Making decisions about birth after caesarean

Women's experiences of their previous CS

Women's first experience of caesarean birth was strongly influenced by the hopes and expectations they had held beforehand. (See 'Women's expectations for their previous birth'). For all but one of the women who were interviewed, their experience of caesarean was also their first experience of childbirth. All of them had opted to give birth at hospital and many felt anxious about what lay ahead. Looking back, some women wished they had been more confident to question some of the decisions made about their care.

The majority of women in the study experienced an 'emergency caesarean', that is, the decision to perform a caesarean had been made after they had gone into labour. The most common reasons for having an emergency caesarean were problems getting fully dilated or the baby starting to show signs of distress. A few women went on from induction of labour post term to having an emergency caesarean without experiencing contractions and dilating only minimally. Two women experienced life-threatening complications due to pre-eclampsia and had to have their babies delivered prematurely.

A minority of women had a planned caesarean - that is, a caesarean that was scheduled to take place before their labour started. Reasons for a planned caesarean included being pregnant with twins, a large baby, a baby in breech position and a difficult previous birth. Women who had a planned caesarean did not necessarily feel less anxious about the operation than those who had emergency caesareans (see 'Women's expectations for their previous birth'). However, they'd had more time to adjust their expectations of what the birth would be like. Most of them felt satisfied with their birth experience. One who woman who had chosen to have a caesarean felt particularly pleased with her decision. However, a couple of women regretted missing out on labour and vaginal birth. One woman felt angry initially when she found out that doctors had misjudged the size of her baby and she could have had a vaginal delivery after all (Interview 06).

The majority of women had epidural caesareans, so they were conscious during the operation, though several felt quite hazy due to the painkillers they had received. Some women had an epidural earlier on in their labour so they were ready to move on to the operating theatre as soon as the decision for a caesarean was made. Others received a spinal block specifically for the operation. Several women felt quite nervous about receiving the epidural and a few women also felt anxious about being operated on without a general anaesthetic. Generally, women found it very reassuring when medical staff kept them informed about what was happening to them at each step. Friendly words providing some distraction were also much appreciated.

There was wide variation in how quickly the decision to perform an emergency caesarean had been reached and how involved women had felt in the decision-making process. For some women, the decision was a gradual process reached in consultation with hospital staff and did not have an 'emergency' feel to it. For others, it happened very abruptly and they were rushed into the operating theatre with little time for discussion. 

Women need to consent to the operation, but depending on circumstances consent might be taken verbally rather than in written form. Not all women could recall a formal consent procedure or signing anything. Several woman said they felt far too stressed or too hazy from painkillers to take in the information provided to them at the time. The women who had a planned caesarean had more opportunity to find information and talk to health professionals beforehand, but this did not necessarily mean that they felt more involved in the decision-making. Some women hadn't felt the need to be given much information or be involved in decisions as they trusted the medical staff to do whatever was necessary. Several women also said they did not feel there had been much of a choice and caesarean had been the only safe way to deliver their baby. Few women were aware what having a caesarean might mean for future pregnancies at the time of the operation. However, a couple of women had much more positive experiences of information provision and felt very happy with the way their views were taken into account. 

Several of the women who had difficulty dilating described a gradual loss of control during their labour. Once they had one intervention, others seemed to follow. Similarly, as time went on and pain became more intense, they found themselves agreeing to forms of pain relief they had originally wanted to avoid. Looking back, some women wondered whether the way in which their care was managed at hospital had the effect of slowing labour down. For example, one woman felt that perhaps she had got into the birthing pool too early and got too relaxed. Others wondered about the effect of drugs such as pethidine, which made them feel too confused or sleepy to move around. (See 'Women's feelings about their previous caesarean').

A few women felt so exhausted from having laboured for many hours that they were relieved when a caesarean was eventually offered to them. Others who went through a long and painful labour would have liked to have been offered a caesarean earlier on and found it difficult to understand that medical staff waited until their baby showed signs of distress. However, a few women felt they should have been given more time to try and give birth vaginally. 

At some stage during their labour, many women had been connected to a fetal heart rate monitor. This restricted their movement and a few women felt that this made it more difficult for them to get comfortable and maybe even contributed to slowing down their labour. Several women also found it very upsetting to witness irregularities in their baby's heartbeat via the monitor.

Last reviewed April 2015.
Last updated Novemeber 2010.

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