Clinical update

Birth after caesarean section

Around one quarter of births in the UK are delivered by caesarean section (CS), with 15% of the operations due to an emergency, while 10% are planned, says the Royal College of Obstetricians and Gynaecologists (RCOG).

Essential facts

Around one quarter of births in the UK are delivered by caesarean section (CS), with 15% of the operations due to an emergency, while 10% are planned, says the Royal College of Obstetricians and Gynaecologists (RCOG).

Picture credit: Alamy

In September, RCOG published updated guidance on vaginal birth after a CS (VBAC), and said that for a majority of women this is a clinically safe choice. Research shows that VBAC has a success rate of around 75% – the same as for first-time mothers. This rises to 85-90% if the woman has already had a successful vaginal birth. The guideline provides details of how to assess a woman’s suitability for VBAC, emphasising a personalised approach. It also highlights the need for a clinical care pathway to ensure best practice in antenatal counselling and shared decision making.

Medical signs for having a planned CS include pre-eclampsia, the baby’s position, the delivery of expected twins or other multiple births, a small pelvis, placenta praevia, infections, a medical issue such as a heart condition and restricted growth of the baby. Signs that an emergency CS may be needed include the baby not getting enough oxygen, the labour not progressing, a lot of bleeding and induction not producing effective contractions.

According to NHS Choices, the main risks of having a CS include infection of the womb or womb lining, thrombosis, excessive bleeding and damage to the bladder or ureter. For babies the most common problem is breathing difficulties. Statistically, women aged over 35 are more likely to need a CS because they have an increased risk of complications, such as hypertension and gestational diabetes. Although it is rare for women to need intensive care after childbirth, it is more frequent after a CS.

Nurses and midwives can play a key role in providing information for both the woman and her partner about their options, including the benefits and risks associated with vaginal birth or a repeat CS. Women who have had a CS are at increased risk of deep vein thrombosis and pulmonary embolism. Pay particular attention to women who have chest symptoms, such as cough or shortness of breath, or leg symptoms, such as a painful swollen calf.


Expert comment

Pat Lindsay, midwife and steering committee member of the RCN midwifery forum

‘There is a tendency to think CS is the province of midwives, but nurses often come into contact with pregnant women who may ask for advice. With increasing numbers of complex pregnancies, women may be cared for on general wards in hospitals too. Nurses should make sure they understand the pros and cons of CS and can refer women to sources of information.

‘Many trusts also employ nurses on postnatal wards where they may be looking after women who have had a CS. It’s important to think about their psychological needs. Nurses also play a key role in advising women how they can reduce their chances of infection, including seeking attention if they feel unwell.’


Find out more

Royal College of Obstetricians and Gynaecologists

NICE guidance: Caesarean section (November 2011)

NICE guidance: Postnatal care (July 2013)

NICE guidance: Hypertension in pregnancy

Multiple Births Foundation

National Childbirth Trust

Disability, Pregnancy and Parenthood

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