R E S E A R C H Open Access © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit ​h​t​t​p​:​​​/​​/​c​r​e​a​t​i​​ v​e​c​​o​m​m​​o​n​​s​​.​o​​r​​g​/​​l​i​c​​e​n​s​​​e​s​​/​​b​y​​-​n​c​​-​​n​d​/​4​.​0​/. Nabawanuka et al. BMC Pregnancy and Childbirth (2025) 25:127 https://doi.org/10.1186/s12884-025-07263-2 BMC Pregnancy and Childbirth *Correspondence: Brenda Nabawanuka brendanabawanuka96@gmail.com 1Department of Nursing and Midwifery, Faculty of Health Sciences, Mountains of Moon University, Fort Portal, Uganda 2Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda Abstract Background  The number of cesarean sections among women with a previous scar has continued to increase in Uganda. Such women can opt for a trial of labor, and the success rate for spontaneous vaginal delivery is 60–80%. This study assessed the preference and determinants of delivery mode among pregnant women with one cesarean scar. Methods  A cross-sectional analytical study was conducted among pregnant women who were attending antenatal care in two public hospitals in Uganda from 1st September to 1st October 2022. Kish Lisle formula was used to get a total sample of 169 pregnant women with one previous scar and nonrecurring indication for cesarean section. These were consecutively recruited into the study, and a modified Poisson regression was performed to identify factors associated with the preferred mode of delivery. Results  The mean age of the participants was 28 (4.88) years. Out of 169 women, the majority 137 (81%) preferred a trial of labor. Mothers who preferred to have more than four children were more likely to opt for a trial of labor (aPVR = 0.27, CI;1.01–1.49, p = 0.009). Mothers who were concerned about the cost associated with cesarean section were more likely to choose a trial of labor (aPVR = 1.2, CI;1.01–1.49, p = 0.03), and mothers who perceived that a cesarean section affects body image (aPVR = 3.06, CI;1.39–6.75, p = 0.03) and being employed (aPVR = 0.84, CI:0.74– 0.96, p = 0.01) were more likely to prefer a cesarean section. Conclusion  Trial of labor after cesarean remains the preferred mode of delivery among women. The desire to have more children and concern about medical expenses increased the likelihood of having a vaginal birth preference. Women with body image concerns and being employed increased the likelihood of a cesarean section preference. It is recommended to consider a trial of labor after cesarean section for all women with nonrecurring indications for cesarean section. Empowering women through health education on the risks and benefits of cesarean section helps them make an informed choice. Keywords  Cesarean section, Trial of labor, Preferred mode of delivery, Previous scar Preference and determinants of delivery mode in pregnant women with one cesarean scar: a cross-sectional study in two urban Ugandan public hospitals Brenda Nabawanuka1*, Tom Ngabirano2 and Joyce Nankumbi2 http://creativecommons.org/licenses/by-nc-nd/4.0/ http://creativecommons.org/licenses/by-nc-nd/4.0/ http://crossmark.crossref.org/dialog/?doi=10.1186/s12884-025-07263-2&domain=pdf&date_stamp=2025-2-5 Page 2 of 8Nabawanuka et al. BMC Pregnancy and Childbirth (2025) 25:127 Background A trial of labor after cesarean section (TOLAC) is a planned attempt to allow labor in a woman who had a previous cesarean birth with nonrecurring indications such as fetal malpresentation, failure of labor progress, fetal distress, cord prolapse, and antepartum hemorrhage [1, 2]. The World Health Organization (WHO) recom- mends cesarean section rates of 10–15% or below in all countries [3, 4]. However, there are increasing rates in most countries worldwide, including Uganda [3]. The cesarean section (CS) rates are currently estimated at 27.2% in developed countries and 8.2–24.2% in low- income countries [5]. A metanalysis and a multi- coun- try study conducted on the trial of labor after cesarean section in Subharan Africa, revealed cesarean section rates after one previous scar varying between 37% and 97% [6–8], this indicates that many women are not given an option of trial of labor following the initial CS. In Uganda, the overall cesarean section rate is 6–11% [9], Although the overall rates of CS in Uganda is low, there is a significant variation in the rates of CS among differ- ent health care facilities throughout the country. Accord- ing to the Uganda Annual National Health Sector Report of 2018/2019, the average cesarean section rates at a tertiary health care facilities in Uganda were recorded at 32% [10]. Additionally, an earlier study performed in health facilities in western Uganda showed cesarean sec- tion rates of 25% [11]. Furthermore, cesarean rates are even higher