Making decisions about birth after caesarean

Women's experiences of their next caesarean

About half of all women who have had one previous caesarean decide to give birth to their next child by planned caesarean (an ERCP) instead of attempting vaginal birth after caesarean (VBAC). Women who decide to book a caesarean usually receive a date for when their operation is scheduled several weeks in advance. Planned caesareans are typically booked for week 39 of the pregnancy. However, medical staff sometimes advise women who hope to have a VBAC to book a caesarean at 42 weeks as a fall-back option in case they do not go into labour spontaneously.

For most of the women we spoke to, their previous caesarean had been an emergency caesarean. Several women said that having a better idea of what to expect and feeling mentally ready for the procedure had helped to make their second, planned, caesarean a more positive experience. A couple of women also said they felt empowered by having made an informed choice to have a caesarean rather than just being at the receiving end of medical care as had been the case with their first birth (see also 'Women's views on choice about birth').

Her second caesarean gave her a sense of achievement because she had actively chosen to give...

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Age at interview: 19

Sex: Female

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Yeah, because I chose to have him that way and I feel that I' it's quite a big, I felt like it was quite a big part of me choosing to have this caesarean anyway. And I was fully' sort of more with it, fully aware of what was going on? this time. And I feel like that was sort of an achievement in itself. Going through, a lot of people who've had, who I know who've had normal deliveries, they've said, 'Oh, you're brave to be like knowing what it's like and going for it again,' and so I felt that I had more' more sort of an achievement this time.

And having an election section, was that like you thought it was going to be?

I've watched it on sort of programmes on the tele, but it was more' it's strange actually, it was like you're watching it through somebody else, it wasn't' because you've got no pain, you just' I don't know, it was a really good experience. The midwives and everything, I think they made it' I suppose everybody's different, but like I found that they relaxed me.

So yeah, it was a good experience.

The anaesthetic hurt but the operation was quick and straightforward and the medical team created a relaxed and pleasant atmosphere.

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Age at interview: 32

Sex: Female

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I went in early, was lucky to get the first slot in the delivery list' and went into theatre, and it was about forty minutes from when I went in to when he was born. The local anaesthetic hurt a lot, [slight laugh] ready for the epidural, they did about six local anaesthetics and that hurt a lot. And it took quite a long time to get the epidural in, but once it was done, it was done really, and then it was quick and easy and over. And [son's name] was with us.

And what was the sensation like of having someone deliver you like that?

Okay, because I'd been there before. This was better because I was expecting it. I knew what I was expecting as well. I knew what was going to happen. I could take in a bit more because I wasn't in a panic, as I was with the emergency caesarean. Everything was really quick as well, with the first one, but the second one, I was quite surprised at how relaxed the staff were, and, you know, and it was their first caesarean of the day and they were very jovial and really, really relaxed me. I don't even remember the midwife being there in the first one, but the midwife this time round was fantastic. She was a distraction and really concerned about my well-being and concerned in making sure that I was okay and cracking jokes and the anaesthetist was chatting away to us, and it was a lot more pleasant, a lot more pleasant.

Most women agreed that undergoing a planned caesarean was much preferable to an emergency operation but one woman recalled her previous caesarean more positively. She thought the effects of the gas and air she'd had during labour had probably helped to make the operation seem more pleasant. On this occasion, she was slightly taken aback by finding herself in a queue of other women waiting their turn.

The atmosphere in theatre was relaxed and professional. But it felt a bit as though she was 'a...

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Age at interview: 40

Sex: Female

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My time to go to hospital was nine o'clock in the morning and I arrived there at nine. I had hoped that it would go ahead at about eleven o'clock, had been kept waiting in the maternity ward, I suppose you would call it and from nine onwards and was told that there'd been some delay, that there were going to be two other little sort of minor operations before mine so I wasn't taken away until half past twelve, one o'clock. It was good because the anaesthetist came to visit me on the ward and explained everything, as did the surgeon. And they were very clear in what, in the instructions that they gave, and answering questions and queries I had, then were taken away and the delivery of the baby came at about ten past two in the afternoon so it had been quite a long wait, it had been sort of five hours after the, the original entering into hospital. So in that aspect it wasn't particularly pleasing. However the baby was healthy and, and everything seemed to be okay and then we were back out of theatre by about three o'clock and up on the ward from then on for about two days.

