“Pulling through”: Women’s experiences of vacuum‑assisted birth at a rural Tanzanian hospital—A qualitative study

INTRODUCTION: Vacuum-assisted birth (VAB) is a vital obstetric intervention to expedite delivery and prevent unnecessary cesarean sections (CS). Despite its benefits, little is known about women's experiences and perceptions of VAB in low-resource settings. This study aimed to explore women's experiences of VAB in a rural hospital in Tanzania, identifying factors shaping their emotional responses and future birth preferences. METHODS: A qualitative design using semi-structured interviews was conducted at a tertiary rural hospital. Thirteen women who had undergone VAB within the previous six months participated. Interviews in Kiswahili were transcribed, translated into English, and analyzed using reflexive thematic analysis by Braun and Clarke. RESULTS: Four themes were generated: Making sense of the unexpected; Balancing fears and necessity; Feeling seen versus feeling ignored; and Redefining future childbearing plans post-VAB. Positive postpartum explanations and reassurance encouraged some women to view VAB favourably in future pregnancies, whereas unresolved concerns led others to prefer elective CS. CONCLUSION: Women's experiences of VAB were shaped by the quality of antenatal preparation, provider communication, respectful intrapartum care, and postpartum support. Embedding antenatal education, effective communication, shared decision-making, and postpartum debriefing into training and supervision may enhance acceptability and sustainable use of VAB in low-resource settings.