Making decisions about birth after caesarean

Health professionals can provide women with important information about risks and complications associated with different ways of giving birth. They can also draw on their professional experience to support women in their decision-making. However, many women find it helpful to talk to other women about their experiences of caesarean and the decision about how to give birth to their next child. Listening to the views of women who have had first-hand experience of birth after caesarean can provide an additional source of comfort and reflection to other women facing similar circumstances and decisions. We asked the women who took part in this study what advice they would give to other women who had a previous caesarean and were pregnant with their next child. The comments they made naturally reflected their own birth preferences and experiences.

Many women stressed the importance of having detailed and balanced information about different ways of giving birth before making a decision. A few said they would encourage women to seek out information for themselves and ask as many questions as possible rather than just rely on the information volunteered by professionals. Several women who'd previously had an emergency caesarean emphasised that it was important to find out why the first caesarean had been necessary and understand what the chances were of similar complications happening again.

While understanding the reasons behind previous complications was thought to be important, a couple of women pointed out that it could be unhelpful to dwell too much on what might have gone wrong during previous births. They advised women to put past experiences behind them and approach each birth afresh, without letting the decision-making process get in the way of enjoying their current pregnancy.

A couple of women said they didn't receive as much antenatal care during their second pregnancy as they did during their previous pregnancy, so there were fewer opportunities for discussion and advice. They advised other women to be aware that they might need to seek out information for their specific situation from elsewhere. 

Several women felt very strongly that the decision of how to give birth after a caesarean was a very personal choice that each woman had to make individually. They acknowledged that considering the possible risks and complications of different birth methods was important but felt that ultimately any decision was likely to be driven by each woman's personal values and unique previous experience. As one woman put it, 'only you know what's right for you'.

Several women said it was important to allow yourself time and not be rushed into a decision by those around you. A few women who had felt under pressure from doctors or midwives to go down a particular route cautioned other women not to be swayed by health professionals' own agendas. A couple of women felt that the judgmental attitudes of some health professionals were likely to contribute to feelings of guilt and failure among women who were unable to deliver vaginally. 

Women who had opted to have a planned caesarean said that women should not be afraid to make their views known and ask for a c-section if that was what they wanted. One woman who had a very positive experience of planned caesarean wanted others to know that it could be 'just as fantastic and empowering an experience' as vaginal birth.

However, others stressed that vaginal birth after caesarean could be a realistic alternative for many women and they should not assume repeat caesarean was the only option. Several women who'd had a successful vaginal birth after caesarean described it as 'an amazing experience' and thought women who opted for a repeat caesarean were 'missing out'. They thought health professionals should take a more positive and encouraging approach towards VBAC and that women facing the decision might benefit from meeting others who had been through VBAC. A couple of women said that there was nothing to be lost and everything to be gained as women who attempt VBAC could still ask for a caesarean at a later stage if things did not go to plan. However, others were put off the idea of attempting vaginal birth precisely because they wanted to avoid having a second emergency caesarean and therefore considered a planned caesarean as the safer option. 

A couple of women felt that, nowadays, childbirth has become 'too medical'. They thought that the clinical nature of the hospital environment, close monitoring during labour and the early use of interventions such as epidurals and induction interfered with the natural birthing process. They felt that once a woman has started on the route of medical intervention, it might be difficult to step back. Their advice to other women - medical circumstances allowing - was to approach birth more confidently and trust in their body's natural ability to deliver the baby in its own time rather than according to a hospital schedule.

Some women found it easier than others to generalise from their own experiences to those of other women in similar circumstances. A couple of women hesitated to advise other women as they felt each woman's personal circumstances were different and therefore giving specific advice was best left to medical experts. However, most women agreed that, when it comes to giving birth, there is only so much you can plan for in advance. And regardless of whether they favoured vaginal birth or planned caesarean, they felt that women might need to remind themselves sometimes that how you give birth does not define who you are as a person.

Last reviewed August 2018.