Making decisions about birth after caesarean
Comparing birth experiences and recovery
In making the decision about how to give birth to their next child, women are influenced by their previous birth experiences and their expectations of what other ways of giving birth might be like (see 'Women's expectations for their next birth', 'Reasons for wanting a planned caesarean' and 'Reasons for wanting a vaginal birth after caesarean').
Many of the women who took part in this study agreed to be interviewed again 6 to 12 weeks after they had given birth to their next child. This allowed us to explore how women's views about different ways of giving birth might have been influenced by their next birth experience and how they felt about the decision they had made after actually going through vaginal birth after caesarean (VBAC), repeat planned caesarean, or, in the case of one woman, a second emergency caesarean. We asked women whether their next birth had matched their expectations, and how they thought their recent birth experience compared to the previous one. (See also 'Women's experiences of their next caesarean' and 'Women's experiences of vaginal birth after caesarean'.)
A few women who had experienced a sense of failure after their previous caesarean, felt very proud to have achieved vaginal birth and said the experience had made up for some of the things they had missed out on with their first birth. For some, it meant that the thought of further pregnancies no longer scared them, and a few said they definitely wanted to repeat what had been 'one of the most amazing experiences' of their lives.
Having had a vaginal birth has made her look at pain differently. But the sense of achievement...
Oh yeah' To be totally honest, I'm glad that I had a natural birth because, like I said before you, your body is built' to give birth naturally like that, so I think. I mean, it's almost like I've really achieved something. I know I sound a bit sad, but, yeah, I, I feel, I'm quite proud of myself in a way because, because I had no pain relief as well, well, technically' yeah, it does give me a sense of achievement. And I think having a natural birth made me look at pain in a different way as well [laughs] I can't moan, you know, you stub your toe and you think, 'Oh, that hurts' and it's like that's nothing! [laughing] I mean, I must admit as soon as I had her I did turn round to my partner and say, 'That's it, no more', and within five, ten minutes I'm like, 'Well, maybe' [laughs].
I'll come on to that later, but you said something really interesting in there about the sense of achievement. And did it make you think differently about the fact that you hadn't had a natural delivery the first time?
Yeah, yeah, it did.
Could you say how?
Well, I mean, obviously, I was all' with having my son first, and then being told to have a caesarean, yes, I was disappointed because I didn't get the experience of, you know, the natural birth, as it were. It wasn't to say that, you know, I'm not as close to my son as my daughter or anything like that, but I don't know, it's almost like I was cheated out of something. I mean, obviously I know that the caesarean was the best option that was, you know, for him, which is fine and I wouldn't change it because of that, but if I could have had a natural with him, I think I would have felt better' in a way. But you know, obviously that, that was by and by but, yeah, I don't know' even though how painful it was it's 'you do get this sense of achievement because you've done it and, you know. I mean, I can remember my mother-in-law talking to me last time and saying, 'Oh, well done', and it was like, I felt like, well, I did actually turn round and I said, 'Well, I didn't really do anything, I got cut open and he got pulled out', you know? It's like at least this time I could actually, if someone says, 'Well done', it's like 'Yes! I did do it', you know [laugh].
She had worried that she might get postnatal depression again, but her experience of VBAC was so...
Oh, excellent. I think a very big part for me is not having the baby blues, because you feel like you, you've done so well, you' I've had no depression with [baby son's name] at all, which I did with [first son's name], I've just had a great time with [baby son's name], just really enjoyed him, you know. And I didn't understand when mothers said to me the first time around, you know, the friends that I had when I had [first son's name], that, 'Oh, you're not over the moon', and that, and I, I was frightened to say, 'Well, no actually, I'm not'. But I know what they mean now, you know, when they say, 'Oh, I feel great about the birth' and that.
And how's your baby been since?
Oh, he's been great. He's been really good. He's a good feeder, a good sleeper. (to baby) excellent, ain't you?
And in any way can you attribute anything that you've felt or experienced since to the way that you delivered this time?
'No, not really, no. No.
I remember you saying the first time about the baby blues, that you weren't sure if it was because it was your first baby or if it was about the section. Have you been able to think more about that now that you've had a, a natural delivery?
