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'). 

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. 

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.

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.

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. 

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. 

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.

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.


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