And what was the actual delivery like?

'well, longer than I remember the last time. They had the, they did say to me that because it was, you know, the previous scarring it perhaps would need a little bit of extra time to stitch up, to make sure the repairs were done properly, which' it put my mind at rest, you know, that nothing was wrong, that everything was going hopefully to plan. And they talked to me through the- more or less the procedure and certainly the staff on the, in the theatre that day, were quite relaxed and everything seemed to be very kind of easy-going. In no way was it stressful or I felt pressurised so in that way, everyone was most helpful and very good at what they were doing, I'm glad to say. [sighs] It wasn't an experience I would like to repeat, you know, again, but if it has to be done and that's the way I wanted it done then I understand, and they worked very professionally to see it to the end.

And was your husband with you in theatre?

Yes.

How was he?

Yes, I think he too found it very calm and very straightforward, which was good'

I think knowing, you know, that it was going to be a caesarean, in my mind, kind of helped in a way, so it wasn't the unknown. I kind of knew what was going to happen. The experience perhaps wasn't' I think the first time, because I had had gas and an epidural and had taken forty hours to see if I could have the first baby, I think at that time, I was perhaps a little bit more not quite with the situation, and therefore the caesarean seemed to happen much more quickly. I mean it wasn't an emergency caesarean, I didn't feel it was an emergency caesarean the first time. Everything seemed to happen in a very kind of pleasant kind of atmosphere, helped by the staff in the theatre. And on this occasion, too, it was very easy-going and quite relaxed. But you just kind of felt that you were in a queue in this, in this instance, which I can understand, you know, it was one of many that were happening that day, so it was kind of' it was just a job to be done [sighs].

Are you okay to go on?

Yes, thank you [laughs].

And to what extent, if any, did this delivery meet your expectations? Was it like you thought it was going to be?

Yes, I suppose so, yes. I mean, any surgery is not pleasant. I don't think, you know, I don't think you can sort of kid yourself that it's all going to be a hunky-dory experience. And you

Several women had to wait for several hours after arriving at the hospital because the operating theatre was busy with medical staff attending to women who needed emergency caesareans. Spending several hours changed into a gown for the operation and without being able to eat or drink was not pleasant, though for some the wait provided an additional opportunity to talk about the procedure with the various medical staff involved.

She had to wait quite a long time beforehand, but the caesarean itself took less than an hour and...

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Age at interview: 19

Sex: Female

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Well they said in the morning to get there sort of quarter to eight in the morning, so my mum and my boyfriend came with me. And we were a bit late but then we were taken into sort of a room. It was like a' it's in the delivery suite, but is like a different, is not the sort of room that you go in when you've gone into labour usually, it's usually sort of overnight before you go into labour sort of thing. And I went in there and there was a lady had just had her caesarean next door, and they came and said that I was third on the list. So they said it should be' they try and do their electives in the morning. But obviously each one's different so they could overrun and it depends how long they take. So they said roughly around half past eleven I would be going down, so I was' then they came in, I saw an anaesthetist, she came in and was talking to me and just really sort of trying to keep me relaxed and just saying' explaining what they'll do and how they'll do it, sort of because it's different to your emergency because you actually walk down to theatre instead of being wheeled down, and they brought like a gown for me to put on. They said it's easier if you're ready because then we can take you straight down literally. Because they clean up obviously the theatre and then they want to take you straight down. So they'd given me a gown to put on and everything and they just said sort of you can't eat anything or drink anything, so I was like, 'Oh' [sigh]. But in the end they had a lot of delays so it took right into' I think it was about half past one I went down, because all the others, there was a few problems with them.

