Making decisions about birth after caesarean
Women's expectations for their previous births
Across the UK, almost 28% of all babies are now delivered by caesarean*.
Most caesareans are carried out for specific medical reasons, whether they happen because of a complication in pregnancy or labour, or are planned before labour starts. Very few are thought to happen because the mother requested it and didn't have any other medical reason but accurate statistics on these numbers have not been recorded so it’s difficult to know exactly how many there have been.
Few women would describe caesarean as their ideal birth, even if it is something that helps end labour and gets the baby born. For many, it is something they are keen to avoid. When a caesarean section takes place unexpectedly, in an emergency, women can find it difficult to cope with the mismatch between the birth they had hoped for and their actual birth experience (see 'Women's feelings about their previous caesarean').
She didn't consider the possibility of caesarean and not knowing anything about it made the experience particularly traumatic.
She didn't consider the possibility of caesarean and not knowing anything about it made the experience particularly traumatic.
And can you remember what kind of delivery you didn't want?
Hmm... You see, I don't remember having much knowledge of caesarean sections at all, at all. I think that's why, when it actually happened, it was so traumatic for me because I, I really didn't anticipate it ever happening.
For all but one of the women we interviewed, their first experience of caesarean was also their first experience of childbirth. Most women said they had looked towards their due date with at least some anxiety. Their expectations about what lay ahead of them were shaped by the experiences of friends and family members, as well as information they got from books, magazines, television programmes and the internet and information provided in antenatal classes. Some women found it helpful to seek out as much information as they could to prepare themselves for labour and birth. Others said they just wanted to know the basics. For a few, there was a sense that seeking out too much detail, particularly on possible risks and complications, might do more harm than good and cause them unnecessary worries (see 'Information needs/sources in previous pregnancy').
She sought out as much information as she could with her first pregnancy but thinks in the end nothing can really prepare you.
She sought out as much information as she could with her first pregnancy but thinks in the end nothing can really prepare you.
And can you remember the kind of information that you wanted with that pregnancy?
I did get quite a lot of information with that pregnancy but I just didn't look into having a section' at all.
And can you remember the kind of information that you did receive? Did you go to ante-natal classes?
Yeah, I went out, I went to a lot more than what I have with this pregnancy. I spoke to a midwife quite, quite a lot more and was given quite a lot of information through leaflets and, and consultations and I went to antenatal classes as well. For me and my ex-husband and myself, so I was never away from [Hospital], just because I wanted' it was my first baby and I wanted to know what I was going in for [of course] but nothing prepares you for it really, I don't think so [laughs].
She bought a book but didn't actually read the section on birth and felt that other women often told her more than she needed to know.
She bought a book but didn't actually read the section on birth and felt that other women often told her more than she needed to know.
So, if you think about the information that you'd wanted when you were pregnant the first time, what, what did you want to know?
I can't remember there being anything specific that I wanted to know, I mean, I think I did what most sort of middle class women do when they get pregnant, which is buy a book and then read it, and then, you know... And I had a, I have a book from - och, one of the big London hospitals, I think it's published by, and it goes through it week by week and I, I looked at it, you know, every week and sort of checked what was going on. I don't think I actually read the section on birth. One of my friends who had a baby said not to read it until closer to the time, but I went to ante-natal classes as well, but I don't think I actually felt that there was anything in particular that I wanted to know. And partly as well, because as soon as you get pregnant, people who have got children start telling you their stories and so, often you have more information than you really need.
Most women described a birth that was 'as natural as possible' as their ideal, though at the same time several acknowledged the possibility that they might need an epidural or other forms of pain relief to cope. Having a water birth was a popular idea among several women, both from the point of view of pain relief and as a natural environment for the baby to be born into. Even though many women had received information about possible risks and complications in antenatal classes or from their midwives, the majority of women had not thought of caesarean as something that could happen to them. However, a few women had actively considered the possibility: a couple of women had a history of complicated births in their family, one woman was pregnant with twins and another woman had been told that her baby was very large. Nevertheless, they all had hoped to give birth vaginally.
She was keen to keep things natural and have a water birth.
She was keen to keep things natural and have a water birth.
Yes.
Can you remember what was in it?
I wanted a water birth.
Can you remember why you wanted to have a water birth?
I think it's sort of because the water's sort of more of a pain relief and I want, sort of wanted it more natural.
She felt confident that she would have a natural birth because the pregnancy itself went so well.
She felt confident that she would have a natural birth because the pregnancy itself went so well.
And what kind of delivery had you wanted when you were expecting your son?
A vaginal birth. I was very disappointed that I didn't achieve that. I didn't feel a sense of achievement, um, having a' I didn't plan- I didn't even think of, about a section in that I was going to have one. So it was a bit of a shock and, when I did have one.
Could you explain why you hadn't thought about it? Was it just something that didn't even enter your mind?
