A-Z

Making decisions about birth after caesarean

Women's experiences of vaginal birth after caesarean

After one caesarean section, about three out of four women with a straightforward pregnancy who go into labour naturally give birth vaginally*. Going through labour after a previous caesarean is regarded as slightly more risky because the contractions will put a certain amount of strain on the caesarean scar. For this reason, women who attempt VBAC are usually asked to come into hospital early on during their labour so that they can be monitored closely. The drugs that may be used to induce women who have had a previous caesarean are different from those that are typically used in a first pregnancy, and for some women, doctors might advise against induction altogether. They may also set a limit on the amount of time that a woman spends labouring to make sure that the strain on the caesarean scar does not get too much.

None of the women in this study who decided to attempt VBAC had previously experienced a vaginal birth. Some had gone through labour before their previous caesarean, but others had never experienced contractions and worried about how well they would cope. Most women who had decided to attempt VBAC said they saw it as 'the natural way' of giving birth and were hoping for a quicker recovery than they'd had after their caesarean. Some also saw it as an opportunity to take back control and experience the kind of birth that they had wanted for their first child. (See also 'Reasons for wanting vaginal birth after caesarean' and 'Women's expectations for their next birth'.)

 

Her experience of vaginal birth was perfect. She had an overwhelming sense of achievement.

Text only
Read below

Her experience of vaginal birth was perfect. She had an overwhelming sense of achievement.

Age at interview: 31
Sex: Female
HIDE TEXT
PRINT TRANSCRIPT
My delivery went really well. I was in for a very short period, for four hours I was in labour. 

I had started about three o'clock and gave birth at half past seven' and it all happened very quickly and ended up being just a perfect. 

I mean, absolutely perfect birth. Even the midwife said it was a perfect birth [slight laugh]. So, and I had no stitches, just had gas and air and he fed within five minutes of being born, he was right on the breast, it was great, absolutely perfect, again. An even more perfect birth, compared to my first, it was just, it was really good. 

And there's just overwhelming sense of achievement I had afterwards was just amazing. 

I think I was on cloud nine for about a fortnight [laughs]. You think you're the only woman who's given birth! [laughs]. 'Right up to the- the bit afterwards' you know where you go just to have an overnight stay, [yeah] and I was really grinning from ear to ear, just felt like, just felt elated, really good.
 

Women's experiences of going through vaginal birth were very varied. A few women gave birth unassisted and after relatively short periods of labour. One woman had just gas and air for pain relief and needed no stitches after the delivery. She described her experience as 'a perfect birth'. Another woman also got through her labour with just gas and air and delivered her baby within two hours. However, her placenta had become stuck to the caesarean scar so she had to have an epidural and go into theatre after the birth to have the placenta surgically removed. 

 

She had a lengthy and painful labour and was glad to have all the pain relief that was available....

She had a lengthy and painful labour and was glad to have all the pain relief that was available....

Age at interview: 37
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
I started labour at roughly three o'clock on the Thursday. 

I went in, straight into [Hospital], because I'd obviously had a C-section before, and I wasn't sure what stage of labour I was in. The contractions were about eight minutes apart and I thought that was quite close. Not terribly painful, but they were coming quite often. I went in, fully expecting to be sent home' but when I got in and they put me on the monitor, they were sort of about four, five minutes apart, and I think because I'd had a C-section before, they wanted to keep an eye on me. 

So then, I think it was probably about six, seven o'clock that I was admitted in and they were, the contractions were just getting stronger by now, and still about four minutes apart' and then I think at about ten o'clock, I had an internal, but I hadn't dilated at all, which was quite upsetting, because I'd been going since three o'clock and now it was ten o'clock and I was in quite a lot of pain at ten o'clock, so they advised me to have a pethidine injection because I probably wouldn't have had the energy to carry on. Because I hadn't even started to dilate, so in their words, 'Proper labour hadn't even started' [slight laugh], which was quite upsetting. 

But anyway, so I had the Pethidine, and that really helped, and glad I had that. I didn't want it to start with, but they did persuade me that it was the best thing. So, but I was glad because it gave me a chance to have a rest and the contractions didn't seem so bad then. And then, I think I was examined at about twelve, oh no, about two o'clock and I'd actually dilated to three centimetres by then, so that was excellent. They did send my husband home at midnight, which was a bit, again, upsetting, but I was' because I'd had the Pethidine, I wasn't really aware of what was going off, but I knew he was going home, but they called him as soon as I dilated to three centimetres. He came back about five o'clock in the morning. And then at three o'clock they wheeled me down to the delivery suite' and gave me gas and air, which was brilliant, I got on really well with that. 