I think it was more about the section, the fact' I just felt like I didn't achieve a natural birth when you' Especially with your first, you feel, you know' I had it in my head that no way would I have a section, sort of thing. It wouldn't happen to me and I was not prepared for it at all. And my head was sort of in the clouds thinking you know, 'I'm going to have a perfect birth' and' And you know, 'I'm going to breastfeed really well', and because it's your first, you don't know what you're getting into and then when you have then it's just like a' it's such a reality check as well, because you've never had to look after something, like a person, be responsible for somebody so much. You know and I think that's got a lot to do with it as well. But yeah, I would say definitely the section, the lack- the failure in breastfeeding as well, that really knocked me a bit.
And how would you compare the two experiences?
Oh, like night and day, like black and white, it's just totally different. I mean after I had [first son's name] I was, if you'd asked me would I have more children I would have went, 'No, definitely not', ninety-nine percent sure I wasn't going to have any more. And then when I met [husband's name], I mean, [baby son's name] was an accident, sort of thing, we hadn't planned sort of thing, but a very happy accident but now yeah, I would have more, no bother. No bother at all.
One woman thought being in better physical shape than with her previous birth had helped her labour and recovery. During her previous labour, she had tensed up a lot but this time she used breathing techniques which she thought made her cope much better with the pain of the contractions.
Not all women were as enthusiastic about their experience of vaginal birth. One woman, who had experienced painful contractions for more than 60 hours before giving birth to her baby thought her previous caesarean had been quicker and overall, possibly less painful.
Compared to her caesarean, vaginal birth felt lengthy and drawn-out. She had a lot more pain...
I think they're just so different, because the caesarean, with [son's name] it was an emergency C-section so I didn't, you know, I didn't know that I was going to have the baby that day, I didn't, I hadn't had any Braxton Hicks contractions, I hadn't felt any, I never felt contractions at all with him. And when I went in they said, 'Oh, you know, you're one to two centimetres dilated' and I hadn't felt anything, [laughs] So I was in very, very early labour and then yeah, as I say, I was, you know rushed in and had' that was it, you know it was done. So it was quick and' I didn't feel tired or, there wasn't any waiting. And I was surprised with that how quickly you do, you do get up and about. I mean, obviously yeah, you've got a scar and you've got to be careful but you know, considering that you've had a major operation and you've had, you know, you can't walk because you've got the spinal block and catheter and everything, you know, you're very quickly in the bath and walking around and stuff and encouraged to do that. So, although you've got to be careful because of the scar, it's not like you're in bed for a few weeks.
And this one, there was all the sort of trauma beforehand, the waiting and a lot of pain, because obviously with a caesarean as well, you've got the pain relief for the operation and afterwards they make sure you've got, you know, I was on painkillers for six weeks so I didn't actually feel any pain' when I came home. Because they're more aware that you might be in pain. So, you know, with this delivery there was a lot of pain before, apart from the, you know, the actual delivery and you sort of aren't offered much pain relief because you have had a natural delivery. And obviously I was in pain with the breastfeeding so I was on a lot of painkillers for that in the end, as well. But that's not, not to do with the actual delivery.
And in terms of the recovery, because you had such a long labour, that was the majority of a week, how long do you think it took you to feel your normal self again after?
Oh, quite quickly, although I mean, I was in hospital until the Sunday lunchtime and I wanted to come home then. Because I had thought that I'd want to spend sort of, you know, because you could obviously come out quickly if you had a natural birth sometimes, and it's all fine. But I thought, 'Oh, I'd like to spend a bit of time in hospital because I want to get to know [daughter's name], you know, and let [son's name] be at home and not have to worry about it so much, because he can't see it. And, but then I really wanted to get home [laughs]. So I was like, 'Oh no, I've got to wait 'til the Sunday, until they take the catheter out'.
A couple of women said they had felt self-conscious about losing control over their bodily functions during and after birth. One woman described the experience as 'pretty undignified'. However, these drawbacks were not enough to make them regret their decision to have a vaginal birth.
She felt slightly self-conscious during her vaginal birth and the pain was intense, but being...
And what about baby, how was he?
So have either of you had any problems that you think are due to the way that you delivered this time?
None at all.
So how did this compare with having had a section? I know it was a long time ago now.
It was more natural, the bonding was definitely a main factor, to bond at that moment they're able to put him on your chest.
Because your daughter went to SCBU after, didn't she?
