Making decisions about birth after caesarean

Information needs/sources in previous pregnancies

For most women, finding out that they are pregnant brings with it a wealth of general and more specific questions and concerns for which they want reliable information. However, knowing which sources to trust and how to separate objective information from rumours and anecdotes can be difficult. Under NHS guidelines, women should be provided with a range of services to help them prepare for labour, birth and motherhood: a series of maternity appointments with qualified midwives, information leaflets in the form of 'pregnancy packs' and the option to attend antenatal classes. In addition, many women seek out information from books and magazines, TV programmes, websites and, of course, other women.

For most women we spoke to, their previous pregnancy had been their first experience of being pregnant. There was wide variation in the amount and range of information women had wanted and had received during that pregnancy. A few women had wanted to know everything there was to know, not just about labour and birth, but also about the development of the baby throughout pregnancy. They had used the library and the internet to do their own research above and beyond what they had learned from health professionals. Others had found the information they received through their midwives more than sufficient. A few women felt that some of the material presented on TV programmes, in women's magazines or on the internet could be more scary than informative. However, others had enjoyed the level of detail these sources provided.

The most common issues women had wanted to know about concerned methods of pain relief and breathing techniques during labour, stages of labour and different birthing positions. A few women had more specific information needs arising from their special situations. For example, one woman with a breech pregnancy was keen to find out about possibilities for making her baby turn. Another woman had been told that her baby was very large and she would have liked more specific advice on how she might prepare for his birth.

For most women, midwives played a key role as information providers. Only those women who had booked a planned caesarean reported having access to an obstetrician before giving birth. Most women were looked after by a team of midwives. For some women, this system worked quite well. Even though many women said they would have preferred to see the same person at each appointment, they still felt the level of care was good. Midwives were often described as friendly and approachable, but some women said the system could make the relationship feel a bit too business-like. A couple of women felt particularly let down by the lack of continuity they experienced in their antenatal care. The very few women who were able to see the same midwife throughout their pregnancy knew that they could count themselves lucky.

Most women in the study had attended NHS antenatal classes, and a couple of women had also attended classes run by the National Childbirth Trust (NCT). NHS antenatal classes are usually taught by midwives and are free of charge, though they can be crowded and places are often limited. NCT classes tend to be run in smaller groups and charge a fee. A couple of younger mothers had not been offered the option to attend classes, though one of them had attended a 'Young Mum's Bump Club' instead.

Of those women who had attended antenatal classes, several judged them to be a very helpful source of information, and most women said they found them helpful to a degree. However, a few women commented that the information had been quite basic. One woman who knew she was going to have a planned caesarean found much of the information irrelevant to her. A few other women said the emphasis on 'natural birth' in their classes had been unhelpful as it led them to have unrealistic expectations. A couple of women saw their classes mainly as an opportunity to make contact with other mothers and looked elsewhere for more in-depth information. 

We asked women whether the information they had received during their previous pregnancy had helped them prepare in any way for their experience of caesarean. A couple of women who had received information on risks and complications beforehand had found it helpful and reassuring when things didn't go to plan. However, several others said that birth complications had either not been discussed at all or not been discussed in sufficient detail to be of use. A few women did recall receiving information on complications as part of their classes, but had not wanted to engage with this information at the time.

Several women acknowledged the difficulty in a first pregnancy of 'not knowing what you don't know'. In hindsight, many had much clearer ideas about the kind of information that would have been useful for them to have. Most women said they would have liked more information about the likelihood of birth complications during their antenatal care. However, they also acknowledged that health professionals might withhold such information to protect women and avoid scaring them unnecessarily.

Last reviewed April 2015.

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