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‘Once a caesarean, always a caesarean’? Challenging perceptions around vaginal birth after caesarean

02 September 2016

Clinical Practice

02 September 2016

Volume 24 · Issue 9

ISSN (print): 0969-4900

ISSN (online): 2052-4307

Abstract

What happens to women's bodies during their first childbirth experience can have profound impacts and consequences for them, including their emotional and physical health and long-term wellbeing. These experiences can affect women's choices and decisions in subsequent pregnancies. A history of previous caesarean birth has considerable and significant influence on how women make choices about future pregnancies. The aim of this article is to increase midwives' knowledge and understanding of the factors and influences around choosing vaginal birth after a previous caesarean birth. The issues explored highlight the importance of informed individualised decision-making and the need for further research to ensure that the evidence base develops greater robustness. Paying attention to these aspects is an essential component of the midwife's role in supporting women's birth choices and ensuring that the risks of adverse events are reduced.

The benefits and safety of vaginal birth after primary caesarean section (VBAC) is a subject of considerable interest to midwives, and one which this journal periodically revisits. Some of this discussion is informed by contrasting views about childbirth. One influential standpoint sees birth as a risky biomedical process, and medical interventions should be used to lessen any risks. A contrasting outlook considers birth, while having elements of uncertainty, to be a normal and life-affirming event for women. This opinion is shared by many midwives (Downe and McCourt, 2008) and is endorsed by professional bodies such as the Royal College of Midwives (RCM, 2016) in its Better Births Initiative. Balancing these opposing perspectives about childbirth in everyday practice is a formidable task. This article examines prevailing ideas about the safety and benefits of VBAC, highlighting the effects of previous caesarean and other influences on women's choices in subsequent pregnancies.

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Adverse pregnancy outcomes

Caesarean section

Vaginal birth after caesarean section (VBAC)

Decision-making

Risk management