She, yeah, I didn't see her until the next day because I'd had general anaesthetic with that. I think the bonding' to be able to appreciate how important it is, that first moment, their first breath even, that was, that was the difference to just go through it with no problems, to be in at two and he's out at half past five, because you know, you hear stories of, 'Oh, you know, we were in there and all night' and then the midwife had given us the option and saying, you know, 'Do you want to go home later on?' after the paediatrician had come round and done the checks, which was the case, and we did come home the same night. But it wasn't until like a few weeks afterwards, it was like an anti-climax and it's like, 'Wow', and then it's the emotions, tears and you know, the sort of 'Wow' because it happened so quick, you know, like with my daughter it was you know, a booked caesarean, you know, you've got the anxiety of a premature baby, incubators, the tubes, it's overwhelming in all aspects. But you know, I can remember just sat in the bath and [partner's name] was just holding him, he was wrapped in a blanket and everything, and I was just, just in a maze, just in a maze, think, 'No way he was in there so many hours ago and now he's here and he's fine', it's just, it's overwhelming.
So what was your experience like compared to your expectations of what a natural delivery would be like, because you obviously had some idea of what it would be like. Was it like that or was it different or'?
It's the pain threshold I think, you know, you hear people who have a bit of gas and air, some have epidural obviously, so they can't feel anything anyway, but the experience, I think with the pain threshold at one point I thought, 'I'm going to have to have an epidural, I c
Most women who experienced vaginal birth after caesarean said their recovery had been a lot quicker than after their caesarean. While most of them found going through labour very painful, they said the discomfort they had experienced after the birth was minor by comparison. They were pleased to be back on their feet again quickly because it meant they could look after their families as normal.
She felt uncomfortable after her VBAC, but it was minor compared to the pain she experienced...
And you hinted before we started recording about the fact that you could do more, because after a section, you're restricted, aren't you in terms of what you can do'?
Yeah, no, it was great to come home and actually see [son's name], my eldest and pick him up and hug him and that was brilliant, because I knew, obviously having a C-section, I wouldn't have been able to have done any of that, and he wouldn't have understood why he couldn't jump on mummy or why mummy couldn't pick him up. So that was brilliant, because I did go through the first week, of being quite upset that suddenly I couldn't spend so much time with [son's name] and I found that really difficult. So it would have been worse, even worse if I couldn't even have held him. No, it was great.
Her vaginal birth was painful, but she was back on her feet much more quickly and able to hold...
However, a few women said the recovery after their vaginal birth had not been as quick as they had expected. Several women had experienced a tear during delivery - either because the birth had been assisted by a suction cup (ventouse) or forceps, or because of the way the baby had come out - and needed stitches after the birth. Some said their tears had healed very quickly, but others were surprised by for how long they felt quite sore.
She found recovery after her forceps delivery more painful than after her caesarean. It took 10...
Well I think, I think because you, because you've had, because you've had a section and they send you home and they say don't do this and don't do that and, you know, and, and because you've got these, you know, these big stitches, well, these big staples and they give you nice strong painkillers to take the edge off it, I think you're perhaps, or other people as well are probably more aware [baby burping] of the fact that you've had quite a traumatic time, whereas a forceps delivery, I think... I mean [husband's name]'s mum had a forceps delivery and, and so I think probably people who've been through it perhaps know a bit more than, you know, but, but when they, I mean, when they send you home and just tell you to take paracetamol and, I mean, it was really, it took really about ten days before I could sit down without thinking about it, kind of thing [slight laugh]. And it really was a lot, a lot more uncomfortable, a lot more painful than I remember it being after [daughter's name] was born, which is, you know, which is an odd thing but, but, because you would think that sort of, the, you know, the kind of major surgery that a section is, you would think that would be worse, but it really wasn't.
One woman who had thought her difficulty in feeding her first child had been caused by her caesarean, was disappointed to experience the same problems with her second child after a vaginal birth. Nevertheless, she felt that VBAC had been a much better experience emotionally for her and her daughter.
Her recovery after VBAC was not as quick as she had expected and she had to revise her belief...
A few women said that vaginal birth had given them a more immediate bonding experience with their newborn.
She had worried about things going wrong during VBAC, but looking back she thinks bonding with...
Mainly' mainly the aftercare, but again, I had an emergency caesarean, I think they must be a big difference with having an emergency caesarean and a planned caesarean. Because obviously when it's an emergency, you're not prepared, you're not sure what's going on, especially if it's your first one. And you really do feel like you're sat on Casualty and you've got, you know, that anything could happen to you, you really feel like that, so' I don't know. Having a normal delivery, you do feel scared, because you're waiting, especially once you know the pros and cons, you're waiting for something to happen, and in your own mind, you're sure that something bad is going to happen. But I think that a lot of that is the gas and air, all the emotions, the pain that you're in. I think if you were thinking on it, on a clear head like I am now, then I'd definitely say it was a better option to have a natural delivery.
