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Making decisions about birth after caesarean
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Previous pregnancy and caesarean birth :
After caesarean birth
Recovery & complications after previous caesarean
Bonding, feeding and support after previous CS
Women's feelings about their previous caesarean
Experiences of previous pregnancy & caesarean
Women's expectations for their previous births
Information needs/sources in previous pregnancies
Women's experiences of their previous CS
Next pregnancy and birth after caesarean :
Decisions about how to give birth after caesarean
Reasons for wanting a planned caesarean
Reasons for wanting vaginal birth after caesarean
Women's experiences of making the decision
Roles of health professionals in decision-making
Roles of partners & others in decision-making
Experience of next birth after caesarean
Women's experiences of their next caesarean
Women's experiences of vaginal birth after CS
Preparing for next birth after caesarean
Women's expectations for their next birth
Information needs & attitudes in next pregnancy
Views on information from health professionals
Views on information from other sources
Taking stock of birthing experiences :
Comparing birth experiences and recovery
Women's views on choice about birth
Advice to other women facing decisions about birth
Messages to health professionals
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Making decisions about birth after caesarean
Subject index
Clip
Pregnancy & children
>>
Making decisions about birth after caesarean
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Aged 40 and over
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Interview 30
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She wants to attempt VBAC but is not too worried about having interventions. Being connected to a monitor from early on might restrict her mobility.
Wanted waterbirth with 1st child, went overdue. Induced at 42 weeks, did not dilate despite interventions. Baby delivered by emergency CS after heart rate dropped. Trusted medical team and feels no regrets, but hopes to have vaginal birth with 2nd child.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 31-35
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Interview 27
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Health professionals should inform women that there is a decision to be made and provide them with the necessary information.
1st child was breech, had planned caesarean. Struggled to breastfeed and felt low for long after. Wanted planned CS with 2nd child, but felt pushed into VBAC by clinicians. Went into labour early and had emergency CS at 38 weeks, found experience worse than previous.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 31-35
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Interview 19
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Statistics about the likelihood of women having a vaginal birth after caesarean confirmed her decision to have a planned caesarean. Played by an actor
Her waters broke 10 days past her due date, but contractions did not start. She was induced, didn't dilate, then had CS after 14 hours of labour. Chose to have a planned CS with 2nd child as felt pessimistic about her chances of having a vaginal birth.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 31-35
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Interview 28
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She thinks it's important that health professionals take into account women's past experiences and support them in their decision-making without tryin
Difficult pregnancy, laboured for 2 days, then found baby was double-breech and had emergency CS. Had trouble breastfeeding and felt very low for 6 months. Uncertain about how to deliver 2nd child, leaned towards planned CS but went into labour early and had VBAC as operating theatre was busy.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 31-35
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Interview 27
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Health professionals should be careful not to stereotype women who ask for a caesarean as simply 'too posh to push'.
1st child was breech, had planned caesarean. Struggled to breastfeed and felt low for long after. Wanted planned CS with 2nd child, but felt pushed into VBAC by clinicians. Went into labour early and had emergency CS at 38 weeks, found experience worse than previous.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 36-39
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Interview 29
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She thinks women are likely to look for information that confirms rather than challenges the birth preference they already have.
1st child delivered with forceps and ventouse. Had bad tear, lost lots of blood. Planned caesarean with 2nd child 16 months later on advice of doctors. Struggled to decide how to deliver 3rd child, pessimistic about her chance of having VBAC, feels planned CS is the safer option.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 30 and under
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Interview 16
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She thinks women are more likely to trust the advice of other women who have had a caesarean than doctors.
Had emergency CS after 18 hours of labour due to 1st baby's large size and awkward position. Recovery was difficult, felt low and exhausted for one month. Same problems of size and position with 2nd pregnancy, advised to have planned CS. Planned CS was much better experience.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 31-35
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Interview 27
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She did not see her midwives much in her second pregnancy and was unsure where to look for balanced and reliable information, so she was pleased to ta
1st child was breech, had planned caesarean. Struggled to breastfeed and felt low for long after. Wanted planned CS with 2nd child, but felt pushed into VBAC by clinicians. Went into labour early and had emergency CS at 38 weeks, found experience worse than previous.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 30 and under
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Interview 17
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She struggled to make up her mind about how to give birth and almost wished the decision would be taken out of her hands. Played by an actor.