I just ' I didn't even think, oh, you know, I thought 'I'll have a natural birth'. I didn't, I didn't' I don't know why I didn't think of it but it, it did disappoint me quite a bit, not having one.
So you don't remember them talking about the section in ante-natal classes?
They did, but I didn't take it in because I just thought 'oh, not me, I'll not have a section', you know. I don't know why. I knew that there was risks that I could have a section, but because the pregnancy went so well, I thought no, everything's going to go' probably just naivety, I think.
Maybe it was because you just, you were focusing on getting on further with that pregnancy'?
Yeah, I think as well with your first' a lot' you know, you're told that you're going to have a beautiful baby and it's going to be thrown up onto your chest and, you know, you're going to breastfeed just like that' I mean, it's, it's nothing like that at all, you know, it's quite hard work [laughs].
She wanted to keep things as natural as possible and thought a water birth sounded ideal for mother and baby.
She wanted to keep things as natural as possible and thought a water birth sounded ideal for mother and baby.
You said you wanted natural and no interventions and a water birth? If you can tell me how you came to that decision?
Mm' The water birth I think because I'd- I'd heard somewhere in my past that the babies coming from a liquid environment and into another environment, that for them it was, the transitional was good if they were coming through water, type of thing. 'And that it's relaxing for the mum and baby, that it's a case as well of, I don't know because I've since found out that, you know, out of water it could have been the same but you bring the baby up and onto you and everything. It just, I don't know, something about it just, something that I'd heard in my past about it stayed with me. I really thought it sounded ideal for the baby and mum.
And what about the naturalness?
The naturalness of it, that's just me all round. That's me in every aspect really, you know, try and give baby organic feed, breastfeed, all the way down the line, sort of'
'so part of a wider philosophy really, in what's best for the baby?
Yeah, yeah. And for me [laughs] and for my family.
Both her sisters had needed caesareans, but she still hoped that she might be able to break 'family tradition' and give birth vaginally.
Both her sisters had needed caesareans, but she still hoped that she might be able to break 'family tradition' and give birth vaginally.
I didn't, I never went into labour, it was ridiculous. I, I was induced after-, at forty-two weeks and basically, after trying the-, well, they started off with the pessaries and then I was on the drip, I can't remember the substance in the drip, but I'm sure you know. And it started off on a Wednesday afternoon, and by Friday afternoon, we opted for' the caesarean, emergency caesarean because I- my cervix hadn't even softened, apparently, never mind' dilated. And, can I add that the same thing happened to my two sisters, exactly the same thing. They were induced and then they were' their cervix didn't dilate and so they had emergency caesareans, but I thought I'd give it a try, you know, didn't think maybe, maybe I'd be different.
So this happened to your sisters before you?
Yeah
So you kind of in the back of your mind had thought this was something that might happen?
Yeah 'yeah, I think they were, yeah.
Oh right.
But I wanted to go for it anyway.
And was this a planned pregnancy, your son?
Yeah.
And had you had any complications when you were pregnant?
No, with the first pregnancy, nothing at all, absolutely nothing; just a little bit of water retention, but' no vomiting, nothing.
And had you an idea in your mind about how you wanted to deliver your first baby?
I would have liked to have been, to have had a water birth, to have had a natural birth; to have been the first in the family to have achieved one really [laughs]. But yeah' it wasn't to be.
And do you remember the kind of information that you'd looked for in your first pregnancy? About, you know, knowing in the back of your mind that your sisters had this problem, had you specifically sought any information about sections?
Oh, gosh, no, no I didn't really, not, not that much about sections, but I certainly' I was working at home at the time and I just read up on, on the whole pregnancy and childbirth and labour, and I just read up it - everything and any books I could get my hands on and got.' Got books from the library and I did, I did read a little bit of caesarean but I really did think that maybe' I'd be the one who broke the chain [laughs].
And what was the information like that you got? Did you, did you get all the information that you wanted, do you think?
Yeah, I got loads. I mean, I bought about two or three books, I went on the internet and, I don't know' there's a baby centre website that I, I got a lot of information from and I obviously spoke to my midwife, who I got on really well with. I went to parentcraft classes, also had NCT antenatal classes with my husband.
Several women had to adjust their hopes and expectations for birth after they were advised to have a planned caesarean. Two women had gone past their due date and there was concern for the baby's health when the recommendation was made. Others were told earlier on in their pregnancy that their baby's size or position in the womb made it likely they would need a caesarean. One woman had requested a caesarean after she found out she was pregnant with twins and had felt pleased that she would not have to go through labour. But most other women worried about the risks of an operation and felt disappointed to miss out on what they had been preparing for.
She felt scared about vaginal birth and was relieved that being pregnant with twins meant that her request for a planned caesarean was granted without problems. Played by an actor.
She felt scared about vaginal birth and was relieved that being pregnant with twins meant that her request for a planned caesarean was granted without problems. Played by an actor.
