Table 3.

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

Initial concepts	Emergent themes/SoFs	Studies contributing to review finding	Final themes	Line of argument synthesis
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]