Another caesarean section? Why??

Gina Lowdon looks very briefly at some of the reasons why repeat caesareans are so common and suggests why this need not be the case.

Many senior, experienced midwives, doctors and obstetricians hold the view that if a woman has had one caesarean section she will more than likely have another. This is a view born of and supported by long experience and, sadly, its truth cannot be denied.

Many sectioned mothers, however, do go on to deliver vaginally without encountering any difficulties whatsoever. One even hears the occasional tale of a mother diagnosed as incapable of safe vaginal delivery giving birth spontaneously to a healthy baby in the ambulance on the way to hospital! But unfortunately, it is more common for women to end up with a repeat caesarean section even when the first operation was carried out for non-repeat reasons such as breech, fetal distress or failure to progress. WHY?

We live in a society which on the whole regards childbirth as a rather painful and potentially dangerous procedure. Many women embark on their first pregnancy with little, if any, first hand experience of either labour or young babies, preferring in the early months not to think too much about what labour might entail and with a wonderfully naive and rosy impression of what their future life with a young baby will be like. They negotiate the ensuing round of antenatal tests, checks and procedures which variously prove to be reassuring, pleasant, confidence-inspiring, odious, unpleasant, demeaning, denigrating, confidence-shattering, disempowering, depending on the helpfulness (or otherwise) of the many maternity personnel they encounter.

Thus a first time mother's state of mind, level of confidence in the natural birthing process, her own body, and the maternity staff who attend her, may vary a very great deal from woman to woman. Her reactions to the hospital environment, the new sensations of labour, the various hitherto unknown personalities, and equipment which surround her, have the power to affect the course of her labour enormously.

If, by the time her second child's arrival is imminent, a mother has gained in personal confidence, perhaps through the successful upbringing of her first born, or because of an underlying attitude that "what she's survived once she's ready to survive again"; or if her attitude has become one of gratitude to the professionals for 'saving' her first baby and confidence in their abilities; she will have unconsciously changed as a person and will approach her second labour quite naturally in a more positive, confident and relaxed frame of mind.

It is more usual, however, for women to embark on a second pregnancy and labour with the negative emotional baggage from the previous experience still intact. Unless they have been able to come to terms with the first experience, to learn from it, to gain a greater understanding of their personal needs and the conditions they need to labour effectively and safely as individuals, they are in danger of finding themselves on the same slippery slope they fell victim to the first time around.

Of course luck plays a part. The mother may well be 'rescued' by a particularly wonderful midwife. She may move to a different part of the country where the 'policies' (i.e. induction at ten days 'overdue') that dragged her down the first time are not in force or are more flexibly applied. She may find herself under the rare obstetrician who actively encourages VBAC.

But luck cannot be depended upon. The best way to tackle the attitude "well you've had one section so you'll probably have another" is to be able to think or say:

"Well I'm a different person now. I know what I need and want for myself and my baby. I know what kind of treatment I'm prepared to accept and under which general circumstances. I am fit and healthy. I have good ideas on how to cope with this next labour, I am no longer afraid of giving birth and I have confidence in my body. I know I can do it. Not all women who have had one section have a second so there's no reason why I should."


First published in the AIMS Journal, Vol 4, No 3, 1991

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