'and then at about, I think seven o'clock in the morning, I actually ended up having an epidural. I think they thought I was getting a bit distressed and I think I was very tired, because obviously I'd been up all night' with the in labour and I had the epidural at seven and that was just fantastic, that just took all the pain away' and you know, I was really glad I had that because it gave, obviously then I slept for a couple of hours, which was, you know, what I needed to do. And the good thing with the epidural is that you could decide how much of the drug you had, they'd come back and say, 'Do you want a top-up', and I'd, you either say, 'Yes' or 'No', and I think I had less of a top-up towards the end, so I could feel the contractions more and so I knew when to push and, and that. And then I think by twelve o'clock, midday, I was fully dilated to ten centimetres and then you had to wait an hour, and then at one o'clock I was told I could start pushing, and she was born at eleven minutes past one, so it was sort of' it all seemed to go quite smoothly really. 

I think I had a text book' labour, as in I dilated every hour on the hour and it all went very well. [Daughter's name] heartbeat, heart rate raised towards the end and that's when they got a little bit concerned, and did the ventouse, which was again, because I'd had the epidural, was no problem, I didn't feel anything. And within minutes of them putting on the ventouse, she was born. I think they only needed to do sort of one attempt with it, and she was born, so, absolutely fine.

Thank yo

Other women's experiences of labour and birth were less straightforward and more painful. A few women had the birth of their baby assisted by a suction cup - also known as a ventouse - and one woman had a forceps delivery.

 

Her baby was positioned sideways and had to be delivered with the help of a suction cup. She was...

Her baby was positioned sideways and had to be delivered with the help of a suction cup. She was...

Age at interview: 22
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
Yeah, well, in the morning, I woke up at six o'clock in the morning with very mild tightenings, which I never had before, but I weren't sure if they were Braxton Hicks so I was timing them 'til ten o'clock in the morning and I thought, 'Oh, something might be happening now'. So I went to see my mum because I thought, 'I need to be around a woman who's been through it all', and she took me from a long walk to try and help it along if it, if it was the day. And it was. I went into hospital about three o'clock, they done a check and I was only one centimetre dilated, which - I was coping with the pain, I thought I was going to go through the whole thing without any pain relief [laughing] because it was really mild. So they said, 'Go home and when you get, when they become a bit stronger, or you feel like you need pain relief, then come back in'. 

And then by quarter to nine, my waters went at home, which I thought was really strange, because I never had any of that the first time round, and then by half past nine, I was running to the hospital in my mum's car, couldn't wait to get there, needed to get there. And I was on the gas and air the minute I got in the room and they were so relaxed in there. Like, I kept going on about I'm having a vaginal birth after caesarean, you know, bring the team in to be prepared, as I was expecting. And this chilled-out midwife - and she pottered around the little room as if I was just any other woman having a normal delivery, so that relaxed me a little bit. And then I was only in labour a total of four and a half hours, and an hour and a half of that was pushing, because he was coming out sideways, so he wouldn't come down properly.

So they went and got the ventouse thingy, which frightened me then because there was a few more members of the hospital in the room so I though, 'Ooh, something's going wrong ', and also I felt not really with it, because of the gas and air, and I had a bit of Pethidine as well. And they were trying their hardest to help me push and encourage me, but I must admit I was at the stage where I felt a bit spaced out on the gas and air, I was panicking because' obviously I was in pain and... there was bits leaking and all that sort of thing and I really thought I was bleeding. I was terrified that I was bleeding and I had my eyes closed all the way through it. So I kept saying, 'Oh, just take me down for a caesarean', and I was begging them for a caesarean! [slight laugh]. But I was fully dilated and it was on its way, it just needed a bit of help with that suction cup, so that was what happened. Out he come and there was no problems at all. I had a bit of a bleed after, which that then frightened me a bit, but I was' my mum was so busy distracting me from what the doctors were doing that I wasn't really aware, I was just admiring the new baby, so' It went really well, I think I had a perfect labour compared to some of my friends who's had, you know, twenty, forty hours of it, so' I think I've done really well in the end. I'd do it again, a lot more relaxed, I know that much.

So, that was more relaxed?

Yeah. Yeah, and I felt a lot better after, as well.

And how was your baby after the baby was born, because obviously, the baby had the ventouse? 

Oh yeah, I did cry about that. When he was first born and they showed me him, obviously he had this big mark on his head, I really thought he was going to stay like it. I know they don't, because I've heard about it before, but at the time, you know, I was really upset, and I thought, because he looked a bit deformed, to be honest [slight laugh]. So I thought perhaps he had some sort of disability that I wasn't aware of [right] that w

A couple of women who had wanted a vaginal birth but went several days past their due date without going into labour eventually agreed to have a planned caesarean, because they felt increasingly uncomfortable and didn't want to be induced. However, another woman who also went overdue had an induction and gave birth unassisted.

