The experience of planning how to give birth, including example stories

We interviewed 37 women, 5 partners and 39 healthcare professionals across the UK.

They told us what it is like to make decisions about planning mode of birth (vaginal or caesarean) in the NHS.

We deliberately tried to hear from diverse people with a variety of experiences, so we could understand the range of things that can be important when people make - or support others to make - this decision.

For our women and partner interviews, we particularly tried to hear from people who are both less likely to be included in research and more likely to be disadvantaged by NHS service provision.

Our participants included those from minority ethnic groups, those on a low household income, young mothers, lesbians, women with health conditions, and those living in rural areas.

Some women have a strong preference for one mode of birth over another, while describe 'going with the flow'.

Louise, for example, strongly preferred to plan for a caesarean birth, and Catriona strongly preferred to plan for a vaginal birth, while Holly and her partner Kate had no preference.

Louise was 31 years old when she was pregnant with her first child. She looked at outcomes of planned vaginal and planned caesarean birth and weighed up how she felt about the different risks of each. She also listened to friends who had planned a vaginal birth talking about their experiences. She felt certain that she wanted a caesarean birth.

A planned caesarean seemed more controlled, calmer. I wasn't really invested in the birth as an experience. I wasn't afraid of the idea of surgery; I found it reassuring that there would be a lot of people in the room with me and that I would have pain relief. Obviously you roll the dice, but I was only planning to have two children, and you're the one that has to live with the complications. I just didn't like the thought of incontinence or my baby getting stuck. Given what I was likely to avoid by planning a caesarean birth, I was prepared to accept serious risks - like placenta accreta and dying - as they were so unlikely to happen.

Catriona planned vaginal births with both of her children, the second a planned homebirth. She read a lot about how she could prepare for a spontaneous vaginal birth and how this might fit with the way she wanted to parent in the longer term.

I just wanted everything to be as calm as possible, to have that control. I investigated natural expulsion and how your body will just release easier if you're in your own space, if you've got familiar people around you. I felt like a caesarean section was an emergency medical intervention. I didn't feel like it was even a consideration for me unless it was absolutely necessary at the very last minute, and I knew the ambulance service was on-hand, or at least aware. I just wanted everything to be as it has been for thousands of years, in as much as my health and the baby's health could make that happen.

Holly told us that she and her partner Kate had no real preference when planning mode of birth.

Kate's family history is of having quite big babies, and her mum and her sister have had caesareans. So, in the back of our minds was kind of the idea that she'd possibly need a caesarean. But in terms of planning for the birth we were both kind of like 'see how it goes' and take it from there. We didn't have any firm ideas of what we wanted. We were just kind of open to being flexible with how things went, when the time did come. And we were open to a vaginal birth or a caesarean, we didn't really have a preference.

People's relationships with their mothers - and their mother's own experience of birth - influenced how they thought about their own decisions. Our four examples come from Jessica (who planned a caesarean birth), Maya (who planned vaginal births) and Korede and Abby who made no specific plans.

Jessica - one of the younger mothers we interviewed - remembers watching a birth reality TV show with her own mum while she was pregnant, and how her mum helped her look through different options. She decided to plan for a caesarean birth.

Before I got pregnant, I was actually of the mindset I'm going all natural. But I don't know where I got that from because I hate pain! But when I asked people about their experiences, I realised there is actually a lot of pain involved. I spoke to family, especially my mum, and they said I don't think you would be able to go through it, as they know I'm not good with pain.

Although Jessica is happy that she planned a caesarean birth - and says she would probably have one again - she was surprised by the pain she felt afterwards.

Maya planned vaginal births with all her children. She thinks this is partly because her own mum had vaginal births.

What your mum went through will definitely impact you because you assume you're just like your mum. So if your mum was told her pelvis was too small and couldn't give birth naturally, you're probably going to go straight to c-section. Whereas my mum had five children, no c-section. She's tiny, I'm tiny.

Korede made no specific plan but has had both vaginal and caesarean births. She told healthcare professionals that either mode of birth would be fine, as long as she and the baby were well. Her own mother, who believes vaginal birth is best, found this difficult to accept.

My mom tried to convince me that doing a CS is very bad, and I have to try and push it out. And I said, “Look, any one it is good, if they want to cut my tummy, let them cut it open as long as they will sew it back.” When I told her that I filled the form for CS and vaginal, any one that is best for me, she was so angry with me. But I didn't let her own belief and traditions disturb me, I was doing what was best for me.

We also heard from Abby, who was only 19 years old when her mum died. A few weeks later she found out she was pregnant. With no partner to help her, and no experience of babies, she had “no idea” how to answer midwives' questions about her birth plan, and really missed the support her mum would have given her.

There was just a big part of me that was like, my body's got to do its own thing. So I just went with the flow. It would have been good to have had a lot more information and emotional support, but I guess that was probably what I would have got from my mum. You know, she would have been like, “well this is how I gave birth”, or “this is normal for a pregnancy”, all those kinds of things.

