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Information for people requesting a planned caesarean birth

Patient information

This leaflet contains information and evidence that you may find helpful in making decisions about giving birth by planned Caesarean Section.

If you do not understand any of the words or phrases used in this leaflet, ask your midwife or doctor to explain them to you clearly. You can bring someone with you to your appointments if you think you might need some support in understanding what is said or in making decisions.

Introduction

Caesarean birth is the preferred mode of birth only when it is considered that the risks of vaginal birth outweigh the possible benefits.The NICE Guideline recommends that where caesarean birth is requested, without medical reason, that we should discuss with you the overall benefits and risks of caesarean birth compared with vaginal birth, and if caesarean birth is still your preferred option, we will facilitate this. Some reasons for this may include:

  • previous birth experience
  • complications in current pregnancy
  • anxiety or fear of giving birth
  • concerns of safety of vaginal birth
  • cultural reasons

To be able to support your choice and aid your decision making around the birth of your baby the following information will guide you in the process of your request and our understanding of your personal needs to support this request.

How can I request a caesarean birth?

If you are considering a caesarean birth for any reason, the earlier that you let us know you are considering this as an option, the easier it is to be able to provide you with all the information you may need and if necessary refer you to the most appropriate services. It is never too early to mention to your care provider that you are considering a caesarean birth. In the first instance you will be referred to the Consultant Midwife Clinic to discuss your personal care and support plan. You can self-refer to this service by sending an email to this address: RosieBirthChoices@addenbrookes.nhs.uk or referral can be made through any of your care providers.

Birth Choices Clinic

At this appointment the Consultant Midwife will explore your individual needs and unique circumstances that have led you to consider a caesarean birth. This is to enable us to better understand your view of birth and to better understand what is important for you and your family. It is a two-way conversation to plan your individualised care and to make sure we document these discussions accurately to be able to communicate the outcome of the meeting with everyone involved in your care.

Sometimes it might be helpful to refer you to other supportive services to gain an in-depth understanding of your request. This might include Psychological Well-Being services or Birth Afterthoughts service for example. It is your choice to accept or decline any referral.

The Psychological Well-Being service is specific to each county, therefore, if you are not living in Cambridgeshire please talk to you community midwife or GP to be referred to the service in your local area.

Once you have met with the Consultant Midwife and following any further referrals if you feel caesarean birth is still the right choice for you, a further meeting is arranged with a Consultant Obstetrician who will discuss the birth with you.

It maybe worth writing down any questions you may have prior to any consultations you have with either the Consultant Midwife or Consultant Obstetrician. One of which could be, ‘what happens if I go into labour before my planned caesarean?’ The answers to any questions will be individualised according to your personalised care and support plan.

These appointments should ideally be completed by 32-34 weeks of pregnancy, and for this reason early contact or referral is appreciated. The operation is usually planned for after 39 weeks of pregnancy, as this is the optimal time for the baby’s lungs to mature, and reduce the risk of breathing complications for the baby and at the same time reducing the chances of you going into spontaneous labour. These will be discussed with you in the appointments outlined above.

What are the risks to myself and my baby if I have a caesarean birth?

This is major abdominal surgery, which carries with it associated risks. Please read the Royal College of Obstetricians and Gynaecologists patient information leaflet in the link below for full details.

Non-urgent advice: Frequent risks

  • Persistent wound and abdominal discomfort, nine women in every 100 (common)
  • Repeat caesarean section in subsequent pregnancies, one woman in every 4 (very common)
  • Readmission to hospital, five women in every 100 (common)
  • Minor cuts to the baby’s skin one-two babies in every 100 (common)
  • Infection, five women in every 100 (common)
  • Haemorrhage, five women in every 1000 (uncommon).

Urgent advice: Serious risks

  • Emergency hysterectomy, seven-eight women in every 1000 (uncommon)
  • Need for further surgery at a later date, five women in every 1000 (uncommon)
  • Admission to intensive care unit, nine women in every 1000 (uncommon)
  • Increased risk of a tear in the womb in future pregnancies, two-seven women in every 1000 (uncommon)
  • Developing a blood clot, 4–16 women in every 10 000 (rare)
  • Stillbirth in future pregnancies, one-four women in every 1000 (uncommon)
  • In a future pregnancy, the placenta covers the entrance to the womb (placenta praevia), four-eight women in every 1000 (uncommon)
  • Injury to the urinary system, one woman in every 1000 (rare)
  • Death, approximately one woman in every 12 000 (very rare)

Useful information

The Royal College of Obstetricians and Gynaecologists patient information leaflet https://www.rcog.org.uk/en/patients/patient-leaflets/choosing-to-have-a-caesarean-section/

References/ Sources of evidence

Caesarean Birth (2021) National Institute for health and Clinical Excellence. Guidance ng 192 https://www.nice.org.uk/guidance/ng192/resources/caesarean-birth-pdf-66142078788805

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Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.

Other formats

Help accessing this information in other formats is available. To find out more about the services we provide, please visit our patient information help page (see link below) or telephone 01223 256998. www.cuh.nhs.uk/contact-us/accessible-information/

Contact us

Cambridge University Hospitals
NHS Foundation Trust
Hills Road, Cambridge
CB2 0QQ

Telephone +44 (0)1223 245151
https://www.cuh.nhs.uk/contact-us/contact-enquiries/