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Making decisions about birth after caesarean

Views on information from other sources

Women who become pregnant again after a previous caesarean have specific information needs. How much information women feel they need is a matter of personal preference, but usually they want to find out how having had a caesarean previously might affect their next pregnancy and birth. (See 'Information needs and attitudes in next pregnancy' and 'Views on information from health professionals')

The women we talked to in this study took part in a clinical trial that tested two computer-based decision aids (see 'About the interviews and the DiAMOND trial'). Both decision aids provided detailed information about a broad range of complications associated with different ways of giving birth after caesarean. All but two of the women used one version of the decision aid or the other. We asked women whether they had used any other sources of information beside the decision aids and information they had received from health professionals.

Some women had gone back to the books they had bought for their previous pregnancy, but typically they had found very little information about birth after caesarean. One woman ordered a book specifically on caesarean, but still found that it could not give her the answers she wanted about her personal chances of having a vaginal birth.

 

A book on caesarean helped her to understand better what went on during her last birth, but it...

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A book on caesarean helped her to understand better what went on during her last birth, but it...

Age at interview: 32
Sex: Female
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'is there any other sources of information that you've looked at or you've contacted?

I mean, I ordered the Caesarean birth book, I can't remember exactly what the title is, from the NCT. Because it's actually quite difficult to find' specific books on things like that and it mentioned there is a website about Caesarean births, I can't remember what the address is, but on' the writers of that book have got this website. So yeah, I did that fairly early on and that obviously talks through about a Caesarean and things. But again it wasn't specific to me so I didn't' it doesn't mention my condition. It mentions if babies are in distress, which is really what [Son] was, but, you know, there could be lots of different reasons for that.

Sorry, I'm just scribbling.

It's alright.

And was that useful information?

Yeah I think so. I mean, just to sort of remind myself, because I didn't have that information before I had the other operation or afterwards really. So it was sort of almost good to read what did happen last time and then sort of, you know' I think that's more what it was, about what happened to me last time and trying to find out if it's likely to happen again. But you can't find that out from books.
 

A few women said they enjoyed watching television programmes about women giving birth in different ways. A couple of women who wanted a VBAC said seeing other women doing it on TV had given them confidence that it could was an achievable goal. However, while some thought that TV programmes were a good way to learn about what can happen during a birth they also said it could be difficult to make comparisons to your own situation.

 

She thinks TV programmes will often give you a more personal perspective but might not be as...

She thinks TV programmes will often give you a more personal perspective but might not be as...

Age at interview: 26
Sex: Female
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I mean, in view of the fact that you'd looked at books and you'd been on the internet and tele, is there anything that was different about the information that you got from there at all? 

[Hesitation] Well no, I don't suppose so but, I mean, obviously if you're watching it on the tele you've basically got a woman that's going through birth and it's like her experience and that sort of thing. Whereas obviously with the information on the computer and that it was' It was basically this is this and this is what happens and that's what could happen. Whereas obviously, like I said with the TV, it was her experience, so I think in that regard if you've' I don't know, I suppose in some ways it's a bit easier if' you're just, you know, you're just told well this could happen, that could happen. But, I mean, you know, like with the woman on the TV it's more like this is what's happening to her so obviously they focus on that, but obviously if that's not, if that's not what you're after information wise then obviously it's just, you know '

 

She read pregnancy magazines to help her make up her mind about how to give birth.

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She read pregnancy magazines to help her make up her mind about how to give birth.

Age at interview: 22
Sex: Female
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So what that's saying is, other than the midwife and the doctor, have you got any information from anywhere else, like magazines, or the internet, or friends? 

Yeah, I've had my head in magazines all through pregnancy, actually. Although, I know everything, I'm sort of waiting' I read stories about, you know, there's normal birth after caesareans and things. So that's about the only other information I've had really.

And what sort of magazines, are these women's magazines, or pregnancy magazines?

Pregnancy magazines, yeah.
 

Many women browsed the internet to find out factual information about different birthing methods. Some women who had a strong birth preference from early on in their pregnancy said they had looked up information before appointments with midwives or consultant to be better prepared in case their preference would be challenged in discussion.