Some of the women we heard from are from communities where there is a strong expectation of vaginal birth. This can make it difficult for women and their communities to understand that they have a choice in planning mode of birth. Our examples are from Margaret (who planned a caesarean birth) and Romola (who planned a vaginal birth).

Margaret is from the Gypsy/Traveller community, where it is usual for women to plan for a vaginal birth. She chose to do things differently by planning a caesarean birth for her first child. Margaret was admitted to hospital during her pregnancy. While there, she saw other women in labour.

It's scary to look at, especially when it's your first and you don't know what to expect. So it put me right off, and I said from that point that I'm too scared to give birth normal. It was the fact as well that I was always suffering palpitations, that my heartbeat would go fast. I'm a panicker, and I knew if I panicked in labour, I'd be scared in case I'd distress my unborn child. Cousins of mine have been left for hours in labour, and women in the hospital left for hours and hours in agony, and they'd get rushed for a caesarean anyway. So I said that I wanted a caesarean section, and that's what I'm settling on. But I felt like I was judged for wanting a caesarean section, when it was up to myself, because I was thinking about my unborn child and my own anxiety at the time.

Romola is from a country where it is generally expected that women will plan for a vaginal birth. She planned for - and had - a vaginal birth with her first child. However, she is glad she was encouraged to be open minded about what might actually happen.

When I got pregnant, I had a strong belief of how I would like to carry the birth out. This is what I want, this is what I don't want, and I don't want to open for other options. But it was very helpful the midwives I had who - without any pressure - explain to me unfortunately there are situation where you have to open your mind, it could end up in emergency caesarean and any other necessary equipment. But it's hard to change your mindset. If your family really doesn't like c-section operations, they will emotionally encourage you to give birth naturally. And this is not a bad thing, but sometimes this is not the case, and you needs to be always open minded. So I can say I'm really proud of myself because I tried to step over my boundaries, and I was open for anything.

We spoke to many who had given birth more than once. Mode of birth plans were clearly influenced by this previous personal experience, as illustrated by five examples from our participants.

Aiming for the same mode of birth again

For some, the mode of birth they had planned in their first pregnancy made people more sure that that had been the right decision for them.

Jen planned a caesarean birth with both her children. With the second,

I was still offered the idea of going for a vaginal delivery, but I was very upfront from the start. No, I want a C-section again.

Kathryn planned a vaginal birth with both her children:

With my second, I absolutely did not want to have a C-section because I knew I'd done it once, I'd given birth once, I knew I could do it again.

Gemma has been thinking about mode of birth options from early in her second pregnancy, as she had a serious tear during a difficult birth with her first child. She is keen to be up and about quickly for her toddler, so would prefer a vaginal birth. In her dreams this would be a waterbirth where she feels in control. However, she wants to avoid induction of labour and knows a range of things could happen, so has explored possible options with her consultant:

I don't think I want a C-section, I just don't want what I had the first time. I said, “Could I have an elective C-section, but could I wait until the 40 week mark, or even beyond?” and she said, “Yes,” but explained if you go into labour beforehand and with it being your second it might be quicker and it might get to the point where a C-section is no longer on the cards. Which I thought, well, to be honest, that would be perfect to me because that's kind of what I'd like.

Aiming for a different birth but keeping an open mind

It is common to have more complications with a first vaginal birth than with subsequent vaginal births. Where this had happened, women often thought long and hard about what would be the best mode of birth choice for them next time round.

Morgan had a serious tear when giving birth to her first child and is pregnant again. She has spoken to friends who have had different birth experiences, and to a consultant who outlined the chances of another serious tear from a vaginal birth. She has almost decided to plan for a caesarean birth, but has also thought about what she might want to do if she goes into labour before the scheduled date:

I'm not thinking so much of the birth, I'm thinking of me, 5, 10 years' time. Which for me at the minute is the way I need to think about it. Because I love training and we're always out and about and I like to climb hills and stuff like that, which requires a good control of urine! I'm very open to the idea that I may still have to vaginally give birth. It's not what I would like because of what could occur, but I can't do anything about that.

Women and partner views after a traumatic birth

Sadly, a traumatic first birth could leave couples undecided about whether to have any more children. Jocelyn assumed she would have a vaginal birth and feels let down by the lack of support after it ended as a caesarean birth under general anaesthetic. Her husband Yunus said,

I would love to have another child, but I couldn't consciously make a decision to do that to another human being. Because of what she had to go through. It was hard to watch. I can only imagine it was even harder to go through. And it has definitely impacted our future family planning. And years down the line we probably will maybe regret not having another child - I don't know, we'll see what happens. I imagine Jocelyn is fearful of going through that process again. And not having the confidence of being able to say, “Are we going to be able to get a c-section? What's going to happen?” You know, once you're pregnant, it's got to come out somehow.