknown. Results of this study will provide valuable baseline data for future randomised controlled trials into this practice. Research question: What are the teaching practices surrounding ABE and the incidence of this type of teaching by IBCLC Midwives across Australia? Method: A descriptive cross-sectional Internet survey containing both quantitative and qualitative questions was sent to Australian IBCLC Midwives. Simple descriptive statistics was used to analyse quantitative data. Content analysis examined qualitative textual data of open-ended questions. Findings: Response rate was 27% (n =347/1269). 93% (n =322) of those responding to the survey had heard of ABE. 60% (n =134) actively teach the practice. Descriptive statistics and content analysis revealed marked differences in teaching practices amongst this specialised group of midwives. Conclusion: This study suggested a large proportion of lactation qualified midwife respondents were aware of ABE and some currently teach the skill. However, advice given to women during pregnancy varied substantially. [Copyright &y& Elsevier]

Summary: Background: Educational portfolios have been used across a variety of disciplines in university education as means of encouraging reflective practice in students and as a form of assessment by which a cumulative record of the student''s experience can be substantiated. More recently, the development of ePortfolios has provided the potential to transform portfolio learning for students in the 21st century. Aim: Development of a pilot ePortfolio for the Bachelor of Midwifery at the University of South Australia (UniSA). Methods: This study adopted an action research methodology and followed the action research cycle of planning, action, observation and reflection in order to develop, implement and evaluate a pilot ePortfolio. An action research group was established to develop the ePortfolio. Results: Once the ePortfolio was developed, it was piloted with 18 first year midwifery students undertaking their second clinical placement. Eleven students provided feedback by completing an anonymous electronic questionnaire and, of these, eight also participated in interviews. Discussion: One of the overriding findings from this project is that midwifery students studying at UniSA consider the portfolio, in any form, a valuable record of their experience. It provides students with an authentic record of achievement, proof of their competency and a final summary of their learning journey. A number of issues with paper-based portfolios were identified; essentially students found that they were confusing at first, cumbersome and created anxiety but that they provided a tangible means of consolidating their learning experiences. With regards to the ePortfolio, students agreed that it seemed more simple, streamline and safe, but there were a number of suggestions for improvement put forward. Conclusion: The paper concludes that ePortfolio is considered ‘the way of the future’ for midwifery students, however a number of issues must be addressed through further collaboration prior to replacing the paper-based ePortfolio. [Copyright &y& Elsevier]

Abstract: Objective: to examine changes in midwives’ attitudes to their professional role following the introduction of midwifery group practice (MGP) (a caseload model of midwifery continuity of care provided to women of all risk levels) and to explore aspects of the model that were working well and those that were not working well. Design: the questionnaire ‘Attitudes to Professional Role’ was used to measure midwives’ satisfaction in terms of professional satisfaction, professional support, client interaction, and professional development. Open-ended questions were also included to offer an opportunity for midwives to expand on their experiences of working in the MGP model. The questionnaire was administered at five time points over the 18-month evaluation period. Round 1 was prior to the implementation of MGP, Rounds 2–4 were at three-month intervals, with Round 5 six months later. Analysis of the structured part of the questionnaire was undertaken by comparing mean scores of satisfaction ranging from −2 (very negative attitudes) to +2 (very positive attitudes), and the open-ended questions were analysed using qualitative content analysis. Setting: the Women''s and Children''s Hospital, Adelaide, South Australia. Participants: questionnaires were distributed to all midwives (n=15) working in MGP in Rounds 1, 2 and 3, and to the 12 midwives remaining from the original sample in Rounds 4 and 5. Fourteen questionnaires were returned in Round 1, 12 in Round 2, 10 in Round 3, nine in Round 4, and 10 in Round 5. Findings: overall, a positive change in attitudes to professional role was reflected in all sub-scales in the period between start-up and 18 months later; a reduction in scores occurred in Round 3. The mean increases were significant for all sub-scales apart from professional development. Five main themes were identified across the rounds in the content analysis: ‘continuity of care’, ‘working pattern’, ‘working environment’, ‘collegiality’ and ‘issues relating to midwifery practice’. Midwives gained particular satisfaction from providing continuity of care and building relationships with women and their families, and through practising autonomously as a midwife. While there was a struggle to manage the hours worked and being on call, high levels of professional satisfaction were maintained. Key conclusions: while there were aspects of MGP that midwives were not satisfied with and wanted to change, overall they were satisfied with the model. Implications: there is a need for ongoing evaluation in order to monitor the short- and long-term impact on midwives of working in a caseload model of continuity of midwifery care. [Copyright &y& Elsevier]

