How do you choose whether to have an elective c-section (ELCS) or a vaginal birth after caesarean (VBAC)? It’s not an easy question to answer, and one of the most difficult and personal decisions you will ever have to make. I’ve tried to put into words below a comprehensive evaluation of the different issues that affected my own choice, in the hope that it might help you make your own mind up!

To be clear, this is NOT a blog which will try to convince you one way or another – it is a guide for how I approached thinking about a decision which is, for many, one of the hardest they will ever make.

Straight after my emergency section with my eldest son, I was adamant that I would have a planned caesarean for any subsequent children to avoid the stress of it, the increased risks of a VBAC (compared to a first time labour), and at a very superficial level I admit I was also thinking: I’ve already ruined my tummy, so why would I mess up downstairs too – might as well have one or the other!

But on the other hand, I really struggled with my recovery. The number one piece of advice I give c-section mamas who come in with their newborns is to accept ALL the help. Don’t try to be a hero, and get yourself properly better. Carrying a pram up the stairs? No. Packing to move home? Not so much. Trying to exercise before 12 weeks? Nuh-uh. Don’t be Helen. Don’t try to play netball 7 weeks post delivery. (Spoiler alert: you can feel things in your tummy moving that you REALLY don’t want to feel moving.)

Take it easy, and in the long run you’ll be able to do so much more, so much quicker. That tricky recovery really made me question if a repeat c-section was the right call for me.

I agonised over the decision for weeks and months. I attended VBAC clinics, I spent hours with consultants who, truth be told, probably got a bit fed up with the level of detail and statistics I asked for (I was a science undergrad in a past life after all!) and I changed my mind at least a dozen times over those 9 months of my second pregnancy.

Ultimately I arrived at a decision, based on my own personal circumstances. I’ve popped below some of the questions that helped me to make that choice. Your actual decision may be different (for example, how was your recovery from your previous c-section? If it was tough, that might put you off another caesarean, whereas if it was smooth sailing then you might be keen for a repeat) but I hope the questions themselves will be helpful in working out what matters to you and what influences your intimately personal choice.

What happened during your previous labour?

This question is important because it helps you understand what you did (and didn’t) like about your delivery last time around, and more importantly, whether it is likely to happen again.

My labour was long and eventful, but ultimately not a question of safety at any point. You can read the full story here but the TL:DR is that my little boy didn’t tuck his head down, so it was nothing to do with me that I ended up have a c-section, nor was there anything I could have done to avoid it.

That was a tick on the VBAC column as it meant that there was no reason to think the same scenario would occur again (the odds of having 2 brow presentation babies are roughly 2,000,000 to 1, so I’d be pretty darn unlucky!)

I also felt that the care I had at the Rosie Maternity Hospital at Addenbrookes throughout (whether the birthing centre, the delivery unit, the operating theatre or the corridors in between) had been stellar and while my experience hadn’t been straightforward, I’d still felt calm, in control and ultimately relaxed – so the idea of going through that all again wasn’t traumatising.

Other things you might want to consider – was your previous baby a chunk? My eldest was over 4kg (8lb 13oz) and overdue which are both negative indicators for VBAC success. I also hadn’t had a previous vaginal birth.

On the other hand, I was in excellent health, under 40 with a BMI of <30, and I hadn’t had a failed induction of labour first time around – all of which are positive indicators.

What’s your situation at home like?

This might seem like a trivial question, but for me it played a huge part in my decision making too, and actually it was a factor which is rarely discussed since it’s not a ‘medical’ issue.

Think about your older child(ren) and how independent or otherwise they are. How would you cope if you couldn’t run around after them or pick them up for weeks? Do you have family around to help? Is your partner the kind of person who can pick up the slack?

I have 19 months between my two boys, and I often laugh now that being pregnant with a toddler is way harder than having a newborn and a toddler…but I’m not really joking. I knew how hard I’d found it caring for myself and my new baby first time around after a c-section, and the idea of trying to look after a (lovely, but) boisterous toddler on top was highly intimidating.

I stressed about how I would carry him up to bed and lift him into and out of his cot. How would I read stories to him on my lap like he was accustomed to doing? Or how would I be able to keep him calm and comfort him properly if the idea of a new baby brother turned his world upside down (he was completely oblivious throughout my pregnancy so there was no sense of preparation!) when all he would want to do is be held?

I’m very fortunate that I have family close by and hugely involved in my children’s lives, and after my first delivery that was an absolute lifeline – but having said that, my husband is self-employed (no paternity leave!) and was out of the house a lot in those early days as a result, so while I knew my family would likely rally around again, it felt like a lot to ask and rely upon.

Ultimately it was another tick in the box for a VBAC as I felt the recovery from a c-section would be particularly difficult with a young sibling at home.

There’s also a question of your future family plans. If you would like to have more children in the future (or perhaps just think there’s a chance you might) then it might be better to opt for a VBAC. I knew I might want another child one day, so I needed to take that into account.

