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Making decisions about birth after caesarean

Advice to other women facing decisions about birth

Health professionals can provide women with important information about risks and complications associated with different ways of giving birth. They can also draw on their professional experience to support women in their decision-making. However, many women find it helpful to talk to other women about their experiences of caesarean and the decision about how to give birth to their next child. Listening to the views of women who have had first-hand experience of birth after caesarean can provide an additional source of comfort and reflection to other women facing similar circumstances and decisions. We asked the women who took part in this study what advice they would give to other women who had a previous caesarean and were pregnant with their next child. The comments they made naturally reflected their own birth preferences and experiences.

 

She would advise women to consider all available information and not be afraid to ask for a...

She would advise women to consider all available information and not be afraid to ask for a...

Age at interview: 31
Sex: Female
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What would you say to another woman who has had a previous delivery by caesarean and was planning her next delivery? What advice would you give to her?

'I wouldn't give any specific advice. I mean, the only think I suppose is I'd say is, 'Just look at all the information that's available and just ultimately decide what's best for you.' I mean, the choice is there, and you know, whatever her personal circumstances are, you know, don't be' if she wants to have a section then, you know, then don't be frightened of saying it because the choice is there. But just to look at all the research, all the information that's there.

Many women stressed the importance of having detailed and balanced information about different ways of giving birth before making a decision. A few said they would encourage women to seek out information for themselves and ask as many questions as possible rather than just rely on the information volunteered by professionals. Several women who'd previously had an emergency caesarean emphasised that it was important to find out why the first caesarean had been necessary and understand what the chances were of similar complications happening again.

 

She thinks in reaching a decision it is important to understand why the previous caesarean was...

She thinks in reaching a decision it is important to understand why the previous caesarean was...

Age at interview: 41
Sex: Female
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If you were to give a message to other women facing this decision, what would you say to them? 

Well I think, understand what your complications were before, why you had to go to caesarean, and I think ultimately that will define as to whether you can try natural for your second birth.

While understanding the reasons behind previous complications was thought to be important, a couple of women pointed out that it could be unhelpful to dwell too much on what might have gone wrong during previous births. They advised women to put past experiences behind them and approach each birth afresh, without letting the decision-making process get in the way of enjoying their current pregnancy.

 

After worrying a lot about the birth of her first child, she made a conscious effort not to get...

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After worrying a lot about the birth of her first child, she made a conscious effort not to get...

Age at interview: 31
Sex: Female
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What would you say to another woman who's had a section and who's planning a delivery, what kind of advice would you give to her?

Well, it depends on how she felt about, going for another section or, or trying for, if she was scared about how' trying for a natural birth. You know, I would say don't, don't worry about it, you know, just, you can only go with the flow, I mean, nature will take it's course anyway. I mean, you'll have what you'll have, what's meant to be, meant to be sort of thing. 

It is worrying but there's no' that's it, it's coming out whether you like it or not [laughs]. One way or the other.

And has anything kind of stopped you feeling that scared? What's been the best thing'?

'I just took it' I just took it into my own head to have a laid back approach to it and not worry so much because I worried so much with the first, with [Son] I was determined not to get myself in such a state like I did with him. It's not worth it because you just, your nine months seem like nine years, you know, so, just a case of, just chill out a bit' [slight laugh], yeah.
 

A couple of women said they didn't receive as much antenatal care during their second pregnancy as they did during their previous pregnancy, so there were fewer opportunities for discussion and advice. They advised other women to be aware that they might need to seek out information for their specific situation from elsewhere. 

Several women felt very strongly that the decision of how to give birth after a caesarean was a very personal choice that each woman had to make individually. They acknowledged that considering the possible risks and complications of different birth methods was important but felt that ultimately any decision was likely to be driven by each woman's personal values and unique previous experience. As one woman put it, 'only you know what's right for you'.

 

She thinks it is important to seek information and advice from health professionals, but in the...

She thinks it is important to seek information and advice from health professionals, but in the...

Age at interview: 38
Sex: Female
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So if you were to give a message to other women who were making this decision about their second delivery, what would you say to other women?