So' I went down about half past one and it was' it was completely different. They asked me what music I wanted on and it was really nice and relaxed. They were all really like sort of welcoming, they weren't' weren't scary, I thought it was going to be a bit, bit sort of' I don't know, you expect an operating theatre to be' because I didn't really remember it from the first time, but it was quite relaxing. Then they give me my' I had a spinal' they gave me that, and then I went numb, and then it all seemed to happen really quickly. They said if you don't feel well or' then just let us know because they said your blood pressure can drop and things. And so it was, it was quite a good experience. And then he was born at sort of just before two o'clock. So from the time I went down it only took sort of half an hour really before' and then he was born and then I was - I was the quickest one, all the others had been in for hours, like over an hour, and it was just over fifty minutes I was in the theatre, so wasn't very long.

One woman went to a private consultant after she felt that NHS staff were pushing her towards vaginal birth and not listening to her concerns. Despite being a private patient she, too, had to wait for several hours before the operating theatre was available. However, she was very pleased with the birth itself and felt reassured that she had made the right choice when the consultant told her afterwards that due to the position of her baby's head she would have been unlikely to have a vaginal delivery.

She has no regrets about going private for her caesarean. The doctor told her after the birth...

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Age at interview: 42

Sex: Female

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Did you ever have second thoughts or change your mind at all?

I didn't at that point, no. I also had huge pelvic pains, so, you know, it all contributed to be the right decision, if you see what I mean. Sometimes, I think the powers work like that, but I had a lot of pain, which apparently was, it's sometimes due to if you've had a previous caesarean, you have scarring, so your baby's pushing on that. And then also, he came to see me after' we hadn't got to that and he said, 'You know, it's amazing, but where your baby was', he said 'You'd have just struggled again. You carry them really high up, they're not engaged', and I said, 'Well, would she have engaged later?' and he said, 'Well the thing is, looking at your anatomy, I don't think she would', he said, 'You made the right decision', so it was amazing [laughs]. So I've no regrets at all. So it's some, something about the way I carry, perhaps my anatomy, the, the heads just don't get right down in my pelvis. So he said, 'I suspect that's why it took so long last time', and why she just wasn't going to come out. So, so it was amazing, so it all was the right decision. So' [smiles].

So with that in mind, what role do you see you had in the decision this time?

Well, I made it totally, yeah, so that's great. And, I suppose I'm lucky that it turned out to be very much the right thing and went so well. I'd say the only' I suppose a few days, actually, to be true, the only doubt I had, had to be fair, because I did sometimes think, 'Gosh, you know, is it unfair on', I mean, obviously after what he said' Sometimes in the days before, while I was in this pain, I thought, 'Is it unfair on her, bringing her out a week early?', I used to worry about that slightly. 'And what if she doesn't breathe?' or'or whatever, but obviously now I know it was the right decision for her as well.

And did you have any reassurance from anyone at all that that would be okay, the fact that you were having her early and that you had these worries about'?

From my own obstetrician, oh yes, totally.

And you were reassured?

Totally, yeah, I was. Because even the, the morning before, I said to him, 'I'm still worried she won't breathe' And he said, 'Well, you know', he again, poor man, probably had to tell me about ten times. But I mean, women are nervous, you know, I suppose I was an anxious patient, though but for perhaps good reason, so for the umpteenth time he told me that it's very unlikely at, you know, I was in my thirty-ninth week and plus, even then he said, 'Look, even if she does, we've got everything here, so don't worry'. So, you know, and I did feel very reassured about that, again, for the twentieth time [laughs].

So how would you say that you feel about the way that you delivered this time?

I think it went really well and I'm, I'm probably really glad I made my decision. And I've no regrets about the money it cost, which was a lot, and, you know, we're not extremely wealthy but, you know, it was the price of a car and car versus baby is not, not a decision I have to think about.

Women had different views about how they wanted to experience the operation itself. Some were keen to be talked through every step of the procedure and wanted to be fully involved in what was happening, while others preferred to distract themselves with music and tried to ignore their clinical surroundings as much as possible.

She felt squeamish about the operation and tried to ignore it as much as possible. Having her...