among women with a previous cesarean sec- tion at up to 68% in developing countries to an estimated 79% in developed countries [12, 13]. There is no evidence showing the benefits of cesarean delivery for mothers or babies who do not require the procedure [3]. A TOLAC remains as low as 25.5% in Uganda [14], yet high success rates among women who undergo a trial of labor after a cesarean section are between 70 and 80% [15–17]. Despite the positive outcomes linked to cesarean sec- tions, they are associated with a higher incidence of com- plications when compared to a successful vaginal birth after a previous CS [18, 19]. The complications of cesar- ean sections include increased risk of hemorrhage, one of the leading causes of maternal mortality in Uganda, postpartum maternal morbidity, anesthesia-related com- plications, endometritis, wound infection, peritonitis, paralytic ileus, and surgical site sepsis, among others [11, 12, 20, 21]. Cesarean section is also associated with higher medical expenses compared to a TOLAC due to a prolonged hospital stay [22]. The high cost of cesarean section leads to a high expenditure on already overbur- dened and economically hard-hit families [23]. Therefore, encouraging eligible women to attempt labor is one of the most effective approach to lower the rate of repeat cesar- ean sections and improve outcomes for both mothers and newborns [24]. Depending on the context and settings, for the sub- sequent pregnancy, women with one previous scar can either prefer a trial of labor or cesarean Sects. [25–27]. The right to choose the desired mode of delivery is a cru- cial component of compassionate and respectful care in midwifery, as it fosters both maternal and neonatal wellbeing [25]. In Uganda, client-centered care remains fundamental to the health service delivery system which includes involving clients’ decision-making about their preferred mode of delivery [25, 28]. The decision of preg- nant mothers to have a trial of labor after cesarean sec- tion is dependent on many factors [29]. These factors include sociodemographic factors [30–32]; obstetric factors, including previous birth experience and future fertility desire [33–35]; prenatal and family factors, such as the cost of cesarean, partner preference, and fear of labor pain [36–38]; and body image concerns, such as disfiguration and reduction of vaginal strength follow- ing vaginal delivery [32, 39]. Additionally, literature has shown a that a trial of labor would be preferred by moth- ers because it prevents unnecessary post-cesarean com- plications and consequently reduces maternal morbidity and mortality [6]. The opportunity to choose the mode of delivery is an essential element of modern obstetrics and respectful treatment [40]. In Uganda, during antenatal care visits, expectant mothers develop a birth prepared- ness plan that outlines their preferred delivery mode, location for child birth and expected financial expenses and the necessity of birth companions during the birth- ing process [10]. There is paucity of data regarding the preference and determinants of delivery mode among pregnant women with one cesarean scar in Uganda, yet understanding the preferences of women on the mode of birth can help midwives and obstetricians to better sup- port women in making an informed choice on the mode of delivery. Therefore, this study assessed the preference and determinants of delivery mode among pregnant women with one previous scar in two public hospitals in Kampala-Uganda. Methods Study design and setting A cross-sectional descriptive and analytical study was conducted from 01 September to 01 October 2022 at two public health facilities in Kampala City. The two facili- ties were Kawempe and Naguru. These two sites receive patients from the Kampala catchment area, they pro- vide specialized services in obstetrics and gynecology including referrals from peripheral health facilities. The services offered at antenatal care (ANC) include coun- selling on danger signs, detecting complications, giving supplements, laboratory tests. According to the Health Management Information system (HMIS Feb to March 2022). Kawempe and Naguru averagely receives 1500 Page 3 of 8Nabawanuka et al. BMC Pregnancy and Childbirth (2025) 25:127 mothers and 750 mothers respectively. Typically during ANC attendance pregnant women make birth prepared- ness plan that includes planned mode of delivery, place of delivery, anticipated material and financial costs during delivery, and need for birth companions [41]. Population and Sample size determination The sample size for this study was determined using the formula for single population proportion by Kish Les- lie (1965) [42]. We