 

She went 14 days past her due date. After she was induced she had a short painful labour and...

Text only
Read below

She went 14 days past her due date. After she was induced she had a short painful labour and...

Age at interview: 33
Sex: Female
HIDE TEXT
PRINT TRANSCRIPT
Well, I had to be induced in the end, as it turned out. She was about two' I was about fourteen days, I think after my due date. Basically, I went in' to the hospital. I was' I had three sweeps to see if they could start the delivery normally but, or start the delivery, whatever, but that didn't work over the space of three weeks [laughs]. and then I just had to wait until there was a space on the Thursday that she was born and I went in about lunchtime. And they spent probably more time getting the line in than we did actually having the baby. Since the line was in, it was about three and a half hours start to finish, natural delivery. Quite, quite painful, but [laughs] quite fast, much faster than I anticipated so, but other than that it was a fairly' uncomplicated, event-free sort of delivery, I mean' Comparing it with the last time I thought, 'Gosh, that was so easy actually', [laughs]. In retrospect, maybe not at the time [laughs]. But certainly afterwards, I thought it was definitely so much easier because I was on my feet within about half an hour of' her being born. I had to have some stitches but that in itself was okay, there wasn't any difficulty. It was a lot less hassle than having a section, that was for sure. But yeah, I mean, as far as I'm' I don't know, I've sort of had experience of a long labour and then a caesarean versus a very quick labour with her, I mean, it didn't seem to be' there was no complications, there was no' they turned the induction off after about an hour, just because it was going quite fast on its own, so. And out she came! Relatively simply [laughs].
 

Most women had known in advance that they would be closely monitored from the time they arrived in hospital. One woman felt lucky to be hooked up to a wireless monitor that didn't restrict her movements. Another woman didn't want to be monitored and only came into hospital once she was in advanced labour. She wanted to give birth in an environment that was as free of interventions as possible and arrived at the hospital birthing suite with a hypnotherapy tape and a doula - a non-medical birth helper who give support to women before, during and after birth. 

 

She had a painful labour but felt well-supported by her husband, midwife and doula. She wanted to...

She had a painful labour but felt well-supported by her husband, midwife and doula. She wanted to...

Age at interview: 37
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
I went into labour early hours of the morning. I phoned the midwifery team. I knew my favourite midwife was on duty so it was sort of almost planned that day was the day I was going to do it. I started getting contractions and they started getting a bit more regular, sort of ten, fifteen, ten to five minutes. Because I was, I'd had a section previously, the midwives wanted me to contact them early so I rang them and I had them here at about five, six o'clock in the morning. Additionally I had also employed a doula. And' she arrived as well and the contractions continued and my daughter then was woken up at seven and following that, my labour stopped really, because my daughter was there and I went into a different sort of mode and it was coming on and off every twenty minutes, half an hour and then it came to lunchtime and my, my labour had stopped, effectively, it was every sort of half hourly. And so everyone left and I was at home with my husband just chilling out and reading the newspaper and it was very nice.

Looking back, if I had gone into hospital, I would have been there for quite a long time. I continued having contractions, but just chilling out, being at home and, and sort of every half hour kind of thing, and about five o'clock that evening, the contractions started getting more regularly. Everyone came back, I got my midwife, my special midwife arrived at five o'clock. She had finished her day's work, she was ready to support me through it and sometimes people say that that's - that's why people deliver because they feel comfortable, they're in their comfortable zone, so the person that supported me was there, everyone was ready to deliver me and my contractions became quite strong and regular and they were every five minutes or so. 

And I can't really remember all the details now as it's thirteen weeks but I was in full on labour and she examined me and I'd dilated to five, six centimetres. Over the next sort of three to four hours, they were getting regular strong contractions. I was doing a lot of yoga positions, using a TENS machine as well and I had the midwife and the doula supporting me pushing and my back, for back pain and back pressure. And' I just had a lot of support and things done for me and like one-to-one attention makes a difference, again. I don't think I would have got that in hospital. 

Not at any time did I feel anxious or worried or concerned about my baby, or the lack of monitoring as everyone's been pushing for the section. I had full faith in the people that were around me. And I think I probably would have had some form of sixth sense to know that something was wrong, possibly. 'I continued on in full labour for three to four hours and as a result of the' decisions that we had made to go into hospital because there was a risk of shoulder dystocia, we went in when I felt as if the time was right, and it was about nine o'clock. Ten to nine, where I was, the TENS machine wasn't really working and I was beginning to use Entonox and I thought, 'This is the time to go in'.

