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Making decisions about birth after caesarean

Reasons for wanting vaginal birth after caesarean

Women who have had a previous caesarean are likely to think particularly carefully about how they want their next child to be born. They can try a vaginal birth after caesarean (VBAC) or have a repeat caesarean that is planned (sometimes also referred to as an 'elective caesarean'). Not all women will be able to choose between these two ways of giving birth after caesarean - some might have to have another caesarean due to medical reasons. Nonetheless, most women have clear ideas about which way of giving birth they would prefer. We asked women about the main reasons why they wanted to have a VBAC. 

Women's preferences were influenced by a wide range of factors. These included their previous experience of caesarean birth, considerations about having further children, their current family situation and the availability of support, as well as 'gut feelings' and more general ideas on what childbirth ought to be about. Of course, all women wanted to give birth in a way that would be safe for themselves and their baby. Many looked to medical professionals to help them decide which option would be best for them (also see 'Women's experiences of making the decision') 

Many women mentioned a quicker and easier recovery as the main reason why they wanted to attempt vaginal delivery. All the women we spoke to had at least one child to care for already. For many women, having to look after a toddler meant they wanted to avoid an operation that might leave them unable to lift, bend or drive a car for several weeks. A couple of women who had felt very ill after their previous caesarean were particularly keen not to repeat the experience. But a couple of women who had made a very good recovery from their caesarean also felt they might not be so lucky second time round.

 

She had felt very ill after her previous caesarean and wanted to avoid another lengthy recovery...

She had felt very ill after her previous caesarean and wanted to avoid another lengthy recovery...

Age at interview: 22
Sex: Female
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What do you think is the one overriding factor that made you want to have a natural delivery? 

Mainly because I found that all the aftercare of a caesarean, which was very hard. I needed a lot of family support and I sort of felt like' they were helping me because I didn't know what to do, although it wasn't really, they were helping me because' I wasn't very well, you know, I wasn't a hundred percent so that was the main thing really.

 

Her reasons for wanting a vaginal birth after caesarean were mainly practical - a quicker...

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Her reasons for wanting a vaginal birth after caesarean were mainly practical - a quicker...

Age at interview: 33
Sex: Female
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And how do you want to deliver this time?

Oh, I'll go for a trial of labour this time, I think. 

And could you say why?

I, purely because of the fact that if you have a section, you can't drive for four to six weeks, it takes ages to recover, it's hard to bend and I've got two four year old children at- at the minute, so if I could avoid it, I would avoid it.
 

A few women were concerned that their children were too young to understand why their mum might have to stay in hospital for a longer period or might not be able to pick them up and give them a cuddle after having another caesarean. 

 

She thought having a caesarean would make things difficult for her two-year-old. He would not...

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She thought having a caesarean would make things difficult for her two-year-old. He would not...

Age at interview: 32
Sex: Female
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You don't want to be labelled because you've had a Caesarean you know that you'll want another one, and it's also quite annoying when people think that it's the easy option [laughing] because it's not.

Yes, you put them right? 

Yes, and especially with the second pregnancy because, to be honest, if I have to have one I have to have one and that's fine and I'll have to deal with it, but it's going to be really difficult with a two-year-old because I couldn't' it's difficult to remember actually, you know, something to remind me of how much I' what I couldn't do. I mean, I couldn't hardly get into bed or anything because I couldn't get the angle, yeah, so it will be very difficult. And he'll be' I don't want me not, me not to be touching him or to be worried, you know, I'd like to be able to hug him and carry on because I've got worries about, you know, the sibling rivalry thing. So I'm sort of like, you know, be careful with me, you know. I don't want to sort of make him think that he's done something. It'll just be generally more complicated.
 

Women's preferences were also influenced by how confident they felt that they would have a vaginal birth this time. One woman who had laboured to eight centimetres dilation with relative ease on her first birth didn't feel frightened to go through labour again. A couple of women who'd considered a repeat caesarean earlier on in their current pregnancy changed their minds towards VBAC after medical professionals had encouraged them that there was no reason why they shouldn't be able to delivery vaginally. As one woman summed up her reasoning, 'if there is no reason not to, then why not try it?'

 

She had considered a caesarean but changed her mind when doctors encouraged her that there was no...

She had considered a caesarean but changed her mind when doctors encouraged her that there was no...

Age at interview: 41
Sex: Female
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I had my mind made up for some time and then I' at one point I had decided I would quite like a Caesarean because at least we can plan, can sort [son] out with childcare. And I had it in my mind that the hernia must have caused me complications before so therefore I'm going to have to go Caesarean, and the baby was also breech. But it's now turned and I've been advised that the hernia didn't cause the complications last time so I'd quite like to try for the natural just for the fact that you can be more mobile afterwards. 

Because I got to eight centimetres last time fairly comfortably, and apparently it's quite a common thing for your first labour for your cervix not to move completely, but eight centimetres is quite a good result to get to, and the fact that I can be more mobile afterwards so that's why I've chosen to sort of go that way now. But sort of still been quite open-minded, if I have to be Caesarean at the end of it, then that's fine. 

A couple of women were concerned about whether having a repeat caesarean would affect future pregnancies. They thought that medical professionals would not allow them to attempt vaginal birth after having had two caesareans, and that this would limit the number of further children they could have. They saw attempting a VBAC as a way of keeping their options open. 

While some women mentioned very practical reasons why they would prefer a VBAC, others had much more personal and emotional motivations. A few women who'd been very disappointed with their first birthing experience looked towards their next birth as a chance for 'putting things right'. They wanted to experience the 'sense of achievement' that they had heard other mothers talk about but that they themselves had felt 'robbed of' with their previous birth. 