adopted a proportion of pregnant women attending antenatal care with one previous cesar- ean section from a previous study performed in Rwanda (p = 0.11) [6], a precision error of 0.05, and a standard normal value (Z) corresponding to a 95% confidence level. This resulted in a total of 169 pregnant women who were included in the study. Using a proportionate sam- pling strategy of 2:1, a total of 112 and 57 women were selected from the two facilities, respectively. At each study site, women were recruited consecutively as they attended their antenatal care visits. Pregnant women with one previous scar with non- recurring indications for cesarean section who above 18 years, and had a low transverse section incision were included in the study. Pregnant women who had less than two years of pregnancy interval, those with complica- tions such as hypertension or other medical conditions, and mothers who were not in good condition or medi- cally unstable enough to answer questions as identified by the health worker were excluded. The data collection tool and study variables Data were gathered using a researcher-administered semi-structured questionnaire specifically designed for this study. Pretesting was done on 20 pregnant women at Mulago Women’s Specialized and Neonatal Hospital, and necessary corrections were made to the questionnaire. The dependent variable in the study was the preferred mode of delivery. The preferred mode of delivery is defined as the choice of either a trial of labor or a repeat cesarean section by women with a history of one cesarean scar. This preference was determined by asking women about their preferred mode of delivery in the question- naire. The response was categorized as a trial of labor or cesarean section. To capture data on potential determi- nants, participants responded to questions to generate information on socio-demographics, obstetric character- istics, prenatal, and body image concerns. In addition, a Likert Scale was used to assess attitudes and perceptions that influenced the mode of delivery. The perceptions and attitudes were graded into strongly agree, agree, neutral, strongly disagree, and disagree. Data collection Data were gathered using a researcher-administered semi-structured questionnaire which was adopted from a review of relevant literature. All questions were writ- ten in English and translated into Luganda (the local lan- guage) and then back to English by two different language experts to check for clarity and consistency. Data were collected by two research assistants who were health workers trained at the bachelor’s level and one at each study site. At each study site, consecutive sampling was used to select participants and this took one month at both study sites to achieve the desired sample of 169 participants. The information about a mother having one previous cesarean section was subjec- tively obtained from the woman and confirmed with the Health Information Management System (HMIS) antena- tal register and the antenatal card. Each selected partici- pant was provided with information about the purpose and procedure for the study, and consent was obtained. Women were asked questions on the preferred mode of delivery, obstetric and prenatal factors such as gravidity, the desired number of children, costs, hospital length of stay, previous childbirth experience, doctor’s suggestions, partner preferred mode, the fear of pain of vaginal birth, cultural beliefs, perceiving cesarean section as risky, per- ception that cesarean section distorts body image, and sociodemographic factors such as age, level of education, employment, and income levels, among others. Data analysis Data were entered into the statistical software STATA version 17 for analysis. In order to dichotomize as binary data, the Likert scale responses were collapsed into three categories: disagree and strongly disagree were collapsed to disagree, agree and strongly agree were collapsed to agree, and the neutral category was oriented to either direction depending on the nature of the question being a positive or a negative question [43],. Descriptive sta- tistics were used to summarize the sociodemographic characteristics of the participants. The preferred mode of delivery was categorized as cesarean or TOLAC. The relationship between the preferred mode of delivery and independent variables was evaluated using bivariate and multiple Poisson regression analyses. Factors that exhib- ited a p value of less than 0.2 in the bivariate analysis were subsequently included in the multivariate model. A p value of less than 0.05 was considered statistically significant. Ethical considerations Ethical clearance was obtained from the