To get, to gather all the information they can and then make the decision on their own, because it's, it's their body [laughs] and it's their baby. 

Obviously, it helps to have the backing of your partner, but I think the final decision rests with the... with the mother, definitely. 

You can get advice, I think from, from your partner and your midwife and your consultant, but I think at the end of the day you really have to just sit down, think about it and make that decision on your own.
 

Several women said it was important to allow yourself time and not be rushed into a decision by those around you. A few women who had felt under pressure from doctors or midwives to go down a particular route cautioned other women not to be swayed by health professionals' own agendas. A couple of women felt that the judgmental attitudes of some health professionals were likely to contribute to feelings of guilt and failure among women who were unable to deliver vaginally. 

 

She would advise women not to rush into a decision but to take their time and talk to others...

She would advise women not to rush into a decision but to take their time and talk to others...

Age at interview: 22
Sex: Female
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If you could give a message to other women who are facing the decision about what to do in their second delivery, what would you say to other women? 

Just not to make the decision straight away, to do all the research, talk to people or look at something like this on your website, really have a look around and find out what other people's experiences is, and what's happened to them. And then make your decision. You know, you've got a nine month's pregnancy, so you don't have to decide straight away. I do think you've got a nice bit of leeway, but you should do it as the end is nearing, so that you're prepared.

 

Based on her own experience, she thinks women who want a planned caesarean need to state this...

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Based on her own experience, she thinks women who want a planned caesarean need to state this...

Age at interview: 31
Sex: Female
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I would say just really try to be open-minded, as open-minded as you can and try not to be influenced by the medical profession if you have a strong feeling or a strong view that you want to go for a trial of labour then make sure that, you know, your opinion is heard, you know, your feelings are heard, and make sure that you express them. Or if you want, you know, if you want to have a section, make sure that you make that absolutely crystal clear as well because I think if you don't make that crystal clear, the opinion is, 'This lady will go for a trial of labour unless she says otherwise'.

Women who had opted to have a planned caesarean said that women should not be afraid to make their views known and ask for a c-section if that was what they wanted. One woman who had a very positive experience of planned caesarean wanted others to know that it could be 'just as fantastic and empowering an experience' as vaginal birth.

 

She would like other women to know that a planned caesarean can be a wonderful experience rather...

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She would like other women to know that a planned caesarean can be a wonderful experience rather...

Age at interview: 37
Sex: Female
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Is there anything about the delivery that you would have liked to have known now with hindsight?

Well, I suppose only the fact that it can be really calm and wonderful and, I said to my midwife, I gave her a copy of the photograph that, of [baby's name] when she was born, because it just looks like it was a natural birth. And I said to her, 'You should show that to people and say, 'That was a section delivery.' Because I think women associate fear to it, I mean, when you go for your hospital visit they don't even show you the theatre. And I think actually, 'Well, you should be showing it", because you do need to be prepared about what might happen. And not to frighten women but to actually say that, "It can be wonderful". That's one thing I felt about it all.
 

However, others stressed that vaginal birth after caesarean could be a realistic alternative for many women and they should not assume repeat caesarean was the only option. Several women who'd had a successful vaginal birth after caesarean described it as 'an amazing experience' and thought women who opted for a repeat caesarean were 'missing out'. They thought health professionals should take a more positive and encouraging approach towards VBAC and that women facing the decision might benefit from meeting others who had been through VBAC. A couple of women said that there was nothing to be lost and everything to be gained as women who attempt VBAC could still ask for a caesarean at a later stage if things did not go to plan. However, others were put off the idea of attempting vaginal birth precisely because they wanted to avoid having a second emergency caesarean and therefore considered a planned caesarean as the safer option. 

 

She thinks women need to allow themselves time to consider all options rather than just have...

She thinks women need to allow themselves time to consider all options rather than just have...

Age at interview: 19
Sex: Female
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If you were to give a message to other women now who are making this decision, what do you think you would tell them? 

Just that everybody's different and depending on your personal circumstances and why you've had a previous section and why? Things like that. Don't just look and say, 'Right, I'm going to have another [section]'. Just take time and just let yourself sort of look into things and get as much information as you can, because it does help a lot. Well, it helped me.

