Making decisions about birth after caesarean

Reasons for wanting vaginal birth after 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 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 VBAC. 

Women's preferences were influenced by a wide range of factors. These included their previous experience of caesarean birth, considerations about having further children, 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. Of course, 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 (also see 'Women's experiences of making the decision') 

Many women mentioned a quicker and easier recovery as the main reason why they wanted to attempt vaginal delivery. All the women we spoke to had at least one child to care for already. For many women, having to look after a toddler meant they wanted to avoid an operation that might leave them unable to lift, bend or drive a car for several weeks. A couple of women who had felt very ill after their previous caesarean were particularly keen not to repeat the experience. But a couple of women who had made a very good recovery from their caesarean also felt they might not be so lucky second time round.

A few women were concerned that their children were too young to understand why their mum might have to stay in hospital for a longer period or might not be able to pick them up and give them a cuddle after having another caesarean. 

Women's preferences were also influenced by how confident they felt that they would have a vaginal birth this time. One woman who had laboured to eight centimetres dilation with relative ease on her first birth didn't feel frightened to go through labour again. A couple of women who'd considered a repeat caesarean earlier on in their current pregnancy changed their minds towards VBAC after medical professionals had encouraged them that there was no reason why they shouldn't be able to delivery vaginally. As one woman summed up her reasoning, 'if there is no reason not to, then why not try it?'

A couple of women were concerned about whether having a repeat caesarean would affect future pregnancies. They thought that medical professionals would not allow them to attempt vaginal birth after having had two caesareans, and that this would limit the number of further children they could have. They saw attempting a VBAC as a way of keeping their options open. 

While some women mentioned very practical reasons why they would prefer a VBAC, others had much more personal and emotional motivations. A few women who'd been very disappointed with their first birthing experience looked towards their next birth as a chance for 'putting things right'. They wanted to experience the 'sense of achievement' that they had heard other mothers talk about but that they themselves had felt 'robbed of' with their previous birth. 

A few women who had a positive previous experience of caesarean were still very curious and excited to experience 'the natural way' of giving birth. A couple of women who did not have much previous experience of labour and contractions felt slightly nervous. At the same time though, they liked the idea of getting first-hand experience of labour instead of just hearing their friends talk about it without being able to join in. They were looking forward to taking part more knowledgeably in conversations with other mothers when talking about childbirth. A couple of women who had missed out on immediate contact with their baby after their previous birth hoped that giving birth vaginally would make bonding with their new baby more instinctive and immediate. One woman said being more mature than when she had her first child and being in a steady relationship with a supportive partner meant she felt confident to embrace vaginal birth as a 'one in a lifetime experience'. 

Alongside various practical and personal reasons for wanting a vaginal birth, a few women also had a strong sense that vaginal delivery was the 'natural' and 'proper' way to give birth. They expressed this by saying things like 'the way your body is designed to do it' or 'the way that God intended it'. They felt that opting for a planned caesarean in the absence of medical necessity was the wrong thing to do. One woman had considered a caesarean for the convenience of giving birth in time to attend her sister's wedding, but abandoned the idea because she felt it was not right.

 

Last reviewed April 2015.

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