Making decisions about birth after caesarean

Reasons for wanting a planned caesarean

Women who have had a previous caesarean are likely to think particularly carefully about how they want their next child to be born. They can try a vaginal birth after caesarean (VBAC) or have a repeat caesarean that is planned (sometimes also referred to as an 'elective caesarean'). Not all women will be able to choose between these two ways of giving birth after caesarean - some women might have to have another caesarean due to medical reasons. Nonetheless, most women have clear ideas about which way of giving birth they would prefer. We asked women about the main reasons why they wanted to have a repeat caesarean. 

Women's birth preferences were influenced by a wide range of factors. These included their previous experience of labour and caesarean birth, considerations for the future, their current family situation and the availability of support, as well as 'gut feelings' and more general ideas on what childbirth ought to be about. Naturally, all women wanted to give birth in a way that would be safe for themselves and their baby. Many looked to medical professionals to help them decide which option would be best for them (see 'Women's experiences of making the decision' and ' Role of health professionals in decision-making').

A couple of women made the decision to have a planned caesarean as soon as they found out that they were pregnant again. One woman who never went into labour during her previous birth felt certain that her experience would repeat itself, as several women in her family had had the same problems with dilating. She felt very sure there was no point in trying for vaginal birth and requested a caesarean early on in her pregnancy. Another woman had developed lichen sclerosus (a chronic inflammatory skin disorder affecting the genital area). She was concerned that a tear during vaginal delivery might cause the condition to flare up again and decided on a caesarean to avoid that risk.

Most women who decided on a planned caesarean with their next child had considered vaginal birth during the early stages of their pregnancy, although with varying levels of enthusiasm. They changed their minds after talking to doctors or midwives and finding out more information at their hospital appointments. One woman who had been very keen to try vaginal birth was disappointed to learn that she had a low-lying placenta (placenta praevia) and therefore would have to have a caesarean, so the decision was taken out of her hands. Another couple of women were advised that a planned caesarean would be a safer option than vaginal birth on the grounds of their medical history or aspects of the current pregnancy such as breech position or large size of the baby, or in one case, a rupture during her first birth. One woman, who had a very difficult first birth, followed by a more positive experience of planned caesarean, said she felt safer with medical intervention. 

For several women, the overriding reason for wanting a planned caesarean was wanting to avoid a second emergency caesarean. They didn't want to risk going through the pain and exhaustion of labour only to be rushed to the operating theatre at the last minute. They didn't like the idea of having another operation but they felt that a planned caesarean would be much less stressful for mother and baby than an emergency one. One woman who had missed out on immediate contact with her baby after her previous caesarean because she had felt so tired and unwell, hoped that after a planned c-section she would be well enough to breastfeed her baby straightaway and bond with him more quickly. Similarly, one woman who'd had her first caesarean under general anaesthetic wanted to make sure she would be awake when her next child was born and therefore felt that a planned caesarean was a better option. Another woman was angry that with her previous birth, doctors had waited until her baby showed signs of distress before deciding to do a caesarean. She couldn't face the idea of going through a similar experience with her second child. 

A few women were particularly worried about the risk of uterine rupture. Even though uterine rupture is very rare, for many women it is the complication that causes them most anxiety. (The risk of uterine rupture following a previous caesarean section is 22-74/10,000 deliveries if VBAC is attempted (0.22 to 0.74 % risk)*). A few women who decided to have a planned caesarean had been encouraged by doctors and midwives to try VBAC. However, this hadn't made them any more confident that they would be able to have one, and a couple of women resented being given what they perceived to be one-sided information. Some felt health professionals were pursuing their own agenda in promoting vaginal birth. One woman felt so little confidence that her wishes would be respected that she chose to see a private consultant instead. Another woman also worried that if she was to attempt VBAC, health professionals might let her labour on for longer than she would want to. 

Several women mentioned the convenience of knowing when their baby would be born as an important advantage of planned caesarean. Having a date booked for the operation meant that they could arrange childcare and support for the time after the birth well in advance. Being able to plan was particularly important for one woman, whose husband worked away from home for long stretches. She wanted to make sure that he would be around for the birth. Nevertheless, she found the decision difficult, as it conflicted with her view that women should not have a caesarean for personal convenience.

Women's decision to have a planned caesarean was often also influenced by the concerns of their partners and other family members.

*Birth After Previous Caesarean Birth; Royal College of Obstetricians and Gynaecologists (2007)
 

Last reviewed April 2015.
Last updated Novemeber 2010.

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