Sharing the decision about VBAC: introducing the ARCS-V motivational learning model

Abstract

Shared decision-making is considered key to influencing women's motivation to choose vaginal birth after caesarean section (VBAC), as when women's self-determination is respected, they are more likely to avoid intervention. However, the shared decision-making conversation can be challenging. This article introduces the ARCS-V (attention, relevance, confidence, satisfaction, volition), an model for understanding and responding to women's motivation to share the decision about VBAC vs repeat caesarean section. Each of the model's components are introduced, including the psychological basis for managing a shared conversation; capturing and holding women's attention on what they need to learn; matching the learning goals with women's personal goals; building their confidence to achieve their optimal birth; and ensuring they are satisfied with decision-making experience. When these educational conditions are met, women are more likely to use shared decision-making conversations to choose optimally.