Design, development, and evaluation of a web-based consultation system for birth after cesarean: a mixed-method study protocol

BACKGROUND: Women with a prior cesarean section frequently face challenges in choosing the mode of delivery, and limited knowledge, negative attitudes toward vaginal birth, and lack of tailored guidance often led to elective repeat cesarean sections. The main objective of this study is to design, develop, and evaluate a web-based counseling system to support and empower pregnant women in making informed decisions regarding vaginal birth after cesarean (VBAC). METHODS/DESIGN: A sequential exploratory mixed-methods study will be conducted in Mashhad, Iran. Phase 1 (qualitative) will use conventional content analysis of semi-structured interviews with 25 pregnant women and healthcare providers to identify needs, expectations, and preferences for a web-based VBAC counseling system. Phase 2 will involve iterative prototype development following the prototyping model, guided by qualitative findings, expert validation, and a systematic review. Phase 3 will evaluate system usability (System Usability Scale) and effectiveness via a two-arm randomized controlled trial with 80 eligible women. Districts will be randomized; intervention participants will access the web-based system, while controls receive routine care. Primary outcomes are VBAC intention, choices, and VBAC actual rates. Secondary outcomes include knowledge, satisfaction, and breastfeeding success. Data will be analyzed using SPSS. DISCUSSION: This study examines the impact of a web-based VBAC counseling system on empowering pregnant women by enhancing their knowledge of delivery options and reducing decisional conflict. The system is designed to support informed decision-making, promote shared decision-making with healthcare providers, and facilitate safer, evidence-based choices regarding vaginal birth after cesarean. TRIAL REGISTRATION: This trial is registered with the Iranian Registry of Clinical Trials under registration number IRCT20170607034378N3, with the registration date 2025-11-15.