It was quite a funny feeling, getting in with the Entonox attached and in pyjamas and two women running after me and my husband and in the back of the car looking like, God, I don't know what, a screaming banshee' And it looked quite funny, but I did it, and I got in there and I still walked through the doors and felt really comfortable and supported. I walked into the birthing suite and there wasn't any sign of any medical interventions, any machinery, it was just the exact same people that were with me at home and I felt really comfortable about it. 

I continued to labour quite strongly, and it was a very, very painful labour. And' just did everything I needed to d

We asked women who had gone through VBAC whether at some stage during their labour they had considered asking for another caesarean. A few women said that the thought had crossed their mind when contractions became very painful or it just seemed like things were not going anywhere. One young woman said she had actually begged her midwife to have a caesarean when the pain got very bad, but, looking back, she was very pleased to have persevered with vaginal delivery. 

 

Her experience was very different from expected. She spent 3 days in hospital with painful...

Her experience was very different from expected. She spent 3 days in hospital with painful...

Age at interview: 32
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
I went in Tuesday night and that was Wednesday morning. And then my husband came in and I was getting on and off painful contractions but, you know, they'd come and they'd be quite regular and then they'd go away again so' It was getting quite painful and I can't remember whether it was Wednesday or Thursday that I'd had the strongest pain tablets they could give me and then I had Pethidine on that ward, because that was the most they could give me. And they were still talking about sending me home, even though my waters had broken and I was in pain. I said, 'There's no way I can go home like this. I can't cope with the''. They were just so painful and I was on this antenatal ward and other people were there, you know, because they were having tests or something early in pregnancy, and there's me having these contractions trying not to be noisy in the middle of the night, you know, while I'm in pain. 

And then on the Thursday I was one centimetre dilated finally, in the afternoon and so I was like, 'Right, okay, great, something might be happening'. And then the Thursday night the contractions were still really painful but they changed, so I thought that maybe something might be happening now, and then in the morning, Friday morning I was four centimetres. And then they moved me to the delivery suite in the morning of that day and then basically I dilated a centimetre an hour so I think I went like eleven o'clock four centimetres dilated and I got in the bath for a bit, but it was really strange. The contractions were less painful and I hardly had any contractions to get, you know, from four centimetres to ten, you know, I could probably count them on one hand. 

So, yeah, then basically at five o'clock I think, in the evening I'd had Pethidine again, and loads of gas and air and at five o'clock I was ten centimetres and then I started pushing and then she was born twenty-five minutes later.

So that bit was really, you know, quick and straightforward. But it was a really out of body experience I think, because of the gas and air. I just 'and I felt like really on a mission to do it. I was like I don't know, maybe you're like that anyway the first time, you probably are, because it's probably a natural thing, but I was just like, 'Right, I'm really going to do this', [laughs] you know, 'Nothing can stop me now', not after like being in hospital since the Tuesday night to the Friday. but then' so that was all fine, and she was fine, but then I went for a bath afterwards and I was really bleeding heavily. And I said, 'I don't', you know, 'I really am bleeding, you know, I know you bleed afterwards anyway but this seems like a lot of blood' and then basically they had loads of doctors come in and I was bleeding from where the placenta was and I had some clots or something, I'm not entirely sure what was what, but then the doctor came in and she had my legs in stirrups and everything and she was picking out these clots from where my placenta was, and it was really, really painful. I was in tears, really stressed out, like [daughter's name] was in the cot at the side but, you know, it was all' people were everywhere and the midwife was sort of saying, you know, to the doctor, you know, 'Be careful, don't'' because she was just really going for it and just like not-, like I was really like beside myself, you know, and this doctor was just' and I know she had to do it, but she was really just sort of, you know, carrying on with it, just ignoring me. So that was really awful. 

But that didn't, after that, obviously the bleeding stopped and everything and that was fine. But, and I felt at the time, 'Oh that was awful, that I had to have that', you know, it wasn't like a straightforward' I was so pleased with myself that I

On the other hand, a couple of women said that when health professionals mentioned to them that they might need another caesarean after they had laboured for several hours, it gave them extra motivation to try and push their baby out. A couple of women described themselves as 'on a mission' to achieve vaginal birth, a mission they hung on to even when things did not go to plan. 

 

She was determined not to have another caesarean. The doctor said she could only push for an hour...

Text only
Read below

She was determined not to have another caesarean. The doctor said she could only push for an hour...

