Making decisions about birth after caesarean

Women's experiences of vaginal birth after CS

About half of all women who've had one previous caesarean decide to attempt vaginal birth after caesarean (VBAC), 72-76% of these women will have a vaginal delivery*. Going through labour after a previous caesarean is regarded as slightly more risky because the contractions will put a certain amount of strain on the caesarean scar. For this reason, women who attempt VBAC are usually asked to come into hospital early on during their labour so that they can be monitored closely. The drugs that may be used to induce women who have had a previous caesarean are different from those that are typically used in a first pregnancy, and for some women, doctors might advise against induction altogether. They may also set a limit on the amount of time that a woman spends labouring to make sure that the strain on the caesarean scar does not get too much.

None of the women in this study who decided to attempt VBAC had previously experienced a vaginal birth. Some had gone through labour before their previous caesarean, but others had never experienced contractions and worried about how well they would cope. Most women who had decided to attempt VBAC said they saw it as 'the natural way' of giving birth and were hoping for a quicker recovery than they'd had after their caesarean. Some also saw it as an opportunity to take back control and experience the kind of birth that they had wanted for their first child. (See also 'Reasons for wanting vaginal birth after caesarean' and 'Women's expectations for their next birth'.)

Women's experiences of going through vaginal birth were very varied. A few women gave birth unassisted and after relatively short periods of labour. One woman had just gas and air for pain relief and needed no stitches after the delivery. She described her experience as 'a perfect birth'. Another woman also got through her labour with just gas and air and delivered her baby within two hours. However, her placenta had become stuck to the caesarean scar so she had to have an epidural and go into theatre after the birth to have the placenta surgically removed. 

Other women's experiences of labour and birth were less straightforward and more painful. A few women had the birth of their baby assisted by a suction cup - also known as a ventouse - and one woman had a forceps delivery.

A couple of women who had wanted a vaginal birth but went several days past their due date without going into labour eventually agreed to have a planned caesarean, because they felt increasingly uncomfortable and didn't want to be induced. However, another woman who also went overdue had an induction and gave birth unassisted.

Most women had known in advance that they would be closely monitored from the time they arrived in hospital. One woman felt lucky to be hooked up to a wireless monitor that didn't restrict her movements. Another woman didn't want to be monitored and only came into hospital once she was in advanced labour. She wanted to give birth in an environment that was as free of interventions as possible and arrived at the hospital birthing suite with a hypnotherapy tape and a doula - a non-medical birth helper who give support to women before, during and after birth. 

We asked women who had gone through VBAC whether at some stage during their labour they had considered asking for another caesarean. A few women said that the thought had crossed their mind when contractions became very painful or it just seemed like things were not going anywhere. One young woman said she had actually begged her midwife to have a caesarean when the pain got very bad, but, looking back, she was very pleased to have persevered with vaginal delivery. 

On the other hand, a couple of women said that when health professionals mentioned to them that they might need another caesarean after they had laboured for several hours, it gave them extra motivation to try and push their baby out. A couple of women described themselves as 'on a mission' to achieve vaginal birth, a mission they hung on to even when things did not go to plan. 

Looking back on their experiences of VBAC, many women said they were proud to have done it and felt an incredible sense of achievement. But one woman also thought that VBAC could be made into too much of a 'big thing' and at the end of the day, the greatest sense of joy came from having another healthy baby.

*Royal Collage of Obstetricians and Gynaecologists (RCOG) - Birth after caesarean.

Last reviewed April 2015.
Last updated November 2010.

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