Once you’ve had multiple c-sections, very few hospitals will allow you to attempt a VBAC due to increased risk of uterine rupture with each addition surgery, so if you’re going to try it, the best time is for your next child after your c-section.

But they may also advise you against having more children once you’ve had multiple c-sections. The reason for this is that successive c-section operations become more difficult as there is usually more scar tissue and this can also become attached to other organs too. More surgeries equals more scar tissue, and I’ve had a number of women in my studio who have been advised not to have more children due to the increasing risk of surgery.

If you have a successful VBAC, then you increase your chances of additional successful VBACs (85-90%, which compares very favourably to first time mums) and therefore keeps the door open on more children.

Do you feel like you need to experience a vaginal birth?

There’s a lot of subconscious language around how we deliver our babies, and to what we should and should not aspire. I’ve lost count of the number of times I’ve had people ask me about whether I wanted/had had a “normal” delivery. The one thing I’ve learned in my job as a newborn photographer – and trust me, I hear a lot of birth stories! – is that there is no such thing as normal.

However, it’s completely ok too to feel that you have “missed out” on a vaginal birthing experience, and need to give it another try (just be aware that if you dreamed of a home birth that it may be a bridge too far – “high risk” isn’t a label that seems to mesh well with “home birth”).

Before my first labour, I had a romantic vision of what my birth would be like and I expect many of you had something similar in your head: you know, the mood lighting turned down low, your favourite tunes on the stereo, and the gentle lap of the warm water in the tub as you breeeeathed your baby into the water birth of your dreams with no pain (and no mess haha) after just a couple of hours of mild contractions. One of the girls from my NCT group had what sounded like the exact replica of this perfect labour I had created in my head, and it all felt a bit unfair that I’d ended up with the 36 hour round trip to a sunroof exit!

Yet I’m a very pragmatic person, and a firm believer that as long as baby and mum are safe and healthy, then the manner of arrival truly doesn’t matter. It was something that really helped me come to terms with having the emergency c-section, and it also meant my decision to VBAC or not to VBAC was largely free from emotion or sentiment, either my own or that subconsciously delivered to me by society. I didn’t feel like I needed a vaginal birth to say I had succeeded – I was very content with the idea that if a c-section was the right call for me then that’s what I would do.

I do have friends who found it really hard that their birthing dream had been derailed, who felt that they had “failed” by not achieving a vaginal birth, and that they needed to go for a VBAC the next time around to try to put that feeling back on the shelf.

I have a lot of sympathy and sadness for that sentiment – there’s still unnecessary and unreasonable stigma around caesarean births, perhaps stemming from the “too posh to push” type headlines, but it’s absolutely phenomenal what our bodies can do, growing a whole new human over the course of 9 months. No one should ever be made to feel like a failure because they gave themselves and their little one the best chance of a happy and healthy life together.

However, there are many reasons why you might feel you need to experience a vaginal birth – maybe you had to have a general anaesthetic and missed your little one’s arrival, or perhaps you didn’t get to have skin-to-skin or the immediate bonding experience you would like. These are all things you should be able to have with an elective repeat c-section, of course, but equally they might influence how you feel about a VBAC, and if it is truly important to you to have that experience of vaginal birth then of course it will influence your decision.

Do you like certainty and planning?

Let’s look at some definite plus points of planned c-sections, and there are plenty! You know the date your baby will arrive in advance (unless they are a bit overeager, of course, but generally consultants like to schedule caesareans for around 38-39 weeks so this is less likely). You’re not left waiting (and waiting, and waiting some more in the case of my eldest son!) and feeling more uncomfortable by the day, while cursing the person who had the indecency to get you pregnant in the first place!

You’re able to plan ahead with childcare, bag packing, maternity leave and all the usual admin. There’s no need to stress over an extensive birth plan which will likely be torn up within minutes of your arrival at the hospital! Most planned c-sections now have very quick discharge timelines too, providing there’s nothing unusual to deal with.

In short, if you like certainly and planning, there’s probably an easy choice here, while if you’re ok with a few more surprises and a less rigorous timeline then a VBAC might still work.

Another minor consideration: if you’re a bit squeamish about things like surgery, you might find the idea of sitting around waiting for a c-section more stressful! I’m the type of person who can cope very well with a change of situation as things develop, but I don’t like to be left with my own thoughts too much beforehand – the idea of sitting in a hospital corridor with a couple of other ladies waiting to be called left me feeling a bit weird!

How do you feel about the physical toll of delivery on your body?

This is a tough one, and probably the question that kept me reconsidering my decision over and over throughout my second pregnancy.

With a repeat c-section, you know what your signing up for. A bit of weird day in the hospital: waiting to be called into theatre, the somewhat odd sensation of someone poking around inside you, followed by some pain, discomfort and several weeks of very limited activity and increased dependency, but ultimately a fairly known timeline of events.