Waters broke but 1st baby's head was outside the pelvis. Induced, then had emergency CS. Agonised over how to deliver 2nd child, persuaded by health professionals to attempt VBAC. Laboured to 7cm, but baby's head not engaged so needed another emergency CS.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 31-35
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Interview 27
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She had not been aware that she could choose to have a caesarean instead of a trial of labour. Using a decision aid gave her more balanced information
1st child was breech, had planned caesarean. Struggled to breastfeed and felt low for long after. Wanted planned CS with 2nd child, but felt pushed into VBAC by clinicians. Went into labour early and had emergency CS at 38 weeks, found experience worse than previous.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 31-35
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Interview 28
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She changed her mind throughout her pregnancy and kept her options open by booking a caesarean for after her due date.
Difficult pregnancy, laboured for 2 days, then found baby was double-breech and had emergency CS. Had trouble breastfeeding and felt very low for 6 months. Uncertain about how to deliver 2nd child, leaned towards planned CS but went into labour early and had VBAC as operating theatre was busy.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 31-35
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Interview 10
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Her partner was very supportive of her preferences, but felt the decision was totally up to her.
Reached final stage of labour with 1st child, cord wrapped around baby's neck, had last minute CS. Felt cheated and experienced postnatal depression. Determined to have vaginal birth with 2nd child. Had easy labour and 'perfect' birth experience.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 30 and under
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Interview 17
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Her husband thought a caesarean would be safer, but he left the decision up to her. Once she had decided to attempt VBAC, he was supportive of that ch
Waters broke but 1st baby's head was outside the pelvis. Induced, then had emergency CS. Agonised over how to deliver 2nd child, persuaded by health professionals to attempt VBAC. Laboured to 7cm, but baby's head not engaged so needed another emergency CS.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 31-35
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Interview 13
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She felt anxious when a growth scan at 34 weeks showed her baby to be breech as she did not want for things to be taken out of her control again.
1st child was breech, so had planned CS. Various complications made her keen to avoid repeat CS. Asserted herself against doctors' recommendations. 2nd child born after 12 hour labour with help of ventouse. Pleased with experience, recovered much better.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 40 and over
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Interview 08
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She went along with her consultant's advice to have a repeat caesarean but did not feel put under pressure in any way. Played by an actor.
Keen on unassisted birth with 1st child. Slow to go into labour and dilate. Had epidural and then CS 2 days after waters broke. Felt cheated at first but adjusted with time. Had planned CS with 2nd child to avoid previous ordeal.
Pregnancy & children
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Making decisions about birth after caesarean
>>
Aged 31-35
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Interview 27
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She suspects most midwives tried to push her into a trial of labour and disapproved of her decision for a caesarean, because they are driven by an age
1st child was breech, had planned caesarean. Struggled to breastfeed and felt low for long after. Wanted planned CS with 2nd child, but felt pushed into VBAC by clinicians. Went into labour early and had emergency CS at 38 weeks, found experience worse than previous.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 30 and under
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Interview 23
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She thinks women should be able to have full choice, but they need good quality information to make an informed decision.
Had lengthy labour with 1st child after being induced, taken for emergency CS after baby's heart beat dropped. Explored options early in 2nd pregnancy, decided on VBAC. 2nd child born after 10 hours, painful labour but great sense of achievement.
Pregnancy & children
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Making decisions about birth after caesarean
>>
Aged 30 and under
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Interview 23
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She thinks that women should have a choice over how they give birth, but that women who are 'too posh to push' are missing out.
Had lengthy labour with 1st child after being induced, taken for emergency CS after baby's heart beat dropped. Explored options early in 2nd pregnancy, decided on VBAC. 2nd child born after 10 hours, painful labour but great sense of achievement.
