Purpose: Evaluate the impact of a computerized decision aid on women's decisions for childbirth after cesarean. Methods: We recruited 96 postpartum women who had just had a cesarean delivery from the postnatal unit of a large university hospital and who had not had a tubal ligation or hysterectomy. The women used a decision aid based on the Analytic Hierarchy Process that helped them prioritize 15 decision factors for their next childbirth. Additionally, they evaluated maternal and infant health risk information for each future birth option based on evidence from a systematic review. The women were asked for their delivery decision (vaginal birth after cesarean, repeat cesarean, or unsure) prior to using the decision aid and again after using the decision aid. We compared the pre and post Decisional Conflict Scale scores and the pre and post delivery decisions. We analyzed factors that predicted whether the women changed their initial childbirth decisions. Results: Paired sample T-tests revealed that patients significantly improved knowledge (average score: 33.9 changed to 24.2 on the Decisional Conflict subscale, p<0.001); clarified values (31.9 to 21.6, p<0.001); reported increased support (33.0 to 28.3, p<0.001); and reduced overall decisional conflict (33.1 to 27.0, p<0.001) after using the decision aid. Lower decisional conflict scores are associated with patients who are more likely to implement decisions. After using the decision aid, 29% of women changed their initial birth decision. Bivariate logistic regressions revealed that the women who reconsidered their decisions were more likely to have providers who had discussed their birth options with them (p=0.005), received feedback from the decision aid that disagreed with their initial birth decision (p=0.026) and felt less certain about their final decision (p<0.001). The multivariate model accurately predicted whether a woman would change her mind in 78% of cases. Conclusions: Decisional conflict improved following use of this childbirth decision aid among postpartum women who are deciding upon future deliveries. Three in ten women reconsidered their birth decisions after using the decision aid suggesting that the decision aid helped the women face difficult trade-offs even if it left them less certain in the decision. Discussion with providers is an important component helping women reconsider their childbirth decisions.