 

Her main concern in making the decision for a VBAC was to recover as quickly as possible rather...

Her main concern in making the decision for a VBAC was to recover as quickly as possible rather...

Age at interview: 41
Sex: Female
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I think I was always sort of a bit afraid of like the pain that people sort of tell you about, but I think as I said before, I've got quite a high pain threshold, what did I have? In fact, I just had gas and air, that's all I had but' but I didn't have any sort of' some people I think have a, a great urge that they want to do natural and I, I didn't have that great urge, that I was desperate to do it natural. I think the, the main reason I wanted to try natural was, as I say for the recovery rate afterwards.

 

She wanted to be more in control than she had been with her previous birth and prove to herself...

She wanted to be more in control than she had been with her previous birth and prove to herself...

Age at interview: 30
Sex: Female
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Well, because of the complications I'd had delivering [daughter] I really wanted another go at doing it as I see properly, and I know there's no proper or not proper way, but I wanted to do it and just prove to myself I suppose that I could just deliver vaginally and that it would all be wonderful and that I'd have a lot more control and would stand up for my own choices and decisions rather than just being part of a process, almost being a slab of meat there that they're doing the doctoring to and ensuring I delivered healthily but' I just wanted to be more in control this time round and do it myself.

A few women who had a positive previous experience of caesarean were still very curious and excited to experience 'the natural way' of giving birth. A couple of women who did not have much previous experience of labour and contractions felt slightly nervous. At the same time though, they liked the idea of getting first-hand experience of labour instead of just hearing their friends talk about it without being able to join in. They were looking forward to taking part more knowledgeably in conversations with other mothers when talking about childbirth. A couple of women who had missed out on immediate contact with their baby after their previous birth hoped that giving birth vaginally would make bonding with their new baby more instinctive and immediate. One woman said being more mature than when she had her first child and being in a steady relationship with a supportive partner meant she felt confident to embrace vaginal birth as a 'one in a lifetime experience'. 

 

She knew that her chances of having a repeat caesarean were higher than those of other mothers,...

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She knew that her chances of having a repeat caesarean were higher than those of other mothers,...

Age at interview: 32
Sex: Female
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What's your preference now for wanting to deliver this time, if you could tell me a bit more about that? 

Naturally if I can. I'd like to have a go at it I think, I think that's' you know, I'd like to see what it feels like and I'm quite determined, you know, to do it I think [slight laugh] if I can. But I know that the likelihood of me having a Caesarean is obviously higher than someone that hasn't got a scar.

And why is it important for you to have a go naturally do you think?

'because that's they way they're supposed to come out I think and I kind of just want to know that I can do it, you know' I think when you, you know, when you're a mum and people, or you talk to someone that's pregnant and they're talking about birth, and it's funny that I don't know what it feels like even though I've got a son. So I know everything else but I don't know that.
 
 

She always wanted to experience vaginal birth for herself. The support of her partner made her...

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She always wanted to experience vaginal birth for herself. The support of her partner made her...

Age at interview: 33
Sex: Female
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I mean, I simply just, have always wanted to experience natural birth. I've heard friends and, the majority of it has been friends talk about it and, you know, seeing it on some of these programmes, just to experience it once, because it would be a maybe once in a lifetime experience, you know, because I sometimes think, 'After this one, no more', and my partner, [partner's name] is like, 'Well, if it was a girl, I think it would be nice to try for a boy', and I'm like 'No', because I had a feeling that it was a boy.

And what's the main thing that's informed your choice about wanting to have natural?

I think just getting more confident in myself and being with a partner that I can put my confidence in as well, and faith and trust and we've got this bond that I know he'll be there and, you know, do what he can do in terms of being a supportive partner. There's no sort of doubt in the back of my mind that he's not going to turn up, or he's not going to get involved. He, he's this person who's going to be all hands on deck, you know.

Alongside various practical and personal reasons for wanting a vaginal birth, a few women also had a strong sense that vaginal delivery was the 'natural' and 'proper' way to give birth. They expressed this by saying things like 'the way your body is designed to do it' or 'the way that God intended it'. They felt that opting for a planned caesarean in the absence of medical necessity was the wrong thing to do. One woman had considered a caesarean for the convenience of giving birth in time to attend her sister's wedding, but abandoned the idea because she felt it was not right.

 

She felt that having a caesarean without medical necessity was wrong, though it would have suited...

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She felt that having a caesarean without medical necessity was wrong, though it would have suited...

Age at interview: 31
Sex: Female
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I think my' sort of my ideal scenario is to' would be to have a natural birth, you know, this time. I, I really didn't want, and I don't want an elective section. I mean, I kind of feel that if, if the same thing happens again, then that's just it, maybe it's just, you know, something to do with, with the way that I'm built or something, but, I, I didn't feel that I wanted to actually arrange to have a, a section. My sister's getting married' the baby's due on [date] and my sister's getting married on [later date] and I'm technically supposed to be a bridesmaid and there was a bit of pressure initially to have an elective section, particularly when I found out that they tend to do them slightly earlier, so, you know, it might be the week before the sixteenth, but I just felt that that was just a really morally suspect reason for doing it, you know, it was very much a bit like being too posh to push, kind of thing.

And it's an odd idea, but why, it seems an odd question, but why do you want a natural delivery this time?

I think initially it was because I had... I was under the impression that if I had section this' if I had another section then that would rule out having any kind of natural delivery and I just didn't like the idea of removing that element of choice. 
 
 

Last reviewed August 2018.

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