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').

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'). 

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.

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.

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. 

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. 

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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