I remember when we met before, you said you felt like you'd been cheated?
Because you hadn't had the labour, do you feel, 'Right, I've done that', now?
Yeah, because I've been sat there with my friends now and we all have our little opinion on it and I have more of an opinion because I've got experience of both now. But I think you bond with the baby a lot better having a vaginal delivery.
Right. And could you explain why you think that is?
I think it's just that after, how you yourself feel after, because I mean, I love my first son to bits, you know, and I loved him the minute he was born, but because, when you have a caesarean, you're in so much pain, you feel like all your insides are going to fall out, it's really horrible. And you're like that for several - they say six weeks, but I think it's about ten weeks before you start feeling a bit more relaxed about the' you know, about your tummy area, but whereas on a natural delivery, like a vaginal delivery, I don't know, I just' although I had a few stitches, I wasn't bouncing around the hospital, but you know, it was a lot easier to get up and out of bed and attend to the baby myself, rather than waiting on other people to help. So I think you just automatically get into the swing of things and a routine better from having a natural delivery.
However, a couple of women who'd had a planned caesarean also said their bonding experience with their next child had been more immediate. They thought this was because they had felt much better in themselves this time round.
After her first caesarean she didn't feel like herself and found it harder to bond with her baby...
Brilliant, I feel differently actually than with' with [child's name] I felt, I just felt' after I felt ill and I felt like I'd failed. And I was quite, it got me quite down actually. But this time I was sort of' I couldn't believe how well I felt, I felt, like I felt too well, that I was going to' I was panicking that I was feeling too well really and that I was a lot more' I don't know, it just felt the way I would expect you to feel after you've had a baby, I felt this time. Unlike last time I didn't, I didn't feel' you're supposed to be happy when you've had a baby, but the first time I didn't. But this time I was just' it was really, really nice, it was a good experience.
And you said a little bit about the differences between having the emergency and the elective can you tell me a little bit more about how they're different?
I found that with the emergency you're' because you're so' I think if you're in labour anyway you're tired, you're just' I had pain relief before that as well so I felt a bit sick and I just didn't feel myself. And I feel because you don't get that choice, it's just, 'You've got to have it', and that's that, I just felt depressed I think about that. And I didn't feed, like after I had [child's name] I didn't breast feed, this time I did. Only for two weeks, but' and I felt that, because I had that choice to do that. With the emergency, because I felt so ill I didn't want to, I just, I felt like' I found it harder to bond with him I think more so.
Most women who chose to have a planned caesarean for their next birth had an emergency section previously. Some of them were quite frightened by their previous experience: they had witnessed their baby getting distressed, or things had happened very fast without giving them time to adjust. Some had also gone through a long and exhausting labour before having the operation. This time round, women said they had felt calmer, more refreshed and more mentally prepared for having a caesarean and this had made their experience much more positive.
Even though it wasn't what she had wanted, her planned caesarean was a much calmer experience...
The procedures themselves, I'm sure, are technically the same, however the experience of them - an emergency section, you've probably already been in labour for quite some time, so you're probably already in a lot of pain and you're probably already exhausted and the baby is often also showing signs of exhaustion or distress of some kind. So you're going into it in a tired and worried frame of mind and your body also is, is exhausted. You have less opportunity to prepare your own thoughts about the section because you weren't intending to have one and so you haven't asked any questions about how you'll cope afterwards, how the procedure itself takes place, what sort of anaesthetic's going to be used, how things are going to take place. So you're less mentally prepared, you're less physically prepared. So I think that actually also affects your recovery. Physically, you're exhausted beforehand and so it takes longer to recover because you, you've run a marathon and then had major surgery Rather then being rested up in bed and feeling quite calm and then having surgery. Emotionally, you don't have time to come to terms with it if you've having an emergency section because whilst it, the whole thing probably takes an hour to organise and, and get all the staff in place, but that however, isn't long enough for you to get your head round it, if you thought you were just going to go in and have a baby and go out again.
A couple of women who had wanted to attempt VBAC had a planned caesarean when they went several days overdue without going into labour. Even though it wasn't the birth they had wanted originally, they were pleased with their birth experience. One woman said that despite not being in control she had felt 'empowered' by the process.
The experience of planned caesarean was much better than she had expected. She felt calmer,...
