Messages to health professionals

We asked the women who took part in our study to reflect on their experiences and tell us what messages they would like to give to health professionals. Several were very satisfied with the care they had received before, during, and after birth and did not have anything specific they wanted to say. However, others made a range of suggestions about how they thought care for women who have had a previous caesarean could be improved.

Communication

• Listen carefully to what a woman is asking advice about - choosing how to give birth is a big decision

She thinks health professionals need to be good listeners and should be prepared to give straightforward advice based on their professional experience. Played by an actor.

 

• Allow sufficient time for discussion 

She thinks health professionals need to allow women sufficient time to discuss their options. Hospital appointments often can feel rushed.

 

• Treat women as individuals and tailor information to their personal circumstances

 

   

It is important for consultants to know their patients' individual circumstances so they don't give advice that is irrelevant.

• Don't make a woman feel guilty about opting for a caesarean

She thinks women should not be put under pressure to attempt vaginal birth if their chances of success are low - it will only make them feel guilty.

Providing Information 

• Discuss options for birth with a woman who has had a previous caesarean early on in her pregnancy

Health professionals should inform women that there is a decision to be made and provide them with the necessary information.

• Provide information in a format that a woman can take away to read and revisit in her own time 

She found it helpful to use a decision aid that allowed her to revisit information and think about her preferences outside the hospital environment.

• Don't gloss over complications if a woman wants to discuss the risks of labour and birth

She thinks it's important to be confronted with the facts, even if they can be scary.

• If a woman hasn't experienced labour provide more information about different kinds of pain relief and how it might affect the birth process
• Bear in mind that a woman who wants a VBAC (vaginal birth after caesarean) might need to refresh her knowledge about labour and birthing positions

Health professionals need to be aware that women who have had a caesarean without labour may need more information about labour and pain relief than other second time mothers.

• Midwives might be better placed then consultants to offer information to women during pregnancy

She thinks midwives are best placed to give women information, because they are the professionals that women see the most. Having a midwife she knew at her birth meant a lot to her.

Supporting women's decision-making

• Ask a woman how she wants to be involved in decisions about method of delivery - some women want advice, others just want information 

Before her VBAC, she would have found it helpful if doctors and midwives could have advised her which way of giving birth was the best option for her.

• Make sure the information you offer is accurate and up-to-date

She thinks health professionals should make sure that information that might influence women's decision-making is accurate.

• Respect and support a woman's decisions, even if you don't agree with them

She thinks it's important that health professionals take into account women's past experiences and support them in their decision-making without trying to persuade them.

• Explore to what extent a woman wants to be involved in decisions about her care during birth itself

Discussing vaginal birth after caesarean

• There are many complex reasons why women might have a preference for planned caesarean, and it is seldom simply a matter of convenience

Health professionals should be careful not to stereotype women who ask for a caesarean as simply 'too posh to push'.

• You may need to reassure a woman that there is no hidden agenda to persuade her to attempt VBAC 

She thinks the NHS have a hidden agenda to push women into vaginal birth to save costs.

• If a woman wants to attempt vaginal birth, be encouraging  - don't use negative terminology such as 'trial of scar'

She understands that health professionals have to inform women about all the risks but thinks they could do more to encourage women that VBAC is possible.

• A woman who wants a VBAC might find it helpful to hear the experiences of others who have done it 

Last reviewed November 2010.