Summary: Objective: to research the role of midwives in Australia from the perspectives of women and midwives. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care. Design: a multi-method approach with qualitative data collected from surveys with women and interviews with midwives. Setting: participants represented each state and territory in Australia. Participants: midwives who were randomly selected by the regulatory authorities across the country and women who were consumers of midwifery care and involved in maternity activism. Key conclusions: midwives and women identified a series of key elements that were required of a midwife. These included: being woman centred; providing safe and supportive care; and working in collaboration with others when necessary. These findings were consistent with much of the international literature. Implications for practice: a number of barriers to achieving the full role of the midwife were identified. These included a lack of opportunity to practice across the full spectrum of maternity care, the invisibility of midwifery in regulation and practice, the domination of medicine, workforce shortages, the institutional system of maternity care, and the lack of a clear image of what midwifery is within the wider community. These barriers must be addressed if midwives in Australia are to be able to function according to the full potential of their role. [Copyright &y& Elsevier]

Summary: Background: The reduction of time available to midwives during the hospital postnatal stay suggests that there is a need to review postnatal care. Innovative strategies are required which give attention to specific family needs and assist in the transition to parenthood. Nevertheless, new ideas and changes are not always readily accepted in midwifery practice. Aim: To enhance the provision of postnatal care to parents in the early postnatal period given time constraints for parents’ hospital stay. Methods: Action research was employed to explore the educational experiences of parents in the postnatal period. An action research group (ARG) was established, comprising predominantly of midwives. Based on data collected from parents through questionnaires, focus groups and interviews, three actions were developed and implemented on a postnatal ward. Results: The actions were evaluated by 122 parents through self-report questionnaires. Midwives working on the postnatal ward and midwives involved in the ARG provided feedback regarding the actions through separate focus group discussions. The parents who participated in the study and, the midwives involved in the ARG, were positive about the actions and perceived them to be beneficial in preparing parents for parenthood. Many of the ward midwives, however, were negative about the actions and questioned their benefit for midwifery practice. Discussion: The negativity of the ward midwives regarding the innovations implemented in the study contrasted strikingly with the positive responses from both parents and the action research midwives. Two themes emerged which may explain the response of midwives to the actions, notably, a lack of ownership of the actions and the problematic nature of the current culture of the postnatal-care environment. Conclusion: It appears that the provision of hospital postnatal care has been influenced by an underlying culture in midwifery practice, which in turn, has impeded the change required to enhance postnatal care. [Copyright &y& Elsevier]

Summary: Background: Midwifery Group Practice (MGP) is a continuity of midwifery care model for women of all levels of pregnancy risk available at a tertiary metropolitan hospital in Australia. This paper presents Part II of the demonstration study exploring the effectiveness of MGP, and reports on women’s satisfaction with the model of care. Methods: A Maternal Satisfaction Questionnaire was developed and sent to all women (n =120) enrolled in MGP over a three-month period. The questionnaire comprised two open-ended questions asking women to list up to three things they liked and did not like about MGP, and a structured section exploring levels of satisfaction through a five-point Likert response format. The open-ended questions were analysed using qualitative content analysis, and analysis of the structured part of the questionnaire was undertaken by comparing mean scores of satisfaction ranging from −2 (very negative attitudes) to +2 (very positive attitudes). Results: Of the 120 women who were sent a Maternal Satisfaction Questionnaire, 84 returned their questionnaire (70% response rate). Three overarching themes were identified in the content analysis of open-ended questions, namely: Continuity of care; Accessibility; and Personal and professional attributes of the midwife. Analysis of the structured part of the questionnaire showed that women were satisfied with the care they received in MGP, as indicated by positive scores on all questions. Conclusions: Women being cared for in MGP are satisfied with their care. [Copyright &y& Elsevier]