Well' I actually chose to have a section, the first time' really because the thought of pushing two of them out would have had me in bits for months beforehand. So we moved to here when I was twenty-eight weeks' and I just asked the consultant, [laughing] 'Can I have a caesarean?' And she went, 'Yes, that's fine'. Because she'd quoted that my chances of having one in the end were about seventy-five percent or something like that.
And I thought, 'Well' I can't, you know, I don't want to push one out and then have a section.' So I, thought, 'Yes, that's great'. So, I was due to go and see her and discuss going in for a planned section when my waters broke and, at four in the morning, I went in that day and had the caesarean at eleven.
And how many weeks were you when you made the decision to have a section?
Oh, as soon as I heard - twelve weeks I think.
So, prior to knowing that you had twins, did you have a preference about how you wanted to deliver?
Not really. I mean, having sort of seen quite a lot of births, I think the whole natural birth thing scares the-, you know' Oh, it's scary! [slight laugh]. So in some ways, when I found out that I was having twins, it was great, because I thought, 'Great - no-one's going to argue with me now! I can have a caesarean.' So' but I mean, if it had been one, obviously, I would have' had it naturally, well, tried to.
Some women had very clear ideas beforehand of how they wanted to give birth and what types of interventions and pain relief they did or didn't want. Others thought the best policy was to remain flexible and either make up their mind as they went along or to trust the staff caring for them to make the best decision for them and their baby. These differences in attitude affected women's decisions about whether or not to write a birth plan and what to put in it.
She didn't make a detailed birth plan - while she hoped to avoid interventions, she didn't feel that strongly about it.
She didn't make a detailed birth plan - while she hoped to avoid interventions, she didn't feel that strongly about it.
I mean, I think, I think the midwives, the community midwives probably asked me about the birth plan and did I have one, but I think because I hadn't' I didn't have any strong feelings about' I think because I didn't have any strong feelings about it, I felt that it wasn't actually a particularly big decision, because I wasn't, you know, I wasn't one of these people who sort of said, 'Oh, no, I definitely want to have a natural delivery and I'm not going to have an epidural and I'm not going to have any, you know, pain relief, I'm just going to breathe through it.' I mean, I wasn't, I wasn't like that at all. I think my, my kind of feeling about it was that I wanted to, you know, I wanted to have what I think most people want to have, which is a natural delivery without having to have intervention and without having to have sort of lots of pain relief and things like that, but then everyone wants that, everyone wants to be able to just sort of pop the baby out in four hours, but I think at the same time, I was kind of thinking, 'Well, if it doesn't work that way then, you know, then it doesn't work that way'.
The birth plan is a written outline of a woman's preferences for her labour and birth. Its purpose is to help staff involved in the woman's care to get to know a bit more about her and become familiar with her wishes for the birth. However, it is important to bear in mind that each birth is different and no-one can predict what labour will be like until it actually happens. Birth plans need to be flexible as labour progresses. Several websites and apps provide suggestions and interactive software to help women produce a detailed birth plan. Some of these provide sample birth plans for planned caesarean as well as vaginal birth.
She didn't feel comfortable stating her preferences too resolutely but thinks she'd be more comfortable talking about them with her next birth.
She didn't feel comfortable stating her preferences too resolutely but thinks she'd be more comfortable talking about them with her next birth.
And had you thought much about how you wanted to deliver your first baby?
Not' well, I mean, I'd always sort of liked the idea of possibly a water birth, but I think because it's the unknown you ' I don't think you tend to' feel so comfortable to say well actually I want this, I want that, and this, that and the other. Whereas this time, I do feel more comfortable. Okay, I can't have the water birth, but'I felt more comfortable to actually ask and talk about it. But yeah, I think it's because it being your first, you' like I said, you don't tend to sort of ask so many questions. Which really you should do because you don't know what's going on, so '
She decided against writing a birth plan because she thought her vision of an 'ideal birth' was unrealistic.
She decided against writing a birth plan because she thought her vision of an 'ideal birth' was unrealistic.
I was always very much one of these people that I didn't write a birth plan, I would go along with what was going to be best for the health of myself and the baby, so' Although in an ideal' I knew that in an ideal world I wanted all the sort of natural birth and, you know, no pain relief and everything, but I didn't write that down because I thought that's not being realistic, so.
Most women had prepared a basic birth plan describing their preferences for pain relief during labour, and most had help from a midwife in preparing the plan. A few women had gone into more detail and asked for specific things to happen after birth, such as their partner cutting the cord and skin-to-skin contact with the baby. However, a few women decided against making a plan as they felt that asking for things to happen in a specific way was 'unrealistic'. A couple of women who had a planned caesarean hadn't been made aware that it was possible to make a birth plan for caesarean birth.
(See also 'Thinking about where and how to give birth' in the pregnancy section of this website)
* Office of National Statistics - Hospital Episode Statistics: NHS Maternity Statistics 2016-17.
** ECV stands for External Cephalic Version: the breech baby is turned externally into the head down position.
Last reviewed August 2018.
Last updated August 2018.
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