Making decisions about birth after caesarean

Views on information from health professionals

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 pregnancy and next birth. Many will look towards health professionals - community midwives, GPs, health visitors, consultant obstetricians and other hospital staff - to inform them about their options and provide reliable information about the different ways of giving birth. Many women also seek out information from friends, books, magazines, TV programmes or the internet but talking to health professionals allows women to discuss their individual circumstances, get answers to specific questions and receive reassurance about particular concerns (see also 'Views on information from other sources' and 'Information needs & attitudes in next pregnancy'.)

The women we talked to in this study also were participants in a clinical trial that tested two computer-based decision aids ('The DiAMOND trial'). Both decision aids provided detailed information about a broad range of complications associated with different ways of giving birth, and all but two of the women received one version or the other. Research conducted in preparation for the trial had suggested that there is was little information available specifically for pregnant women who have had a previous caesarean. Also, women can find it difficult to seek such information from health professionals when, as one woman put it, 'you don't know what it is that you don't know'.

We asked women what they thought about the information they'd received from health professionals during their pregnancy. Their comments were influenced by having used the decision aid as an additional source of information and they often drew comparisons between what they had learned from health professionals and from their involvement in the trial.

For many women, it was important to get information that was tailored to their personal circumstances and medical history and the decision aid couldn't provide this. They were keen to find out whether problems that had led to their previous caesarean were likely to happen again and how likely they were to have a vaginal birth after caesarean (VBAC) if they decided to try. Many women thought that talking to a consultant at their hospital appointment had given them valuable information about their personal risk. However, one woman was convinced that she wouldn't be able to have a vaginal birth on the basis of her family history and felt disappointed to receive 'standard advice' that didn't consider her specific situation.

Women who have had a previous caesarean will typically have two or more hospital appointments with a consultant obstetrician to talk about their birth preference and possible risks and complications. However, the first appointment is often scheduled to happen at the time of the 20 week scan, so many women will not receive specific information about birth after caesarean earlier on in pregnancy. Looking back, some women thought that the timing of information received from health professionals could have been better. One woman asked to see a consultant early in her next pregnancy, because she was keen to have her questions answered as soon as possible. A few women had been given information about what their caesarean might mean for future pregnancies immediately or soon after their previous birth, but many had not. Some of those who received information at that point said thinking about another baby had been the last thing on their mind back then. 

Several women received leaflets from their doctor or midwife about the advantages and disadvantages of different ways of giving birth. Most found it helpful to have written information that they could read and revisit in their own time. However, one young woman pointed out that such information might be particularly useful before attending appointments rather than afterwards. Similarly, several women said they found it helpful to have gained information from the decision aids before talking to health professionals, because they felt better informed and more confident to ask questions.

A few women commented that they had received conflicting pieces of information from different health professionals. This concerned issues such as their chances of having a vaginal birth, when to report to hospital, being monitored during labour and whether they would be induced.

A common perception was that midwives seemed more supportive of VBAC whereas consultants seemed more likely to emphasise the risks of VBAC over the advantages. However, a few women thought that all NHS staff were driven by an agenda to promote vaginal birth and reduce the number of caesareans. They felt that the information they'd received from health professionals within the NHS was one- sided in favour of VBAC. One woman felt so strongly about 'not being given the whole story' that she went to see a private consultant instead.

However, a couple of women reported the opposite experience, with hospital staff trying to discourage them from attempting VBAC. Several women who had had a VBAC thought that medical staff could do more to encourage women that it was a realistic option (see 'Messages to health professionals'). 

A few women acknowledged that health professionals have to manage a difficult balance, informing women about the things that might go wrong while at the same time supporting them in their decision-making and giving reassurance to their concerns. They thought that having a decision aid that women could access independently and in their own time to find out additional information if they wanted to would be a useful addition to the information provided by health professionals.

We asked women who they thought was the most appropriate health professional to provide information to pregnant women with a previous caesarean. Most women felt that community midwives should take on this role as they were the ones women saw most often and could build a relationship with. 

Even though several women said they would have liked more time with their midwife and to see the same person rather than a team of people, midwives were often regarded as more approachable, more trusted and better placed to provide reassurance and advice when it was needed than hospital consultants. However, a couple of women thought having access to 'neutral' information from sources outside the healthcare system was also very important.

Last reviewed August 2018.


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