With a VBAC, the upside is potentially huge – no complex operation involving scar tissue (if this has grown attached to your bladder, for example, then things can be more tricky for the surgeon) and perhaps just minor swelling or a small tear downstairs and feeling back to yourself within just days.

However, there is also a potentially downside too – obviously the very small risk of uterine rupture, which gets all the headlines, but also the far higher chance of a complex labour leading to an instrumental delivery and/or extensive tearing, with significant pain and discomfort and the potential for ongoing problems. If you could guarantee the former, then I daresay a lot more pregnant ladies would sign for the VBAC without a second thought.

I was personally very stressed that I could have a long, difficult and painful labour, only to end in either a repeat c-section on an emergency basis, or – worse in many ways – a traumatic vaginal delivery that would cause me significant problems downstairs. It drove me up the wall that I would only truly know the “right answer” after the event.

Of course, most these risks aren’t really any different to those for a first time mum planning her labour, and we are prepared to accept those risks first time around, so it makes sense that it would be the same second time too. It’s just somehow harder to make that call when you have an additional option (in the shape of a c-section) which wasn’t visibly available to you the first time.

My decision

As you may be able to tell from the various details I’ve shared above, I ended up choosing to attempt a VBAC delivery with my second son. Ultimately the main factors that swayed me were the idea of dealing with c-section recovery while also caring for my 1 year old, and also an optimism I carry inside me which means I believe the best will happen, so I was convinced that I would have a straightforward delivery (just as I had been convinced first time around, naturally!).

Of course it helped that I knew pretty much all the issues I encountered during my first delivery could be attributed to my son’s head position (including the extensive length of my labour and ultimately the necessity of a c-section) and this head position was a non-repeating factor.

And even though I knew that having had a late, larger baby previously worked against me, I also felt that I would always regret not trying, as I would never know if I could have had that straightforward labour and delivery that would get be back to being myself quicker, being independent again and getting back to playing netball sooner!

However, I did make this decision with caveats.

Taking control of your VBAC

My number one rule was that I did not, under any circumstances, want to be induced or given a hormone drip. This was because I considered the significant increase in risk for uterine rupture that this caused to be unacceptably high. I would allow my waters to be artificially broken to speed along labour, but only if things were already progressing well.

I also fought to give myself the best chance of a successful VBAC. When you choose that route, you will still also be asked to schedule a planned c-section should your little one not arrive in good time. This is in part because well-cooked babies are typically bigger (growing an estimated 0.5lb a week over the last few weeks) and bigger babies have lower success rates with VBACs.

My consultant pushed me to schedule my section for 39 weeks (they usually advise 38-39 weeks apparently) but I pushed to be given a later date. My reasoning here was that as my eldest son was 11 days overdue (and I have a family history of late babies) I wanted to give my VBAC baby the best chance of arriving on his own timeline before the planned section, so I negotiated hard and eventually booked in a caesarean at 41 weeks.

Finally, I still wrote a birth plan, albeit one that was much shorter than the idealistic nonsense I generated first time around! It basically said 3 things:

No inductions/hormones
TENS machine as soon as possible
Please keep me informed and educated on what is going on

This last point is probably the most important advice I can give to anyone approaching delivery of their baby.

No matter what worries you have or decisions you’re weighing up ahead of your labour, the only thing you can guarantee is that even the best laid plans will go out of the window. You are in control of how you cope with a situation, of course, but the situation itself is just something you have to go with on the day, however it presents and develops.

So the most important thing is that you feel able to play an active part in your own delivery, to be kept informed of what is going on and anything you ought to consider, and then be able to make those choices for yourself.

Good maternity hospitals (and the Rosie Maternity Hospital was absolutely phenomenal at this, in both the birth centre and the delivery unit) empower you in your labour – they give you the information you need and then allow you to call the shots as you so desire. That doesn’t mean you can’t ask for their opinions and input, or ultimately ask them to make the call. But you have the option to choose.

As I say, good maternity hospitals will do this as standard, but there’s no harm in putting this in your birth plan so that there’s no room for doubt. In my experience, most women who struggle with their delivery speak about labours that happened ‘to’ them rather than ones in which they actively participated.

So I firmly believe that empowerment of women to make their own decisions during labour is hugely beneficial to feeling positive about your birthing experience, regardless of the details and whether you choose a c-section or a VBAC.

Ultimately, whatever conclusion you come to when planning a delivery after a prior Caesarean, don’t let anyone else push you into it. It’s your decision – a very personal decision – and you’re the person who has to live with it. Whatever you choose, it will be the right call for you.

I wish you the very best of luck, and of course if you’d like to ask me any questions, let me know if this helped you, or perhaps share another factor that impacted your own decision to VBAC or not to VBAC, then feel free to contact me!

Should I have a VBAC (vaginal birth after Caesarean section) or an ELCS (elective C-Section)?