Makerere University School of Health Sciences Research and Ethics Committee (SHSREC 2022 − 336). Adminis- trative approval was obtained from the directorate of Page 4 of 8Nabawanuka et al. BMC Pregnancy and Childbirth (2025) 25:127 both facilities. All study participants provided written informed consent and were informed about their right to withdraw from the study at any time. Results Sociodemographic and obstetric characteristics of the study participants The mean age and standard deviation of the pregnant women was 28 (± 4.9) years. Most of the women 109 (64.5%) were in the third trimester of pregnancy, with a mean gestational age of 27 (7.1) weeks. The mean length of hospital stay in the previous cesarean section was 7 (11.6) days, and less than half of the participants 72 (42.9%) were discharged after three days. The majority of women reported having been able to resume normal activities within 6 weeks of cesarean section. The mean time to the resumption of normal functioning in the pre- vious cesarean section was 2 ± 0.8 weeks (Table 1). Preferred mode of delivery The proportion of women that preferred a trial of labor after cesarean was 81% at 95% (CI 74-86%). Factors associated with preferred mode of delivery The results from binary modified Poisson regression analysis showed that level of education (cPVR = 0.76, CI; 0.71-092, p = 0.09), employment status (cPVR = 0.81, CI;0.71-092, p = 0.001), desired number of children (cPVR = 1.1, CI; 0.99–1.31, p = 0.057), fear of pain dur- ing vaginal delivery (cPVR = 0.82, CI;0.68–0.98, p = 0.03), medical expenses (cPVR = 3.06, CI;1.39–6.75, p = 0.005), and a cesarean section affecting body image (cPVR = 1.25, CI;1.04–1.48, p = 0.01) were significantly associated with the preferred mode of delivery (Table 2). The multivariate analyses were conducted by enter- ing all the plausible variables in the bivariate analyses as independent variables into a modified Poisson regression model. After controlling for confounding factors, women who had a perception that a CS affects their body image (those with a desire to have more than four children (aPVR = 0.27, CI;1.01–1.49, p = 0.009)) and mothers who were concerned about the cost associated with cesarean section (aPVR = 1.2, CI;1.01–1.49, p = 0.03) were more likely to choose a trial of labor, whereas those who were employed (aPVR = 0.84, CI;0.74–0.96, p = 0.01) were more likely to opt for a cesarean section. (Table 3) Discussion Our study found that more than 81% of pregnant women preferred a TOLAC in their current pregnancies. This indicates that women are both aware of and willing to pursue vaginal deliveries following a cesarean sec- tion. This could be due to concerns about the safety of Table 1  Socio-demographics and obstetric characteristics of participants Variable Frequen- cy (N = 169) Per- cent- age (%) Mean (SD) Age 15–24 25–34 35 and above 38 109 22 22.5 64.9 13.0 28(4.88) Residence Rural Suburban Urban 34 30 105 20.1 17.8 62.1 Level of Education No formal education Primary education Post-primary education Tertiary education 6 95 46 22 3.6 56.2 27.2 13.0 Employment status unemployed Employed 56 113 33.1 66.9 Marital status Not married Married 15 154 8.9 91.1 Religion Anglican Catholic Moslem Others 40 56 43 30 23.7 23.1 25.4 17.8 Gestational age(weeks) ≤ 28 28–40 100 69 59.2 40.8 27(7.1) (0.49 Parity 2 3–4 > 5 90 69 10 53.3 40.8 5.9 2(1.36) Gravidity 2 2–4 ≥ 5 79 68 22 46.8 40.2 13 3(1.53) Experience with previous CS Good Bad 68 101 40.3 59.8 The desired number of children < 4 > 4 116 53 68.7 31.4 Resuming chores/recovery Within 6 weeks Above 6 weeks 61 108 36.1 63.9 2(0.8) Length of hospital stay Less than 2 3 days > 3 days 20 52 96 11.9 30.9 57.1 1.57(0.49) Cost of cesarean Less than 60,000 60,000–300,000 300,001–800,000 800,001–3,000,000 72 48 29 18 43.1 28.8 17.4 10.8 362,784(626333) Page 5 of 8Nabawanuka et al. BMC Pregnancy and Childbirth (2025) 25:127 cesarean sections to both the mother and the neonate [44], socioeconomic consequences of cesarean sections among others [45].Therefore health care providers caring for candidates of TOLAC should be aware of and able to counsel patients regarding the benefits of a trial of labor and knowledgeable in quality intrapartum care for better maternal outcomes in this setting [46, 47]. Our results were similar to those in a systematic review of thirty- eight studies comprising 19,403 women, where 85% of the women preferred vaginal delivery over CS after a previous scar [16]. The findings were also similar to a study in Brazil and other studies that reported high levels of willingness to have vaginal birth after cesarean [48]. The factors that were found to be associated with the preferred mode of