Psychological Determinants of Preferring Vaginal Birth After Cesarean: Fear and Self-Efficacy

Abstract This study aimed to identify the psychological determinants of the preference for vaginal birth after cesarean versus cesarean after vaginal birth and to develop a prognostic nomogram. This cross-sectional study included 400 participans. Data were analyzed using multivariable logistic regression and ROC analysis. Contrary to expectations, the preferring vaginal birth after cesarean group reported significantly lower childbirth self-efficacy (p = 0.045) and higher specific birth fears (p < 0.001). Multivariable analysis identified husband’s education (OR: 2.32), negative previous birth experience, and fear of pregnancy and childbirth problems (OR: 0.84) as significant predictors of preferring vaginal birth after cesarean preference. ROC analysis demonstrated that the fear of pregnancy and childbirth problems had statistically significant discriminative ability in predicting birth preference (AUC = 0.68, 95% CI: 0.63–0.73, Sensitivity: 76%). A paradoxical association exists where women with higher fears and lower self-efficacy are more inclined to choose preferring vaginal birth after cesarean, which may reflect a motivation to avoid repeated surgery. High fear levels may indicate a strong motivation for a trial of labor rather than a request for cesarean.