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Age at interview: 30

Sex: Female

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The night before the C-section, one of the nurses came round to make sure I was all prepared. 'Nil by mouth from midnight onwards, and they gave me a couple of little tablets, I think, to settle your stomach, so you don't react to the anaesthetic. On the morning itself, the surgeon came and talked to me again. He'd come previously for me to sign the consent forms a couple of days previously, but he came to talk to me and so did the anaesthetist, and make sure I was all ready for it and I that I didn't have any final questions and then my husband and I went down to the delivery suites and sat about for a little while, maybe an hour or so, whilst they were all getting ready. I had the two, I can't remember what they're called' to give you blood transfusions, they put in the little pipe, the little thing ready, I can't remember what the word is for that?

Canula?

Canula, thank you. I had canulas put into both of my hands, ready, because they were expecting a lot of blood loss, so they wanted two canulas in, ready to give me loads and loads of blood, so I was sitting there with these in my hands and trying not to look at my hands, because I'm very squeamish so from that point onwards I was like, 'I can't look'. And then I think I actually walked into the operating theatre, all in my gown with my stockings on and my canulas in my hand, I had to sit on the edge of the bed, sit up very straight and still for the anaesthetist to put the spinal in, in my back, which didn't take too long, and then leant back, and then they started the actual procedure. Shall I describe the procedure?

Okay, first of all, after having the spinal, or if you have an epidural it's the same, they check that you've gone numb, they're sort of pinching your toes and, and spraying something saying, 'When do you feel this?' and 'When does it stop feeling cold?' and working out, you know, that you're totally numb where you should be. And then they put up the big screen so you can't see anything, and you're obviously lying on your back, and you can't see anything sort of past mid-chest level. And the bed itself is tilted slightly to the left, which is I think so that all your innards are nicely out of the way when they chop you up. So [smiles], 'and then they actually performed the procedure, which I ignored as much as possible. Obviously you can't see anything and my husband was up talking to me, the anaesthetist also talks to you; they're really nice. And you can have a CD on of your choice, just to take you mind off of it and listen to some music. A couple of minutes later, you're presented with a baby, and it's all bundled up. They check it, check that it's breathing and everything and bundle it all up in a blanket and then give it to, and there's just about space for the baby to balance between your face and this, this sheet screen that's up. So the baby's there, and you can look at it and kiss and cuddle it and everything and that's quite nice, and whilst they're doing that, whilst you're distracted with the baby then they're delivering the placenta and stitching you back together again. So, getting the baby out is the quickest part. Once they start, then you've probably got a baby within ten minutes and then they're just patching you up again, which probably takes about three quarters of an hour.

The medical staff talked her through the delivery moment by moment. Having a first glance at her daughter still attached by the cord was wonderful.

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Age at interview: 37

Sex: Female

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I had to be in at seven o'clock in the morning and I was given a bed and obviously told not to eat and drink anything. And I was told exactly what was happening by nurses and they told me what time they were going to come and collect me, which they did. I suppose my only sort of nervous part then was that emergency sections would take preference over planned ones and I was a bit anxious because I did then want to get on with it. But that didn't happen, thankfully and went down to theatre and'it was very, it was quite surreal really because it was very different to my first delivery. Which was an emergency- an emergency section, because everything seemed to happen so fast the first time, and this time it was extremely relaxed. And what I really enjoyed about this delivery was the fact that I wasn't exhausted, and I wasn't absolutely terrified. This time I knew exactly, I was calm and had I'd had a good night's sleep, I felt completely ready to have the baby and the theatre team, I specifically asked them. I said I wanted to know everything that was happening, and they told me everything that was happening moment by moment, which was wonderful. And also I chose to be the first to sort of see the baby and they put the screen down and held her up by the cord so I was the, obviously well, they would have seen her first, but to say it was a girl. And that was a really wonderful moment. It was lovely.

So, has it in any way revised your previous opinion that with the delivery...

Mm

...it maybe wasn't the section, it was the way, it was that you'd laboured before having a section, and it was having an emergency rather than a section per se?

Yeah, I think that still, obviously out of choice, I would have loved to have had a natural childbirth just because that's the way I think you're meant to give birth, but, but having said that, you know, I've got friends that are pregnant at the moment and I've said to them all, if you have a section, it can be' wonderful. It doesn't mean it's not going to be wonderful, because I think people associate having a section with being quite scary and things have gone wrong. But it wasn't like that for the second time with me. Everything was fine, it just was the safest way for this baby to be delivered. And she was ten' two so I was quite glad I didn't have it naturally now [laughs].