 

Unless the chances are stacked against them, she would advise women to attempt VBAC, because it...

Unless the chances are stacked against them, she would advise women to attempt VBAC, because it...

Age at interview: 26
Sex: Female
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I'd probably say if you've had a section before and the chances are okay for you to have a natural, I would definitely go for the natural.

Personally, I, you know, I know I keep saying it but it's the sense of achievement afterwards, and you know, you do feel proud that you've done it, it's like, 'Yes, I have done it, like I can do it' You know, there's no shame in actually having' I'm not saying you have to have it all with no pain relief or anything like that, but I think it's the sense of, you know, the fact that they've actually come out the way that God intended, you know. I think it does, you know, it does sort of, you know, it does sort of make you feel proud and everything, you know.

A couple of women felt that, nowadays, childbirth has become 'too medical'. They thought that the clinical nature of the hospital environment, close monitoring during labour and the early use of interventions such as epidurals and induction interfered with the natural birthing process. They felt that once a woman has started on the route of medical intervention, it might be difficult to step back. Their advice to other women - medical circumstances allowing - was to approach birth more confidently and trust in their body's natural ability to deliver the baby in its own time rather than according to a hospital schedule.

 

She would caution women that once they have had an intervention, others are likely to follow and...

She would caution women that once they have had an intervention, others are likely to follow and...

Age at interview: 30
Sex: Female
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I think it's lovely to have a choice. But you've got to actually be able to back that up and provide a choice. When I went in with my first baby, I was thinking that I'd have a midwife with me the whole time. That I'd be able to make a decision about whether I wanted this form of pain relief or that form of pain relief, in a normal rational way. But when you're halfway through having a baby, you can't think in a normal rational way and quite often, even if you can think straight, you may not have the opportunity to do so. Once you start having any type of intervention during the delivery, you are then on a conveyor belt and one intervention then leads onto the next to the next to the next, so if you start with a' if you have an epidural, that then slows you down, so then you have another drug to speed you up again, and by then of course you're lying flat on the back so you can't move around. Once you have something, be prepared to go all the way and have all the different interventions and once you're on that conveyor belt, you can't say no, the choice is pretty much out of your hands.
 
 

She thinks birth is a very natural thing and medical interventions are likely to hinder rather...

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She thinks birth is a very natural thing and medical interventions are likely to hinder rather...

Age at interview: 37
Sex: Female
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I would just urge anyone to, to think twice about having to have medical intervention because birthing is a very natural thing. My daughter was eight pound seven, and a big baby, and I did rip. But eh' I did it naturally and I think you can put your mind to anything and you can do it. And I think, another reason why I knew that I could do it was that I'm a nurse and I have seen all the kind of people that will, will recover from surgery adequately because they've got it in their mind, they know that they're going to do it, and positive thinking is definitely the way. 

Some women found it easier than others to generalise from their own experiences to those of other women in similar circumstances. A couple of women hesitated to advise other women as they felt each woman's personal circumstances were different and therefore giving specific advice was best left to medical experts. However, most women agreed that, when it comes to giving birth, there is only so much you can plan for in advance. And regardless of whether they favoured vaginal birth or planned caesarean, they felt that women might need to remind themselves sometimes that how you give birth does not define who you are as a person.

 

She thinks it is good to have a plan but remain flexible at the same time. Experiencing vaginal...

She thinks it is good to have a plan but remain flexible at the same time. Experiencing vaginal...

Age at interview: 32
Sex: Female
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And if you were to give a message to other women that were making the decision about how to deliver the second time, what message would you send to other women? 

Yeah, get as much information as possible, and definitely have a plan, but then, like you always have to be with this business, you know, you have to be really open minded to it'you know, and you really do. You can't like have your heart set on, 'I really want to experience a natural birth' and to be honest, I'd say it's not the be all and end all. I don't really feel that I'm a better person, you know, and I don't feel, you know, that she's a better baby or anything because I had a natural birth.

Last reviewed August 2018.

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