Pregnancy & children
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Making decisions about birth after caesarean
>>
Aged 30 and under
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Interview 17
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She thinks women who don't have a strong preference about how to give birth might find it difficult to make up their own mind and be swayed by the vie
Waters broke but 1st baby's head was outside the pelvis. Induced, then had emergency CS. Agonised over how to deliver 2nd child, persuaded by health professionals to attempt VBAC. Laboured to 7cm, but baby's head not engaged so needed another emergency CS.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 30 and under
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Interview 16
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She thinks women should not let themselves be influenced too much by the opinions of other people. It is more important to have accurate information.
Had emergency CS after 18 hours of labour due to 1st baby's large size and awkward position. Recovery was difficult, felt low and exhausted for one month. Same problems of size and position with 2nd pregnancy, advised to have planned CS. Planned CS was much better experience.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 31-35
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Interview 19
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She would advise women to consider all available information and not be afraid to ask for a planned caesarean if that was their choice. Played by an a
Her waters broke 10 days past her due date, but contractions did not start. She was induced, didn't dilate, then had CS after 14 hours of labour. Chose to have a planned CS with 2nd child as felt pessimistic about her chances of having a vaginal birth.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 31-35
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Interview 28
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She thinks negative media coverage of women who have a caesarean is unhelpful and could sway women in their decision when they might have very good re
Difficult pregnancy, laboured for 2 days, then found baby was double-breech and had emergency CS. Had trouble breastfeeding and felt very low for 6 months. Uncertain about how to deliver 2nd child, leaned towards planned CS but went into labour early and had VBAC as operating theatre was busy.
Pregnancy & children
>>
Making decisions about birth after caesarean
>>
Aged 31-35
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Interview 27
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She had not realised that she could refuse to have a VBAC until a midwife told her so, following her 36 week scan.
1st child was breech, had planned caesarean. Struggled to breastfeed and felt low for long after. Wanted planned CS with 2nd child, but felt pushed into VBAC by clinicians. Went into labour early and had emergency CS at 38 weeks, found experience worse than previous.
Pregnancy & children
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Making decisions about birth after caesarean
>>
Aged 36-39
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Interview 15
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She feels it was right for her to have full control over the decision to have her second child by planned caesarean and thinks every woman should be o
Went overdue with 1st child and was induced at 42 weeks, but drugs had no effect. Delivered 3 days later by epidural CS. Determined to have planned CS with 2nd child, as felt unlikely she would go into labour. Planned CS was a wonderful experience, far less tiring.
Pregnancy & children
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Making decisions about birth after caesarean
>>
Aged 30 and under
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Interview 16
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Because she did not have any control over her first birth, it was all the more important to her to be able to make an active decision to give birth to
Had emergency CS after 18 hours of labour due to 1st baby's large size and awkward position. Recovery was difficult, felt low and exhausted for one month. Same problems of size and position with 2nd pregnancy, advised to have planned CS. Planned CS was much better experience.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 31-35
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Interview 20
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She thinks women should be involved in decision-making as much as possible but at the same time the idea of patient choice can be taken too far.
Went 8 days overdue with 1st child, laboured for 48 hours. Had epidural and then emergency CS when child became distressed. Easy recovery but felt wrong about having planned CS with 2nd child. Considered it during labour but persevered and had vaginal birth assisted by forceps.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 30 and under
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Interview 14
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Making a choice about how to give birth to her second child was difficult because she felt uncertain which was the best option. Now she feels more con
Admitted to hospital with pre-eclampsia, 1st child was born 6 weeks premature and had to spend 10 days in SCBU. Found it very difficult to decide how to give birth to 2nd child, worried about risks either way. Had vaginal birth assisted by ventouse.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 31-35
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Interview 27
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Based on her own experience, she thinks women who want a planned caesarean need to state this clearly because health professionals tend to assume that
1st child was breech, had planned caesarean. Struggled to breastfeed and felt low for long after. Wanted planned CS with 2nd child, but felt pushed into VBAC by clinicians. Went into labour early and had emergency CS at 38 weeks, found experience worse than previous.