Abstract: Objective: to investigate the relationship between adherence to six of the Baby Friendly Hospital Initiative (BFHI) Ten steps to successful breast feeding and the duration of breast feeding in first-time mothers. Design: a prospective study to assess the duration of breast feeding up to 6 months postpartum. Survival analysis techniques (Kaplan–Meier curves and Cox proportional hazard models) were used to interpret the data. Participants: 317 women who had given birth to their first baby (at term) in a large teaching maternity hospital in Adelaide, South Australia, during the period March to November 2003. Findings: ignoring all other factors, we found that women whose babies received a bottle feed, used a pacifier or dummy, or who used a nipple shield during their postnatal stay, were at significantly greater risk of weaning (p⩽0.05). After adjusting for socio-demographic variables, self-efficacy, intended duration of breast feeding, and method of delivery, the results unexpectedly showed that the only significant predictor of early weaning was breast feeding on demand. However, a composite variable indicating use of one or more of nipple shields, a dummy or bottle feeds while in hospital resulted in a significantly greater risk of weaning (p=0.05). Implications for practice: socio-demographic and cultural factors may be more important determinants of the duration of breast feeding than some of the very specific hospital practices targeted in the Ten steps to successful breast feeding. From a public health perspective, we may influence the duration of breast feeding through better post-discharge support services, or through interventions that improve attitudes to breast feeding in specific socio-cultural and economic groups. [Copyright &y& Elsevier]

Abstract: Objective: to develop and validate national competency standards for midwives in Australia. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care. Design: a multi-method, staged approach was used to collect data through a literature review, workshop consultations, interviews, surveys and written submissions in order to develop national competency standards for Australian midwives. Subsequently, direct observation of practice in a range of settings ensured validation of the competencies. Setting: maternity-care settings in each state and territory in Australia. Participants: midwives, other health professionals and consumers of midwifery care. Findings: The national competency standards for the midwife were developed through research and consultation before being validated in practice. Key conclusions: the national competency standards are currently being implemented into education, regulation and practice in Australia. These will be minimum competency standards required of all midwives who seek authority to practise as a midwife in Australia. It is expected that all midwives will demonstrate that they are able to meet the competency standards relevant to the position they hold. Implications for practice: the competency standards establish a national standard for midwives and reinforce responsibility and accountability in the provision of quality midwifery care through safe and effective practice. In addition, individual midwives may use the competency standards as the basis of their ongoing professional development plans. [Copyright &y& Elsevier]

Abstract: Objective: to assess the ability of a Breast-Feeding Self-Efficacy Scale (BSES) score measured at 1 week postpartum to predict the duration of breast-feeding in first-time mothers, and to develop a minimal set of potential confounders, including the BSES and demographic variables, for comparing the apparent effect of other influences on the duration of breast-feeding. Design: a prospective cohort study, with primary outcome the duration of breast feeding up to 6 months postpartum. Participants: 317 women who had given birth to their first baby (at term) in a large teaching maternity hospital in Adelaide, South Australia, during the period March to November, 2003. Findings: the BSES at 1 week postpartum was a strong predictor of the duration of breast-feeding in these first-time mothers. Its ability to predict the duration of breast-feeding was largely independent of the other factors (intended duration of breast-feeding, mother''s level of education, country of birth, housing situation, smoking status and method of delivery), which were also found to be significant predictors of breast-feeding duration. Implications for practice: the BSES (including a new short form version) has been confirmed by our study as an important instrument for identifying women at risk of early cessation of breast-feeding. Together with other demographic variables, it should be useful for targeting limited resources to those most in need. [Copyright &y& Elsevier]