 

She had decided early on that she wanted to attempt vaginal delivery and looked at various...

She had decided early on that she wanted to attempt vaginal delivery and looked at various...

Age at interview: 30
Sex: Female
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So I did do a little bit of digging around and read up on vaginal birth after C-sections and tried to scare my midwife by saying I wanted a home birth and she just laughed at me, because it was the same midwife as last time. But yeah, I did read up on it in a lot more detail just to find out would I have to have a C-section as a matter of course or would I have to' would I have any options or choices.

And can you remember the kind of sites that you looked at then?

Started off with just the, the sort of Mum's Net chat sites and then followed various links, and the one that I ended up on when I was really wanting to find out about a VBAC was the NICE, National Institute for Clinical Excellence, that one, and I printed off a whole chunk of paperwork to read, everything. So I thought, 'Right, I'm going to know everything that they know now, I'm going to do as much as I can to find out.' [Laughs].

A few women said they had gained helpful emotional support from learning about other women's personal experiences through websites or chat-rooms. Others were more critical of these informal sources of information.

 

She looked up information from official medical and scientific websites, but did not trust...

She looked up information from official medical and scientific websites, but did not trust...

Age at interview: 42
Sex: Female
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What I do... I do use the internet a heck of a lot, so... But I mean, I go... again, I use sites like Royal College of Obstetricians, Royal College of Paediatricians. I don't use the' and read papers and things like that, I find that interesting.

So not women's mags and things like that?

No. No, I don't buy those [laughs]. 

You want it from the horse's mouth?

Yeah, no, I go to the proper websites, because the other thing I do know from the internet is that there's this... there's this one called "babycentre" which has a chat room on it. And a lot of what's on there is rubbish, that the women are chatting, they really don't know what they're talking about, so you have to be careful. But the Royal College of Obstetricians actually for this birth has lots of papers online you can just read, which is interesting.

And how did you find reading them?

Interesting, I find it really interesting.

I was wondering, were you scared at all?

No

Especially after what you've been through the first time.

It's funny, isn't it, because like, when I'm, yeah, I know, because even though it was horrific I can still read them dispassionately. I did a science degree myself so, I think I can - I'm quite a scientist so I quite enjoy it really, yeah [laughs].

 

She made friends with other women who were keen to attempt vaginal birth through an internet...

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She made friends with other women who were keen to attempt vaginal birth through an internet...

Age at interview: 33
Sex: Female
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And what other information sources have you used this time?

Erm, again, watching programmes on the tele [laughs]. I'm a bit addicted to like the baby channel [laughing].

Do you find them scary at all though?

I do, some of them are a bit scary, but it's really nice when a woman's had a previous section and she then goes on and has a natural delivery because it really makes you think, 'Well I can do this, if she can do it I can do it,' you know, 'I can do that as well.' I've discussed, I've' I gone on the internet, I've been on to a website on the internet and I've made friends on there and I've discussed it with them as well. 

Do you think it's a common dilemma for women then, being in your situation?

I would say so, yeah, yeah.

And is that the kind of thing that you've been getting from the other women you talk to?

Yeah, yeah.

They've had sections and they're making decisions?

Yeah, yeah, mm.

I've not seen them, so what kind of things do they say?

Erm, well they're basically in the same situation as me where, you know, they want to have a natural delivery but they don't really know throughout the whole of their pregnancy how it's going to end up, so they feel like everything's up in the air because you don't know what sort of delivery you're going to have. Even if you want a natural birth and it's actually planned to have a natural birth, you don't know really if that's going to happen, because obviously with a previous section, you know, you really are closely monitored and you can get told at any point, 'No, I'm sorry, but you've got to have a section now,' so'
 

Several women said it was difficult to know which sources of web-based information could be trusted. A few women had dealt with this challenge by restricting their internet searching to the websites of reputable medical organisations. Information from such websites was thought to be more balanced and trustworthy than information provided by commercial baby websites. However, one woman said it could be difficult to make sense of information on there. Other women preferred the commercial websites, because they had more material on women's own experiences.

