What are my options after a caesarean birth?

This is quite a common question. Unfortunately, the answer is not straightforward.

Hospital policies continue to influence things both overtly in terms of whether there are written (or unspoken) caesarean targets, but also more subtly through common practises such as induction guidelines / tolerance for the length of 2nd stage labour etc.

It is possible to avoid automatically having another caesarean, always assuming of course the reason for the first caesarean is not likely to recur in each pregnancy. Hospitals are being increasingly encouraged to support VBACs (Vaginal Births After Caesarean) and NICE guidelines state that:

“Women have the right to choose VBAC… Therefore, this model would support a woman being able to choose her preferred mode of birth in consultation with the healthcare professionals responsible for her care.” NICE guideline

Some hospitals offer special clinics aimed at encouraging just this. If this is your aim, it is worth asking what is available at your hospital and your local doctor surgery as these classes can provide lots of information and support about how to manage your pregnancy and labour to help increase your chances of achieving a vaginal birth.

For those women preferring another caesarean this will, in many cases, be dependent upon the opinion or policy of those responsible your care. Some hospitals do not encourage a planned caesareans (even after a previous one) if there is no medical need. A previous caesarean no longer constitutes a ‘medical need’, unless, as already mentioned, your first caesarean was for reasons which are likely to recur in a later pregnancy.

“Know your rights Calmly discussing your options, knowing what can and cannot be insisted upon and the difference between a required and suggested caesarean, puts you in a strong negotiating position. From Chapter 3 of Caesarean Birth: A positive approach to preparation and recovery.

For example: Where a caesarean request is being refused you have the right to a second opinion.

“Recommendation 39: An obstetrician has the right to decline a woman’s request for a CS. If this happens, they should refer the woman to an NHS obstetrician in the same unit who will carry out the CS.” NICE guideline

There is a lot of detail in Caesarean Birth: A positive approach to preparation and recovery about ways to manage these discussions, whether your aim is to avoid or indeed plan a caesarean. Either way, there are quite a lot of things you can do to help you case.