Several women had mentioned the greater degree of certainty about when and how they would give birth as an important reason for their decision to have a planned caesarean. Being able to plan ahead, arrange childcare and make sure that partners and other family members are around for the birth were seen as advantages of planned caesarean over VBAC. (See 'Reasons for wanting a planned caesarean'). However, for a couple of women things did not turn out as planned. They went into labour spontaneously before the date booked for their caesarean.

One woman, who had a planned caesarean with her first child and no previous experience of labour, initially mistook her contractions for stomach pains. Once she had arrived at hospital, her baby was found to be in a back to back position and showed signs of distress. She had to be delivered by emergency caesarean and found the experience much worse and more painful than her previous, planned, caesarean.

She went into labour before the date booked for her caesarean. By the time the theatre was available she was in advanced labour and was advised that it would be safer to carry on with vaginal birth

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Age at interview: 31

Sex: Female

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It was about ten o'clock on Saturday night my, I thought my waters had broken but I wasn't too sure. And I laboured through the night, but I wasn't sure if it was Braxton Hicks or whether I was actually going into labour. At five o'clock on the Sunday morning I realised that it was the, the real thing so I phoned the hospital and we went up. It must have been about half past seven when I got to the hospital and I was examined. I was only two centimetres at that stage, so I decided I would just have the elective section and [pause].

And were you admitted then?

I was admitted but the theatre was busy because they'd had a really busy night so I was put in the side bay and told I'd get taken in as soon as, as there was a space for me and they came back about an hour later just to check how I was doing and I was about seven centimetres by this point so I was told I couldn't have any pain relief because I was having the elective section, but I could have morphine or gas and air, so I asked for morphine [laughs] [okay] and by the time she went away to organise the morphine and came back, it was too late to have any pain relief and I got pushed very hastily into a side room and he came out in about, well, it seemed like about ten minutes.

Okay. So, at what time do you think that your mind was changed from having the section to having a natural delivery? At what point in that process do you think that happened?

To be honest, I didn't actually change my mind. The consultant' when the midwife realised I was, I was in advanced labour and I was ready to push, the consultant came round and he apologised for the wait because the theatre was busy and everything and he explained to me that because the head was so far down, that there was added complications with a caesarean that there wouldn't have been if I'd had it initially and he strongly advised me to have a natural delivery, but at that point I could actually feel that he was literally going to be any minute so I thought, 'Oh well' and it was nice of him to say, you know, 'We're really sorry and would you still like an elective section but it's more dangerous for the baby and we really don't have time anyway', but it just all happened so fast.

So what do you think now was your role in the decision-making when it came to the actual labour?

When it came to the final labour, I don't think I had any choice at all. I think it was all down to the fact that the hospital was busy, the theatre was busy and everything went so quickly that there wasn't time for me to have a section, but I don't think I actually changed my mind.

And what was the actual delivery like for you?

Absolutely fine, no problems at all. Yeah. With hindsight, and now that he's here, I'm actually glad I had a natural delivery because it was, it was quite easy, I have to say, a lot easier than I thought it would be. I guess I was just very lucky and my recovery was fine. I mean I was at the gym and swimming four days after he was born so, it was a lot easier with having a second that had a natural delivery.

It took her some time to realise she had gone into labour. Once at the hospital, staff advised an...

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It took her some time to realise she had gone into labour. Once at the hospital, staff advised an...