Summary: Objective: to investigate the provision of parent education during the early postnatal period in order to gain insight that, through stakeholder collaboration, will contribute to the development of innovative strategies to enhance the provision of postnatal education in a contemporary health-care environment. Design: the study comprises the first stage of an action-research project. The first stage of research sought to explore the experiences of mothers and fathers in the early postnatal period by conducting a questionnaire within 4 weeks of the birth of their baby. The data obtained from the questionnaire is to inform an action-research group for stage two of the project. Setting: The Children, Youth and Women''s Health Service, a large city maternity hospital in South Australia, covering a range of socio-economic strata. Participants: 85 parents completed and returned the questionnaire, comprising 52 mothers and 33 fathers. Measurement: an anonymous self-report questionnaire was purpose designed to provide each parent with an opportunity to reflect on their own experience, with particular emphasis given to the provision of education and support during the early postnatal period. Findings: a number of themes emerged, including a window of opportunity during the postnatal hospital stay to provide education and support, despite the reduction in the length of stay; the need for a family-centred approach to maternity services; and the significance of self and social network in the early transition to parenthood. Conclusions: The findings from this stage of the research, combined with a review of the literature, provide insight that will contribute to stage two of the study. At this stage, an action-research group will continue planning to develop specific actions to enhance the provision of education to parents in the early postnatal period. These actions will subsequently be implemented and assessed. [Copyright &y& Elsevier]

Background Listening to women as part of their antenatal care has been recognized as valuable in understanding the woman’s needs. Conversations as part of routine antenatal interactions offer ideal opportunities for women to express themselves and for midwives to learn about the woman’s issues and concerns. The antenatal visit and the convention of antenatal consultations for midwives have not been well explored or defined and much of what takes place replicate medical consultative processes. As a consequence, there is little to assist midwives construct woman-centred care consultations for their routine antenatal care practice. This study showed how some practices were better in promoting the woman’s voice and woman-centred care in the hospital setting. Method Contemporary focused ethnography using both interview and observations, explored how midwives from six different public antenatal clinics in South Australia organized their antenatal care consultations with pregnant women. Findings Thematic analysis of the data provided insights into professional interpretation of woman-centred practice. How midwives interacted with women during routine antenatal care events demonstrated that some practices in a hospital setting could either support or undermine a woman-centred philosophy. Conclusion Individual midwives adopted practices according to their own perceptions of actions and behaviors that were considered to be in accordance with the philosophy of woman-centred care. Information arising from this study has shown ways midwives may arrange antenatal care consultations to maximize women’s participation. [ABSTRACT FROM AUTHOR]

Background Vaginal birth is a safe mode of birth for most women who have had a prior caesarean with a transverse incision. Despite the evidence, most Taiwanese women who have had a previous caesarean are rarely offered the opportunity to consider any possibility other than a repeat caesarean. Aim This study explored factors affecting Taiwanese women’s decisionmaking regarding vaginal birth after cesarean. Methods Ajzen’s Theory of Planned Behaviour provided the theoretical framework to underpin the study, which adopted an interpretive descriptive methodology. Sequential semi-structured interviews were conducted with 29 women who had a previous caesarean and were pregnant between 34 and 38 weeks gestation, ten women who attempted vaginal birth in the third to fifth day postpartum, and 25 women in the fourth week postpartum. Boyatzis’ method of thematic analysis was used to identify themes and codes. Findings This paper reports the findings of the prenatal interviews with 29 participants. The major factor influencing women’s decision-making was to avoid negative outcomes for themselves and their babies. Three thematic codes describe influences on the women’s decisions: ‘past experience of childbirth’, ‘anticipating the next experience of normal birth’ and ‘contemplation on the process of childbirth’. Conclusions Women who have had a previous caesarean section are prepared to have a vaginal birth but are not always supported to carry out this decision. Changing the models of antenatal care is recommended as a strategy to overcome this difficulty therefore empowering women to make a meaningful choice about VBAC after a CS. [ABSTRACT FROM AUTHOR]