delivery were the desire to have more children, the belief that a cesarean section affects body image, a concern that cesarean section is associated with increased medical expenses, and being employed. Women who had body image concerns were more likely to choose a trial of labor compared to their counterparts. Table 2  Prenatal characteristics, family factors, and body image concerns of participants Variable Disagree n (%) Neutral n (%) Agree n (%) Previous childbirth experience 23(13.61) 13(7.7) 133 (78.7) Future fertility desire 58(34.3) 32(18.9) 78(46.8) Doctors’ suggestion 27(15.9) 3(1.8) 139(82.3) Partner choice 101(59.8) 16(9.5) 52(30.5) Fear of pain during vaginal delivery 97(57.4) 13(7.7) 59(34.9) Cultural beliefs 120(71.0) 19(11.2) 30(17.8) Medical expenses 40(23.7) 14(8.3) 115(68.3) Repeat cesarean section is perceived to be risky 54(31.9) 10(5.9) 105(62.1) Long hospital stays 48(28.4) 11(6.5) 110(65.1) The woman prefers a safe choice 76(44.9) 6(3.5) 87(55.5) Women’s belief 43(25.4) 37(47.3) 89(52.6) Time needs 40(23.7) 21(12.4) 108(63.9) Gynecology examination anxiety 91(53.9) 2(1.2) 76(44.9) A cesarean section will affect my body image 64(37.9) 4(2.37) 101(59.8) A vaginal delivery will cause body disfiguration 114(67.5 18(10.7) 37(21.9) A vaginal delivery will lower my vaginal strength 99(58.6) 24(14.2) 46(27.2) Table 3  Bivariable and multivariable analyses of factors associated with the choice of mode of delivery Variable CS TOL cPVR (95% CI) p Value aPVR (95% CI) p value The desired number of children < 4 > 4 26(81.3) 6(18.7) 90(65.7) 47(34.3) Ref 1.1(0.99–1.31) 0.057 Ref 0.27(0.15–1.01) 0.009* Cesarean section affects body image Disagree Agree 39(60.9) 25(39.0) 71(67.6) 34(32.4) Ref 1.2(1.08–1.53) 0.004 Ref 1.2(1.01–1.49) 0.03* Fear of pain during vaginal delivery Disagree Agree 97(69.8) 42(30.2) 20(66.7) 42(33.3) Ref 0.82(0.68–0.98) 0.03 Marital status Married Single 29(90.6) 3(9.4) 125(91.1) 12(8.8) Ref 0.01(0.25–0.27)) 0.91 Previous Experience with cesarean section Good Bad 10(31.4) 22(68.8) 58(42.3) 79(57.7) Ref 0.92(0.79–1.06) 0.235 Medical expenses affecting choice Disagree Agree 40(23.7) 54(31.9) 14(8.3) 10(5.9) Ref 3.06(1.39–6.75) 0.005 Ref 3.06(1.39–6.75) 0.03* Occupation Not employed Employed 4(12.5) 28(87.5) 52(37.9) 85(62.0) Ref 0.81(0.71-092) 0.001 Ref 0.84(0.74–0.96) 0.01* Partner choice Disagree Agree 20(62.5) 12(37.5) 97(70.8) 40(29.2) Ref 0.92(0.78–1.10) 0.39 Page 6 of 8Nabawanuka et al. BMC Pregnancy and Childbirth (2025) 25:127 This could be due to women who underwent cesarean section expressing fear of negative reactions from their husbands regarding their surgical scars, which would affect their marital relationship, among others. This is in agreement with studies that cited that cesarean section delivery was associated with body image disturbances and low self-esteem [49, 50],. The desire to have more children in the future was also found to be associated with a preference for a TOLAC. A growing body of medical literature documents this as a robust fact, women undergoing cesarean section end up having less children, and this association could be physi- ological or through maternal behavior after cesarean sec- tion, for example, they may engage in contraception after delivery to have faster recovery [40]. This is also in line with a study done among pregnant women in Isfahan on correlates and determinants: intention for cesarean sec- tion versus vaginal delivery revealed that women who intended to have fewer children, cesarean section would be more considered. Because, one important indication for cesarean section is repeat cesarean section whereas a woman who has greater fertility intention tends to have lower intention to do CS [51]It is therefore not surpris- ing that in this study, women who wanted more than four children were more likely to opt for vaginal deliveries than a repeat cesarean section. In our study, a belief that a cesarean section is expen- sive increased the likelihood of choosing a TOLAC. This is because Uganda is still a low-middle-income country where people lack access to medical care because they cannot afford it [52]. This is in agreement with a WHO report that looked at global numbers of cost of addition- ally needed and necessary cesarean sections performed per year that revealed high costs associated with cesar- ean Sect. [53]. Additionally a study performed in Bangla- desh on the economic burden of cesarean section showed a high cesarean section delivery rate, and the negative health outcomes associated with the procedure on moth- ers and childbirths incur enormous economic burdens on the families [54]. The employment status of the women was also another associated factor; this is