Making decisions about birth after caesarean

Women's feelings about their previous caesarean

Childbirth is generally thought of as a 'landmark experience' for a woman. Most women attach great importance to how their child is born and will spend a lot of time during their pregnancy thinking about and preparing for birth (see 'Women's expectations for their previous birth'). Even though these days many babies are delivered with the help of interventions such as induction, forceps, ventouse (suction cup) and caesarean, many people still think of unassisted vaginal birth as the 'normal' way to have a baby. It is very common, therefore, for women who have a caesarean to feel dissatisfied with their birthing experience. 

When we talked to women, a year or more had passed since their previous caesarean. For one woman (Interview 26), the experience was 13 years ago. Virtually all the women said they felt the caesarean had been the right thing to do at the time, but most had some negative feelings about it at some point after birth. The extent of these feelings, and the reasons why they felt that way, varied greatly. Several women said they felt in a state of shock immediately afterwards because it had been an emergency operation. Several regretted having lost control over the birthing process. One woman who had a planned caesarean remarked that it felt wrong for someone else to 'chose' her child's birthday. Others said they felt 'disappointed' or 'cheated' out of what they hoped would be a very special experience and admitted feeling envious of mothers who'd had a vaginal birth.

Having a birth that was so different to what they had hoped led a few women to look back on their pre-birth expectations as unrealistic. They were critical of the information provided in antenatal classes and thought that the focus on 'natural birth' was likely to lead women to have false expectations (see 'Information needs/sources in previous pregnancy').

Psychological research suggests that people tend to cope better with traumatic events if they had the chance to prepare themselves for them. Women who had a planned caesarean could be expected to feel more positive about their experience than those who assumed that they would have a vaginal birth or felt very strongly about keeping things as natural as possible. Amongst the women we spoke to, those who found it easier to come to terms with their caesarean were women who a had planned caesarean, those who had no strong feelings about how to deliver or who had expected complications. A couple of women who had a planned caesarean nevertheless felt disappointed, and others said the information they had been given beforehand had not prepared them enough for the after-effects of the operation. One woman, who had been advised to have a caesarean because of a big baby, felt angry when he turned out to be normal size at birth. 

Not all women had negative feelings about their caesarean. Several women felt that it wasn't the birth that they had wanted but it was the only option available in their particular circumstances. They trusted in the decisions made by the medical staff and felt that the operation had saved them and their babies from more serious harm. Thinking like this helped them to accept what had happened. A few women also stressed that it had been important for them to at least attempt a vaginal delivery. They had felt involved in decisions about how long to labour and when to stop trying. Knowing that they had tried their hardest made it easier for them to accept that vaginal birth was just not going to happen for them. 

Caesarean is a major operation and recovery after a section is often slower and more painful than after a vaginal birth. Unsurprisingly, women's feelings about their caesarean were also influenced by how much pain they had experienced, how long it had taken them to get 'back to normal' and how well their caesarean scar had healed. For a few women, recovery had actually been better and quicker than they had expected, so they thought of themselves as lucky compared to other women. (See 'Recovery and complications after previous caesarean'.)

Most women didn't doubt that their caesarean was medically necessary. However, a few women had gained additional information that had made them more critical of the care they had received. They felt that a caesarean could have been avoided if their labour had been managed differently. A couple of women said they had never received a proper explanation about the exact reasons why a caesarean had been performed. Not understanding the reasons made it more difficult for these women to come to terms with things and made them anxious that problems might repeat themselves during a future birth.

Many women find it difficult to voice disappointment about the birth of their child. They might think of themselves as ungrateful, because they feel low even though they have a healthy baby. Also, a sense of excitement about the new baby amongst family and friends might make it difficult for women to express negative feelings. 

The majority of women said the caesarean had not affected the way they felt about themselves. However, for a few women, a personal sense of failure about not having managed to give birth 'properly' lingered on long after the caesarean. Reflecting on what had happened brought back painful memories for some women and made them feel very emotional. A few women experienced postnatal depression or a long period of low mood after their baby's birth and felt this was at least in part because of the trauma of caesarean birth (see 'Bonding, feeding and support after previous casesarean').

As time went on, women gradually became reconciled to what had happened and looked at things in a more detached way. Some had consciously tried to put it to the back of their minds and not dwell on it. However, a couple of women said they felt judged by other mothers because they hadn't had a 'natural birth'. 

Last reviewed April 2015.

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