Age at interview: 33
Sex: Female
HIDE TEXT
PRINT TRANSCRIPT
I woke up at half past four in the morning and realised I was getting contractions and they were five minutes apart and lasted about forty seconds. So I rung up the delivery suite and they said to come on in straight away. I had to wait about an hour and a half for my parents to turn up to look after my daughter, and then we got into hospital and we taken into a room straight away, and the midwife at the time said not to suffer and if I wanted gas and air to go ahead and use it, but I used my TENS machine for quite some time. I wasn't actually examined straight away, I think I was at the hospital for about two or three hours before they examined me, so I was quite anxious to find out how far along I was. And then when I was about six centimetres dilated I went on the gas and air, and I said to the midwife at the time I don't know if I would like an epidural, I don't know how far along I can go. I didn't want to feel out of control. And she said, 'Well, you're doing fine as you are, just let me know once you feel like you need one,' and I got to eight centimetres and I decided that it was just too much and I had an epidural. But unfortunately with that my labour slowed down a bit so' but by positioning myself on my left side it soon sped back up again. I think I was fully dilated about one o'clock in the afternoon, but I wasn't allowed to push for I think it was about an hour and a half because they wanted my son to come down as far as possible. And he was delivered at half past four by ventouse. Because of the epidural I obviously lost quite a lot of the sensation so I couldn't really tell if I was pushing in the right place or not, so I needed a little help in the end. But that was fine by me because I'd rather have that than a caesarean. 

'You've told me a lot there. At any time was there a concern that you might need a section at all?

Once I was fully dilated, a doctor came in and said, 'We'll let you push on your own for an hour, but that's all you're allowed is an hour because of your previous section.' And then we would have to, then we would have to go ahead and use some other method to get the baby out. And so at that point I started thinking please don't let it be a caesarean. I think I probably even said, 'I don't want a...,' you know, 'I don't want a C section.' But obviously once I'd been pushing for an hour they then had to come in and help me out, so'

And were you worried that you only had an hour, did that concern you?

I think it did a little bit at the time, but I suppose you're so concentrating on getting this baby out you don't really sort of take much notice of the time, but once the doctor comes back in and you know she's going to say something, you think, oh please, I don't want a caesarean, I'll try anything but I don't want a caesarean right now, just give me a chance. But luckily they said, 'We'll try the ventouse and see how we get on with that.' I think they were going to take me to theatre by they decided not to and I delivered in the room that I was in at the time.

And having had the ventouse, was that something you felt prepared for to have assistance?

I knew there was a possibility it could happen, and one of the reasons why I held off so long having the epidural, because I knew if I had one quite early on there was a greater chance of me having a caesarean, so I left it as long as possible, and in fact I was absolutely amazed that they gave me one at eight centimetres because I do believe they don't normally so late on, but because the anaesthetist was available I could have one. But' 

But do you think it was something you were prepared enough to have?

Looking back on their experiences of VBAC, many women said they were proud to have done it and felt an incredible sense of achievement. But one woman also thought that VBAC could be made into too much of a 'big thing' and at the end of the day, the greatest sense of joy came from having another healthy baby.

 

She feels proud to have achieved VBAC but also glad to have experienced both ways of giving birth...

She feels proud to have achieved VBAC but also glad to have experienced both ways of giving birth...

Age at interview: 32
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
So how do you feel now about the way that [daughter's name] was delivered this time? How do you feel about this birth?

I'm really proud of myself, that I did it. And it was, I'm really pleased that I've experienced both' You know, afterwards I felt, you know, I was looking at her thinking, 'I can't believe I pushed you out!'. You know? [laughs]. Because it was a really amazing thing, and I think it's nice, because you just don't know how you'll feel ever about a baby, do you, when it's born, the bonding and, because it was a second baby and things and I was really sort of thinking, 'Oh, I hope I can love her as much as, you know, the first one'. So that was, it was really nice to have felt that, you know, I had a different experience with her [smiles]. 

No, my general sort of thought on it is, to be honest, I don't think it would have matter now, if I'd had a C-section... It, you know, it can be made into a big thing about having a natural birth after a caesarean that it's going to be so different, you know.

And I actually just think, you know, you're just happy to have another, you know, healthy baby, and actually although I was really, really pleased that I had a natural birth and very proud of myself, like I say, and really determined to do it, and I really was, I was so glad that I'd done it and that I managed to, or had the chance to. Actually you know, if I'd have had a C-section I would have, I think I would have just, you know, been happy that she was okay, because it did go on so long for me, so I did feel quite, well, very tired by it.

*Birth Options After Previous Caesarean Section; Royal College of Obstetricians and Gynaecologists (July 2016)

Last reviewed August 2018.
Last updated August 2018.

donate
Previous Page
Next Page