Table 1

Characteristics of included studies and quality assessment

Author	Aim	Country (region)	Resource	Setting	Number of participants	Type of participant	Method	Quality assessment
Melman et al 47	To explore barriers and facilitators for delivering optimal care as described in clinical practice guidelines.	The Netherlands (European)	High	Rural and urban	30	Obstetricians and midwives	Telephone interviews and focus groups	B
Foureur et al 66	To explore the views and experiences of providers in caring for women considering VBAC.	Australia (Western Pacific)	High	Urban	18	Obstetricians and midwives	Semistructured interviews	B
Lundgren et al 65	To explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates.	Ireland, Italy and Germany (European)	High	Rural and urban	71	Obstetricians, midwives, neonatologist and GP.	Focus groups	A−
Lundgren et al 64	To investigate the views of clinicians working in countries with high VBAC rates on factors of importance for improving VBAC rates.	Finland, Sweden and the Netherlands (European)	High	Rural and urban	44	Obstetricians and midwives	Interviews and focus groups	A−
Litorp et al 63	To explore obstetric caregivers’ rationales for their hospital’s CS rate to identify factors that might cause CS overuse.	Tanzania (African)	Low	Urban	32	Obstetricians and midwives	Observation, interviews and focus groups	A
Marshall et al 62	To evaluate the ‘Focus on Normal Birth and Reducing Caesarean section Rates’ programme.	UK (European)	High	Rural and urban	16	Obstetricians and midwives	Semistructured interviews	B
Colomar et al 61	To assess opinions of the determinants of the high rate of caesarean births in Nicaragua as well as possible barriers to and facilitators of optimal caesarean birth rates.	Nicaragua (Americas)	Middle	Unclear	17	Doctors and obstetric decision makers	Focus groups	A
Lofti60	To explore effective strategies to reduce caesarean delivery rates in Iran.	Iran (Eastern Mediterranean)	Middle	Unclear	10	Obstetricians and midwives	Semistructured interviews	C
Dunn et al 59	To reduce high rates of ERCS <39 weeks across the Eastern Ontario region.	Canada (Americas)	High	Unclear	9	Nursing cirectors and managers	Key informant interviews	C
Wang and Ding46	To explore reasons for obstetric medical staff choosing CS for themselves in the absence of medical indication.	China (Western Pacific)	Middle	Urban	11	Health professionals	Semistructured interviews	C
Liu et al 45	To explore affecting factors of continuing increase in CS rate in rural area.	China (Western Pacific)	Middle	Rural	9	Health professionals	Focus groups	C
Cox58	To explore the barriers associated with the ACOG VBAC guidelines.	USA (Americas)	High	Rural and urban	24	Obstetricians, midwives and an administrator	Semistructured interviews	A-
Yazdizadeh et al 57	To identify barriers to reduce the CS rate in Iran, as perceived by obstetricians and midwives as the main behavioural change target groups.	Iran (Eastern Mediterranean)	Middle	Urban	26	Hospital directors, obstetricians and midwives	In-depth interviews	A−
Wanyonyi et al 56	To determine perceptions on the practice of VBAC among maternity service providers in East Africa and possible solutions (including acceptability of evidence, guidelines, and audit).	Kenya, Uganda, Tanzania and Ethiopia (African)	Low	Unclear	63	Doctors and midwives	Semistructured questionnaire	C−
Chen et al 44	To explore informed choice and autonomy of uterine-incision delivery making in China.	China (Western Pacific)	Middle	Urban	51	Health professionals	In-depth interviews	D
Chaillet and Dumont39	To investigate obstetricians perceptions of clinical practice guidelines and to identify the barriers to, facilitators of, and obstetricians’ solutions for implementing these guidelines in practice.	Canada (Americas)	High	Urban	27	Obstetricians	Focus groups and semistructured interviews	C
Kamal et al 54	To explore the views of health professionals on the factors influencing repeat CS.	UK (European)	High	Urban	25	Doctors and midwives	Semistructured interviews	A

ACOG, American College of Obstetrician and Genecologists; CS, caesarean section; ERCS, elective repeat caesarean section; GP, general practitioner; VBAC, vaginal birth after caesarean.