Decision Aid: Choosing how to have your baby after a Caesarean Section
This information is for you if you have previously had a caesarean section. You will be
offered an appointment at about 20 weeks at the antenatal clinic at the RVI to discuss your
options for delivery this time.
This “Decision Aid” is aimed at helping you to think about your options before your
appointment and many women also find it helpful when considering their options.
To help you make the right choice for you, we recommend that you also read the enclosed
patient information leaflet “Choices for birth after caesarean section” before your
appointment. We hope that you will find it helpful when you start to think about things that
are important to you.
If you could fill the decision aid out, after reading the patient information leaflet, it will help us
to understand how you feel about the decision and to support your choice to either try for a
vaginal (normal) birth or have a planned elective caesarean section. Please bring the
completed decision aid with you when you come for the 20-week appointment.
We would also like to encourage you to write a list of any concerns or anxieties that you may
have as well as any other notes that you have made about your choice.
We do not expect you to have made a firm decision by 20 weeks (although some women
have). We will listen to you and talk through things with you to help you gain a clearer picture
of what you want to do.
The decision to make: I have had one previous caesarean and I need to decide
whether to:
1) Have a planned (elective) repeat caesarean section
2) Plan a vaginal birth
3) Plan for a vaginal birth but have an elective caesarean if I don’t go into labour
before 42 weeks.
When do I need to make the decision?
Before my 36 week appointment with the
consultant or midwife.
Adapted from Ottawa personal decision Guide, O’Connor, Stacey, Jacobsen 2004 by Claire Leader
Please give a score to the pros and cons of each option as follows:
1 = Does not influence my decision
2 = Influences my decision a little
3 = Influences my decision moderately
4 = Influences my decision a great deal
5 = Strongly influences my decision
Scale
Planned vaginal birth - Pros
Planned caesarean section - Pros
1-5
 75 out of 100 women will achieve
vaginal birth.
1-5
 May avoid labour
 Able to plan the birth and feel in control
 Shorter hospital stay (can go home
after 6 hours at the earliest)
 Reduced risk of baby having breathing
difficulties (2-3 out of 1000 will have
breathing difficulties compared to 4 out
of 1000 who opt for ERCS)
 90 out of 100 women will achieve elective
caesarean section
 Reduced risk of the caesarean scar opening up
to 1 in 1000 women
 Reduced risk of requiring blood transfusion (10
out of 100 women will require transfusion)
 Less chance of your baby being
transferred to the neonatal unit
 Most natural way to give birth and this
has associated benefits to mother and
baby
Planned vaginal birth - Cons
Planned caesarean section - Cons
 Uncertainty about when labour will
start
 10 out of 100 women will go into labour before
the planned caesarean and deliver vaginally or
have an emergency CS
 25 out of 100 women will need an
emergency caesarean section
 Pain and difficulty moving around following the
operation
 Continuous monitoring of your baby’s
heart by cardiotocograph is advised
 Longer hospital stay (up to 3 days)
 Risk of the caesarean scar opening up
(approx 3 out of 1000 women)
 Will need caesarean section for all future
pregnancies
 Risk of hysterectomy (1 in 10,000
women)
 In future pregnancies the placenta may develop
under the scar making it difficult to remove at
caesarean section causing bleeding and
complications. This occurs in 2 out of 100
women. [Hysterectomy]
 20 out of 100 women who plan a
VBAC but need an emergency
caesarean will require a blood
transfusion.
Scale
Adapted from Ottawa personal decision Guide, O’Connor, Stacey, Jacobsen 2004 by Claire Leader
What role do you prefer in making a choice?

I prefer to share the decision with………………………………………………

I prefer to decide myself after hearing the views of……………………………

I prefer that someone else decides (who?)……………………………………..
Do you have enough support and advice from others to make a choice? Yes
Are you choosing without pressure from others?
Yes
No
No
Next Step: This section suggests next steps if you are not able to make a decision. Tick any
items you would like to try.
Knowledge (If you feel you do not have enough facts)
List your questions
Note where to find answers (eg library, health professionals, counsellors)
Find out more about the benefits and risks
Values (if you are not sure what matters most to you)
Review the scores in the grid overleaf to see what influences you most.
Talk to others who have made the decision
Read stories of what mattered most to others.
Discuss with others what matters most
Support (if you feel you do not have enough support)
Discuss your options with a trusted person (eg. Health professional
counsellor,family,friends)
Focus on the opinions of others who matter the most
Ask others to complete this guide (eg partner). Find areas of agreement.
When facts disagree, agree to get more information. When you disagree on
what matters most, respect the other person’s opinion. Take turns to listen
and then mirror back what the other has said that matters most to them.
Adapted from Ottawa personal decision Guide, O’Connor, Stacey, Jacobsen 2004 by Claire Leader
Notes and questions prior to your appointment:
Adapted from Ottawa personal decision Guide, O’Connor, Stacey, Jacobsen 2004 by Claire Leader