because employment status highly correlates with good living standards and high income. This further implies that they can afford to pay for cesarean section and all the expenses associated with it. These findings are consistent with the results of sev- eral studies where a significant association was found between the mother’s employment status and request- ing a cesarean delivery [55]. However, other studies have reported no association [56]. Study strengths To our knowledge, this is the first study in Uganda that examines and expands information on the preference and determinants of mode of delivery among pregnant women with one previous scar in a resource limited set- ting. The study conducted an association between a wide variety of factors, among these are body image concerns that are commonly excluded in earlier studies. Study limitations This study looked at the factors that were associated with the mode of delivery only from the mother’s perspective and thereby did not capture provider and health systems perspectives, which may have a larger influence on cesar- ean section rates. Conclusion and recommendations This study investigated the preference and determinants of delivery mode among pregnant women with one pre- vious cesarean section, the majority of pregnant women preferred a trial of labor over a repeat cesarean section. The factors that were found to be significantly associated with the preferred mode of delivery were as follows: the factors that were found to be associated with a trial of labor after cesarean section were the desire to have more children, the belief that a cesarean section affects body image, a concern that cesarean section is associated with increased medical expenses, and being employed was associated with having a CS. Health education for women should continue with current information regarding the risks and benefits of cesarean delivery during ANC. This will enable them to make decisions that will be in the best interest of the mother and the child. The findings of this study provide a direction for mid- wives in maternity care on continuous education, coun- seling of women about the benefits of a trial of labor, and supporting them in making meaningful decisions regard- ing their preferred mode of delivery. Providing a trial of labor to pregnant women with one previous scar instead of a repeat cesarean section will reduce the economic burden and cost of cesarean sections. More in-depth rationales and reasons for intention to do a trial of labor after cesarean be explored in a qualita- tive study. Abbreviations VBAC � Vaginal birth after Cesarean section TOLAC � Trial of labor after cesarean WHO � World Health Organization CS � Cesarean section PVR � Prevalence ratios cPVR � Crude prevalence ratio Acknowledgements We thank all pregnant women who participated in the study for giving their time and valuable information. Great thanks to the research assistants who participated in collecting data and the staff of Kawempe National Referral Hospital and Naguru Hospital (China-Uganda Friendship Hospital) for the support rendered to us. Page 7 of 8Nabawanuka et al. BMC Pregnancy and Childbirth (2025) 25:127 Author contributions BN, JN and TN wrote the main manuscript text, and TN prepared the figures.all authors reviewed the manuscript. Funding The study received no funding. Data availability The data set can be provided by the primary author on request. Declarations Ethics approval and consent to participate Ethical approval was sought from the Makerere University School of Health Sciences Research Ethics Committee (approval number MAKREC-2022-336). Ethical approval and consent to participate in the study were obtained from the Makerere School of Health Sciences Research Ethics Committee (SHSREC-2023-336). Administrative clearance was sought from the study hospitals, and all participants provided written informed consent before completing the questionnaire. The study was performed based on the ethical principles in the Declaration of Helsinki. Consent for publication Not applicable. 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Preference and determinants of delivery mode in pregnant women with one cesarean scar: a cross-sectional study in two urban Ugandan public hospitals Abstract Background Methods Study design and setting Population and Sample size determination The data collection tool and study variables Data collection Data analysis Ethical considerations Results Sociodemographic and obstetric characteristics of the study participants Preferred mode of delivery Factors associated with preferred mode of delivery Discussion Study strengths Study limitations Conclusion and recommendations References