Pregnancy & children
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Making decisions about birth after caesarean
>>
Aged 40 and over
>>
Interview 08
>>
She thinks health professionals need to be good listeners and should be prepared to give straightforward advice based on their professional experience
Keen on unassisted birth with 1st child. Slow to go into labour and dilate. Had epidural and then CS 2 days after waters broke. Felt cheated at first but adjusted with time. Had planned CS with 2nd child to avoid previous ordeal.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 31-35
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Interview 20
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She thinks health professionals need to allow women sufficient time to discuss their options. Hospital appointments often can feel rushed.
Went 8 days overdue with 1st child, laboured for 48 hours. Had epidural and then emergency CS when child became distressed. Easy recovery but felt wrong about having planned CS with 2nd child. Considered it during labour but persevered and had vaginal birth assisted by forceps.
Pregnancy & children
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Making decisions about birth after caesarean
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Aged 36-39
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Interview 12
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She gathered information from as many sources as possible, but her decision to attempt VBAC was made independently of what she found out. Represented
Keen on vaginal birth with 1st child, felt she lost control at hospital, had various interventions and emergency CS. Decided to have VBAC with 2nd child against consultant's advice, but supported by doula and midwife. Very pleased with unassisted birth.
Pregnancy & children
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Making decisions about birth after caesarean
>>
Aged 31-35
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Interview 09
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She thinks it is important that health professionals encourage women to make the choice that is best for them rather than what they think is best.
Pregnant with twins, had CS when she did not dilate beyond 9cm. Felt happy with her care and recovered well but disliked need for support after the operation. Keen to have vaginal birth with 2nd child. Went two weeks overdue, then delivered very quickly after being induced.
Pregnancy & children
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Making decisions about birth after caesarean
>>
Aged 36-39
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Interview 12
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She thinks as a nurse with an insight into the medical system she was more able to assert her wishes than other women might have been in the same situ
Keen on vaginal birth with 1st child, felt she lost control at hospital, had various interventions and emergency CS. Decided to have VBAC with 2nd child against consultant's advice, but supported by doula and midwife. Very pleased with unassisted birth.
Pregnancy & children
>>
Making decisions about birth after caesarean
>>
Aged 31-35
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Interview 09
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Her reasons for wanting a vaginal birth after caesarean were mainly practical - a quicker recovery so that she would be able to drive and look after h
Pregnant with twins, had CS when she did not dilate beyond 9cm. Felt happy with her care and recovered well but disliked need for support after the operation. Keen to have vaginal birth with 2nd child. Went two weeks overdue, then delivered very quickly after being induced.
Pregnancy & children
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Making decisions about birth after caesarean
>>
Aged 31-35
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Interview 09
>>
Her husband is keen for her to have a VBAC because he thinks she will recover more quickly and it would be difficult if she could not drive.
Pregnant with twins, had CS when she did not dilate beyond 9cm. Felt happy with her care and recovered well but disliked need for support after the operation. Keen to have vaginal birth with 2nd child. Went two weeks overdue, then delivered very quickly after being induced.
Pregnancy & children
>>
Making decisions about birth after caesarean
>>
Aged 31-35
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Interview 26
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Her decision to attempt vaginal delivery was guided more by instinct and listening to her body than by information about risks.
1st child born prematurely at 30 weeks by emergency CS due to preeclampsia. Had good physical recovery but felt 'in shock'. 13 years later felt keen and confident to have VBAC with 2nd child. Had short but intense labour, birth was painful but 'amazing experience'.
Pregnancy & children
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Making decisions about birth after caesarean
>>
Aged 30 and under
>>
Interview 24
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Her partner wanted her to have a water birth with their second child. He thinks having a caesarean is 'cheating'.
Had planned CS one week pat her due date when it was found that baby had stopped moving. Mother experienced rupture and needed a blood transfusion. Wanted a water birth with 2nd child but advised to have planned CS due to previous complications.
Pregnancy & children
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Making decisions about birth after caesarean
>>
Aged 31-35
>>
Interview 20
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She felt that having a caesarean without medical necessity was wrong, though it would have suited her to bring the birth date forward. She also wanted
Went 8 days overdue with 1st child, laboured for 48 hours. Had epidural and then emergency CS when child became distressed. Easy recovery but felt wrong about having planned CS with 2nd child. Considered it during labour but persevered and had vaginal birth assisted by forceps.