Several women commented on the relaxed atmosphere in theatre during their operation. A few women described how staff had chatted to them throughout the operation and made jokes to put them at ease. For one woman, who had gone to a private consultant for her planned caesarean, knowing that she was in the hands of experts and was kept fully informed about her care made all the difference.
Her experience in private care was much better than her previous caesarean. Last time she had...
Yeah, well, a hundred percent better. It just went really well, no, no' it was actually nice, and then obviously the hospital was that bit nicer, so, it was a pleasant experience, yeah.
And how would you describe the first, in relation to that?
Well, I mean, obviously' I was out of control, because you know, as you know, nobody really told me what was going on. I had issues like the, you know, in my notes later, I saw the consultant had spoken to the nursing staff at one o'clock in the day about possibly doing a caesarean. But nobody spoke to me, and it wasn't until seven o'clock so I struggled for twenty-seven hours, felt out of control. Obviously I did things like vomit a lot and things like that because it was such a nightmare. So obviously I had a very unpleasant time for myself, plus this, this epidural situation and plus then having an emergency operation, it's just, it's just horrible, so you know, I had a very pleasant experience in, in comparison.
And this is, this is an odd-sounding question, but did having the elective caesarean meet your expectations of what you thought it was going to be like?
It was more pleasant. I kind of thought I'd be more scared and, and you know, that, I don't know, I just' I suppose I had such bad memories of birth, it was pleasant, people talking, you could talk and, have a bit of a laugh even, I'm not joking, so it was pleasant, yeah, I remember we talked about, you know, we had a few jokes about names and daughters and, and it was just very pleasant, so that's nice [smiles].
However, not all women experienced their second caesarean more positively than their first. One woman said the birth of her second child had felt like a 'job to be done'. She remembered her first emergency caesarean more positively, though she thought having been under the effects of gas and air might have affected how she felt. Another woman, who had booked a planned caesarean for 3 days before her due date went into labour early and had to be delivered by emergency caesarean instead. She didn't feel mentally ready for the baby and experienced much worse pain than she'd had with her first, planned, caesarean.
The pain she felt after her emergency caesarean was much worse than after her previous section....
That was my next question really, if you compared the two experiences'?
'yeah, it was worse this'
'and was that the biggest difference, the pain, for you?
The pain, the pain and I think that, the pain and probably because there was no risk to [daughter's name] as such when you know, when I had an elective section, the reason I had that was because she was breech, she wasn't in any distress or anything like that. This time around, you know, I'd gone into labour and, which was fine, but the fact that the waters were a funny colour and then, and then obviously his heartbeat was dropping I think with each contraction, so it was quite' even thought they said it was a semi-emergency section, not, because you have, they have to fill out a form, class what they rate it as and you have to sign a consent form, so it was classed as a semi-emergency section. It, by the time we'd got into surgery, sorry, into the operating theatre, and I was actually on the bed, they were sort of, you could see that there was a little bit of panic going on, and the whole experience to me was more frightening and a lot more painful than the first time around. Everyone was more relaxed the first time around.
This sounds an obvious question in view of what you've said, but in what ways was it different to what you expected it was going to be like, I mean, the whole thing was completely different to what you expected it to be?
I think probably the pain. I mean, obviously the first time around, I never had any pain with the epidural at all, no problems whatsoever, and that was absolutely horrendous, the pain of that, I can, I can still remember that now. The section itself, well, you know, once you're led down, it takes about five minutes for, five minutes I think for [baby's name] to be born and then it was longer to be stitched up, like I said. The, afterwards as well' I felt before, I was cared' before, the midwife stayed with me, went into the recovery room, she was' the midwife I had with [daughter's name] it was very, you know, she was there all my, you know, the whole time. Because this was a bank holiday weekend, and it was a Sunday, there was no continuity with the staff and I was put in a room afterwards that was made, as I say it was like a makeshift recovery room and the midwife that actually was there that had delivered, was there when [baby's name] was delivered, was sort of with me for half an hour, then went off for a coffee break, and then came back for half an hour and then finished her shift, and then someone else came in, who was only there half an hour to give me a wash, then someone else came in, then someone else. There was no continuity, where last time, I had' my midwife was there the whole time, right the way through until I actually went onto the ward, so I didn't have that this time round.
And how did that make you feel, having all these different people coming in?
Really unsettled actually, and really, almost like I was in the way and a real inconvenience because it happened over the bank holiday weekend.
Last reviewed August 2018.