Birth options after a previous caesarean…

There are a lot of people with a lot of opinions about which way a mother should birth after a previous caesarean. And I am not just referring to medical personnel. It is not uncommon to find men as well as women with strong views on which mode of birth is best – often with little or no medical information to back up their opinion.

It is natural, after a negative birth experience, to be tempted to assume the other birth mode is better, but this may not be the case (unless specific medical indicators suggest otherwise). Where this is the case it is very important we try to ensure our opinions are based in fact not just gut feel.

Unfortunately, with some medical personnel, personal preference will play a part in the advice given and hospital targets are known to impact advice in some facilities. Working out when this is the case is tricky. But unless there are specific medical indicators in the current pregnancy, or a specific outcome in your previous birth which indicates one birth mode over another it is actually far less clear cut than we are led to believe and very much more about our own person view on risks and benefits.

My book dedicates a full appendix (11 pages) to facts and figures about benefits and risks of vaginal and caesarean birth. There are a lot of statistics about medicine’s current understanding of likely outcomes based on numerous international studies. Using this it should be possible to form your own opinion about levels of risk, types of intervention you consider preferrable etc. For example: some women may, on reviewing data view the risks associated with instrumental interventions in a vaginal birth as more risky than a planned caesarean.

Whatever you choose, always remember that in absolute terms the risks of adverse outcomes with either birth mode are incredibly small. Indeed a recent study looking at birth data from over 70,000 births in Scotland between 2002 and 2015 states that:

While “Attempting vaginal birth was associated with an increased risk of the mother having serious birth and post-birth related problems compared to electing for another cesarean section…the absolute risk of complications were small for either type of delivery. Overall, just 1.8% of those attempting a vaginal birth and 0.8% of those having a planned cesarean experienced serious maternal complications.”

The 2019 NICE Intrapartum Care guideline reports on the review committee’s discussion of the evidence, finding “There was no strong evidence to suggest a difference in outcomes for the baby between a vaginal birth or a repeat caesarean section, and the committee felt that healthcare professionals should inform women about this to aid decisions about mode of birth.”