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Age at interview: 31

Sex: Female

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Well, I'd never been in labour before, because I didn't actually go into labour with my first daughter, with my first child [yeah] and it was' I was booked to have an elective section, I think four days, yeah, sorry, three days before my due date but on the thirty-nine plus one day, which was the Saturday night, I sort of woke up in the early hours of the morning with niggling tummy pains and didn't really think much of it and then two hours later woke up with really bad stomach pains again, not realising that I was in labour, and then after taking some paracetamol, it wasn't going away, it got worse. I woke my husband up, and as I went to wake him up, my waters broke, and at that point we decided then to phone the midwife. We paged the midwife, paged her twice and she didn't ring back so I phoned [Hospital] hospital direct and they got someone to ring me back and because on my notes obviously it says that 'Mrs [name] is not to go through a trial of labour', the midwife on call at the time at the hospital said, 'Obviously you need to get in straight away' but she had to clarify whether I would be going to [Hospital 1] or to [Hospital 2], because [Hospital 1] was full, in fact they were over full. So they phoned back within sort of ten minutes to say no, they could fit me in, to come straight in so I think we went in about half past six that morning, and when I was in there I' the consultant gave me an internal examination and told me that I was three centimetres dilated, he was back to back and that they wanted to go ahead quite quickly with a C-section, because the waters were of a funny colour and they were worried that he was in distress, and he was born at 10.07 that morning, and it was not a very nice experience, having an emergency section. And then I had to wait in the recovery room for approximately six hours because they never had a bed, so I had to wait 'til Sunday evening really before I could go onto the ward.

And how do you feel about the way that you delivered this time?

It wasn't very nice. It was very, I would say probably for the first ten days, that includes the time I had in hospital, I was not really with it. I was very spaced out because it had been such a shock, and it's completely different to having a planned section. Just a couple of things, for example whilst they try to make you sort of as relaxed as possible, you know, I was obviously contracting, which I'd never done with my first pregnancy. When they actually got me into the operating theatre, they couldn't find [baby's name]'s heartbeat, then when they did it had dropped, but no-on was actually telling me this information, they were just talking amongst themselves, which then made me feel even worse. When the anaesthetist put the needle in my back, she touched a nerve, because she was rushing, well, I wouldn't say she was rushing, but obviously because it was an emergency, and I've now got numbness in my knee, which they say will probably never come back and, but where they've sort of damaged this, this nerve, and when he was born it took a lot longer obviously to stitch me up because there was obviously a lot of scar tissue there from the previous section so, and because as well the, the two recovery rooms that they have were full, I had to go into a separate room, which they'd made into a recovery room, and then wait there for sort of six hours, which, yes, it was a bit scary really.

And I don't know if you could say which bit was worse really because it all sounds quite a horrendous experience, but what was it like going into labour, because that must have been, I would imagine quite terrifying because that's not what you wanted to do?

Yeah, it was very frightening actually. Because I'd been having Braxton Hicks practice contractions all

A few women ended up having a planned caesarean even though their preference was for VBAC. One woman was diagnosed with a low-lying placenta (placenta praevia) during the second half of her pregnancy, meaning that the baby's exit from the womb was blocked. She had a planned caesarean at 38 weeks and felt very relieved to put the operation behind her without any complications. Knowing in advance that this caesarean was medically unavoidable meant that she did not experience the sense of disappointment that she had felt after her first emergency caesarean. Another couple of women who had hoped to have a vaginal birth went several days past their due date without going into labour and eventually went along with medical advice to have a planned caesarean rather than wait any longer or be induced.

She had wanted a vaginal birth but when she went past 42 weeks without going into labour planned caesarean seemed the only conclusion.

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Age at interview: 32

Sex: Female

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The elective was not out of choice. It's called elective just because you have to have it, in a way [yeah]. But to me, it was almost, yeah, it wasn't out of choice at all. I didn't elect to have it, it was just that I wasn't going to fight the medics and go over forty-two weeks just in case there were difficulties with the placenta. I didn't want to take the risk, but I don't consider that I made the choice to have the caesarean, really [slight laugh]. I think it was' the only conclusion.

I think I got to the last week and I thought, I think, as in forty-one weeks' term, and I thought, 'Right, it really doesn't look like I'm going to have a natural birth', so I kind of wanted to have the elective section a bit earlier if possible [right] but I spoke to them and they just said if there was an available position they would let me know, but otherwise it stayed the same, which was a day before forty-two weeks. Which I was fine with as well.

Recovery after their second caesarean was very different for different women. A few experienced several weeks of pain and soreness while others were able to move about without too much discomfort after just a few days. (See also 'Comparing birth experiences and recovery'.)

Last reviewed August 2018.
Last updated August 2018.