Making decisions about birth after caesarean

For all but one of the women we spoke to, their previous caesarean had been their first experience of childbirth. When they became pregnant again, their thoughts about how to give birth to their next child were invariably influenced by what had happened during their previous pregnancy and birth. For example, a couple of women who had experienced postnatal depression after their previous birth worried about how another birth might affect them. Others who'd had a planned caesarean due to complications in their previous pregnancy (a large baby, a baby in breech position or a premature delivery due to pre-eclampsia) were concerned that these complications might repeat themselves. A couple of women who miscarried in earlier pregnancies didn't want to start planning for the next birth before a crucial number of weeks had passed. 

We talked to women after they'd had at least one hospital appointment with an obstetrician to discuss their birth preferences and previous medical history. Because the women we talked to were taking part in a wider study of decision-making about caesarean, many of them had also received a computer-based decision aid that was designed to help them compare the risks and complications associated with different ways of giving birth after caesarean (see 'About the interviews and the DiAMOND trial'). This is an unusual situation as most women in the country are not yet offered a formal decision aid.

Some women had strong preferences of how they wanted to give birth to their next child while others said they were just going to 'go with the flow' - in other words, they would see how things turned out when they went into labour but would not set their hopes on having a vaginal birth. Several women said they wanted to be more involved in decision-making about their next birth than they had been previously. At the same time, they felt more mentally prepared that things might not go to plan. One young woman had even made two birth plans, one for a caesarean and one for vaginal birth, to be prepared either way (Interview 14). A few women had to adjust their plans for giving birth at later stages of their pregnancy due to complications such as a low-lying placenta (placenta praevia), size or position of the baby. Others changed their minds after finding out more information about risks and complications. (See also 'Women's experience of making the decision'.)

A few women looked to their next birth as an opportunity to put a negative first birthing experience behind them and to realise the hopes they had held during their previous pregnancy. For some, this meant wanting to go through labour and vaginal birth with as little medical intervention as possible. For others, it meant opting for a planned caesarean straightaway. As one woman said, 'My worry is that I'll give it a go and I'll have a long traumatic labour and then still have to have an emergency caesarean, so you end up feeling a hell of a lot worse than I did last time.' The idea to have an emergency caesarean after having laboured for hours was something that worried both women who wanted to attempt vaginal delivery and those who wanted a planned caesarean.

A few women who had hoped to have a water birth with their next child felt disappointed when they were told that they would not be able to use the birthing pool because medical staff wanted them to be monitored closely from early on in their labour. A couple of women were also concerned that being connected to a fetal heart rate monitor as soon as they arrived in hospital would not allow them to be as mobile as they wanted to be. One woman who had considered a home birth changed hospitals because staff at the first hospital insisted that she should come in as soon as dilation had started. She felt strongly that the medical atmosphere of the hospital environment had interfered with her previous labour, so she decided to hire a doula (a non-medical birth helper) who could support her at home during the early stages of labour.

Most women had prepared a birth plan for their next birth or were planning to do so. Some had made a plan together with their midwife, but others had used the internet to help them or just based it on their own ideas. Several women who were hoping to give birth vaginally said they had gone into much more detail than for their previous birth. Having been through the process before, they had a clearer idea of their wants and needs regarding pain relief and birthing positions. One woman also said she felt more confident, second time round, to express her wishes. At the same time several women said it was important to keep an open mind - as one woman said, 'You can make a plan, but who's to say it's going to go that way?...You've just got to be open-minded about it and let nature do its thing.' A couple of women who had decided to have a planned caesarean didn't see the point of making a detailed birth plan, but a couple of others put down things like the kind of music they wanted to have playing and their wishes for contact with the baby afterwards.

Last reviewed August 2018.