Table 3 Qualitative evidence synthesis: summary of initial concepts, emergent themes and final themes

Operative delivery not contemplated

Expectations and preparedness for AVD - a birth you couldn’t plan for

Hurrell 2006 [26]

Coming to know AVD by experience

In high income settings, it might be inevitable that women will be unprepared for an AVD because it is not an outcome readily considered: women may not be offered, or may avoid, antenatal education, and it is an outcome arising from an unexpected chain of events making it difficult to prepare for. Because of this, women’s condition, adequate pain relief and interactions with staff are all the more important. Assisted vaginal delivery is an intervention that can be frightening and invasive; it can be experienced as violent. Women can feel like failures, and women and partners can also feel relief and positive emotions. Women and partners may need to understand why an AVD was the right care for them (indication). Views on future delivery mode are mixed including increased confidence for a vaginal birth and preferences for a future caesarean birth.

Murphy 2003 [23]

Births plans meaningless

Antenatal education

Keeping an open mind

Perception of necessity

Beliefs about need/indications for AVD

Hurrell 2006 [26]

Feelings of failure

Murphy 2003 [23]

Beliefs about problems with baby

Unable to recall

Finding a context for their birth experience

Reconciling/coping with personal experience

Hurrell 2006 [26]

Difficulties with moving on

Effective pain relief absence of major concern with AVD

Pain during assisted vaginal delivery

Hurrell 2006 [26]

Turbulent feelings about the actual experience

Sjödin 2018 [30]

Working with pain/enabler

Nystedt 2006 [32]

Experiencing pain as traumatic (barrier)

Zwedberg 2015 [31]

Violence and injury

Frightening and violent experiences

Hurrell 2006 [26]

Being possessed by fear and distress

Sjödin 2018 [30]

Being conscious, but somewhere else

Nystedt 2006 [32]

Zwedberg 2015 [31]

Goldbort 2009 [33]

Fathers feeling positive and emotional

Positive or beneficial reactions

Hurrell 2006 [26]

Zwedberg 2015 [31]

Fathers coping strategies – finding strength to support their partners

Nystedt 2006 [32]

Relief of an end to labour

Feeling unperturbed

To be part of a team

Active participation through collaboration and involvement

Hurrell 2006 [26]

Trust, control and relationships

Wish to be involved in decision-making

Zwedberg 2015 [31]

Fathers feelings of inclusion/exclusion

Sjödin 2018 [30]

Lack of trust in caregiver

Balancing control and trust

Hurrell 2006 [26]

Balancing feelings of control and trust

Zwedberg 2015 [31]

Feeling of loss of control

Sjödin 2018 [30]

Nystedt 2006 [32]

Goldbort 2009 [33]

Communication

The need to understand and be understood

Hurrell 2006 [26]

To understand

Zwedberg 2015 [31]

Sjödin 2018 [30]

Put off a future pregnancy

Mixed views about any future pregnancy and delivery

Hurrell 2006 [26]

Implications for future reproductive choices

More confident about a future vaginal delivery

Murphy 2003 [23]

Preference for a caesarean

Zwedberg 2015 [31]