Pregnancy & children
>>
Making decisions about birth after caesarean
>>
Aged 31-35
>>
Interview 18
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She chose a planned caesarean to minimise the risk of her lichen sclerosus returning. It annoys her that people who don't know her reasons might think
Chose to have planned caesarean with 1st pregnancy as expected twin. Felt fully involved and had 'stress-free' birth experience. Found decision difficult with 2nd pregnancy but decided on repeat CS to avoid complications with lichen sclerosus.
Pregnancy & children
>>
Making decisions about birth after caesarean
>>
Aged 31-35
>>
Interview 19
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There is no longer a medical reason for her to have a caesarean but after battling with herself she has decided to stick with that option because of h
Her waters broke 10 days past her due date, but contractions did not start. She was induced, didn't dilate, then had CS after 14 hours of labour. Chose to have a planned CS with 2nd child as felt pessimistic about her chances of having a vaginal birth.
Pregnancy & children
>>
Making decisions about birth after caesarean
>>
Aged 36-39
>>
Interview 15
>>
She was convinced that she would not go into labour naturally because of her previous experience and family history. It made her confident that she wo
Went overdue with 1st child and was induced at 42 weeks, but drugs had no effect. Delivered 3 days later by epidural CS. Determined to have planned CS with 2nd child, as felt unlikely she would go into labour. Planned CS was a wonderful experience, far less tiring.
Pregnancy & children
>>
Making decisions about birth after caesarean
>>
Aged 31-35
>>
Interview 28
>>
She thinks a planned caesarean will allow her to bond better with her baby because she will be far less exhausted than she was after the long labour a
Difficult pregnancy, laboured for 2 days, then found baby was double-breech and had emergency CS. Had trouble breastfeeding and felt very low for 6 months. Uncertain about how to deliver 2nd child, leaned towards planned CS but went into labour early and had VBAC as operating theatre was busy.
Pregnancy & children
>>
Making decisions about birth after caesarean
>>
Aged 31-35
>>
Interview 11
>>
She thought having a caesarean would make things difficult for her two-year-old. He would not understand why she could not play with him and might bla
Rushed to have CS after baby passed meconium and stopped moving. Had quick recovery. Keen to experience vaginal birth with 2nd child, laboured for 66 hours. Some complications afterwards but glad to have experienced giving birth both ways.
Pregnancy & children
>>
Making decisions about birth after caesarean
>>
Aged 31-35
>>
Interview 11
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She knew that her chances of having a repeat caesarean were higher than those of other mothers, but she wanted to know what vaginal birth was like.
Rushed to have CS after baby passed meconium and stopped moving. Had quick recovery. Keen to experience vaginal birth with 2nd child, laboured for 66 hours. Some complications afterwards but glad to have experienced giving birth both ways.
Pregnancy & children
>>
Making decisions about birth after caesarean
>>
Aged 30 and under
>>
Interview 14
>>
She had felt very ill after her previous caesarean and wanted to avoid another lengthy recovery and the need for extra support.
Admitted to hospital with pre-eclampsia, 1st child was born 6 weeks premature and had to spend 10 days in SCBU. Found it very difficult to decide how to give birth to 2nd child, worried about risks either way. Had vaginal birth assisted by ventouse.
Pregnancy & children
>>
Making decisions about birth after caesarean
>>
Aged 31-35
>>
Interview 26
>>
She always wanted to experience vaginal birth for herself. The support of her partner made her feel confident and secure enough to attempt it.
1st child born prematurely at 30 weeks by emergency CS due to preeclampsia. Had good physical recovery but felt 'in shock'. 13 years later felt keen and confident to have VBAC with 2nd child. Had short but intense labour, birth was painful but 'amazing experience'.
Pregnancy & children
>>
Making decisions about birth after caesarean
>>
Aged 36-39
>>
Interview 15
>>
She feels very practical about her caesarean. It was important to attempt vaginal delivery, but she had no doubts that surgery was the only option in
Went overdue with 1st child and was induced at 42 weeks, but drugs had no effect. Delivered 3 days later by epidural CS. Determined to have planned CS with 2nd child, as felt unlikely she would go into labour. Planned CS was a wonderful experience, far less tiring.
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