 

She has used websites where women share their experiences but also sites designed for health...

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She has used websites where women share their experiences but also sites designed for health...

Age at interview: 38
Sex: Female
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I mean it's a horrible thing the internet, but I would always go on that if I felt that it was necessary.

Is there anywhere in particular that you look when you go on the internet?

I try and go on the ones that are aimed at doctors rather than' which is stupid because then you don't understand it but just to try and get the facts that the doctors are getting rather than what they want people to know. But a mix of both really.

Did you find them scary at all?

Sometimes.

But generally you feel like you're more informed having looked at them?

Yeah.

And where have you got the most information from with this pregnancy do you think?

It's hard to say really because I think when you get to your third pregnancy I think there's a bit of' well it's a true assumption that you know quite a lot of things anyway, or you should know by then. So I don't think there's the same level of discussion, obviously I didn't go to any antenatal classes apart from the first time. What I've always done is you go on these baby world sites and ones where they've got you know people putting messages of their own experiences. So I've sort of gone onto those a bit.

Has that been useful?

It's quite comforting.
 

A couple of women thought it was better to rely on information from health professionals than try and find out things for yourself. (See 'Information needs & attitudes in next pregnancy' and 'Views on information from health professionals'.)

Some women found it very helpful to talk to other women who had had the experience of another birth after caesarean. However, not all women knew others with similar experiences. One young woman said she was the only one among her friends who had had a caesarean. Women who wanted to attempt vaginal birth after caesarean (VBAC) thought it would be useful to hear from others who had been through it. A few women also said they would trust other women more than they would trust information from health professionals.

 

She thinks women are more likely to trust the advice of other women who have had a caesarean than...

She thinks women are more likely to trust the advice of other women who have had a caesarean than...

Age at interview: 19
Sex: Female
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I would probably say like this research, like asking people, instead of just going by what doctors say and things like that, I think people who have been through it their self, I think they're probably the best sort of' because everyone's different and everyone has different sort of experiences with things, and I think that's the only way they're going to sort of give' I think women would probably listen more to people who've been through it themselves than doctors who just' I know they're medical people, but I think it's more important to listen to people, I'd probably has listened, obviously with your study as well it was more sort of about women who've had things, so I think that's why I listened to it more myself.

 

She thinks women who had a VBAC are the best source of information for pregnant women who want to...

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She thinks women who had a VBAC are the best source of information for pregnant women who want to...

Age at interview: 37
Sex: Female
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I personally think, I mean, this is talking about other women that have done it, actually normal birth stories are definitely' I think you, you believe that more so than you believe medics and midwives. You believe women that have done it. I really do think. So summaries of birthing experiences may be' you know, people like me that have delivered would be a really supportive thing.  Information, the fact that it's a natural thing, maybe not so medicalised, so look, if you' mind over matter, even hypnotherapy, and God forbid, I never thought I'd ever think about that, but you know, that kind of thing.

How did you get into going down that road?

I go to yoga classes, and there was a lady there, a lady who recommended it and said that she had a beautiful birthing experience. And I was just hanging on straws and really, you know, despite being really strong to everyone, I actually, beneath, behind everything I was kind of slightly concerned that it wasn't going to happen. So I was grasping at straws and doing anything, so, it was a recommendation from another woman, and it worked. And because the end few weeks of my pregnancy, I was under quite a lot of stress over the fact that people were saying to me, 'Come into hospital', and, you know, 'You are at risk of' oh gosh, exploding, that's a good way of describing it, but yeah, rupturing, it's almost like that, 'You're going to die, your child's going to die, come into hospital', so I needed something psychologically to get me through that and I listened to these tapes and it just said, 'You're going to do it, you can do it', and that's what I needed. And I think in business, they work, they work a positive thought is definitely the way forward. 

So' yeah, positive thought.

However, others thought it was best not to be too influenced by the birth stories of other women because every pregnancy and birth is different. Some also thought women were more likely to share 'horror stories' than positive experiences. 

(For a selection of web-based resources for women who have had a previous caesarean, see the 'Resources' section).

Last reviewed August 2018.

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