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A class to help you explore your options for Birth after Caesarean

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Columns are titled for ease of searching - there is also a search box in the top righthand corner if you know which topic you are looking for

Click on the website link/page/document to either view or download

Use the grey bar to the side of each column and at the bottom to scroll up and down or along

Please note that CW Trust is not responsible for information and links provided by outside organisations

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Information on why we may ask you to "step on the scales" following the birth

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The padlet which accompanies the main antenatal course

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Slides from the workshop

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A selection of videos promoting pelvic health, also in other languages

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Pelvic Health and Wellbeing during Pregnancy and After Birth Videos
To translate this page into another language then please use the recite me accessibility toolbar. The accessibility toolbar can be used to adjust elements for individual needs. This looks at aspects such as font style, size, colour, zoom functionality, keyboard navigation, screen readers and more.
The London Maternity Clinical Network has collaborated with Imperial College Healthcare Trust, North West London Local Maternity and Neonatal System (LMNS), South West London LMNS, South East London LMNS, LMNS service-user representatives, Maternity Voices Partnership, and other NHS professionals to create a series of videos about the changes the body undergoes before, during, and after birth. From pelvic floor health and bladder care, to posture and returning to exercise, these videos have been developed by NHS Physiotherapists and Healthcare professionals and will provide information and useful advice about supporting your body's journey through pregnancy and beyond.

These videos will enable women to:​

Understand and manage physiological changes that occur in pregnancy​

Optimise pelvic floor health​

Understand how to exercise safely in pregnancy and after birth ​

Be knowledgeable about self care in the postnatal period​

Know when to seek medical advice and referral​

Pelvic health and wellbeing during pregnancy and after birth
POGP are hosting these videos in support of the educational value and relevance of the content, this does not imply direct involvement in its development.

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Pelvic Health and Wellbeing during Pregnancy Videos

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To translate this page into another language then please use the recite me accessibility toolbar. The accessibility toolbar can be used to adjust elements for individual needs. This looks at aspects such as font style, size, colour, zoom functionality, keyboard navigation, screen readers and more.

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How and when to do pelvic floor exercises

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How and when should I do pelvic floor exercises? | NHS

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Improving your baby’s position for birth

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Improving your baby’s position for birth

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“Spinning Babies”

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Parenthood Starts with Pregnancy

You and your baby are working together! Your job is to dilate, baby's job is to rotate. Empower yourselves with our daily activities, body balancing techniques, and smart birth positions for a more comfortable, confident birth.

Proactive Preparation for Easier Birth

Join others who are enthusiastic for your life-giving year! Find a Spinning Babies ® Certified Parent Educator to start using techniques for comfort in pregnancy and smoother progress in labor through our unique approach to physiological birth.

Help Change Birth on Earth

Find Spinning Babies ® Workshops and events near you to start helping parents experience a more confident and comfortable birthing process for both themselves and their baby.

For additional education to even further enhance your pregnancy and labor preparation, shop our extensive collection of digital downloads, videos, DVDs, workbooks, and more.

Daily Essentials can be practiced daily throughout pregnancy to help bring balance and comfort - and an easier, shorter birth.

Spinning Babies® Parent Class

Spinning Babies® Parent Class provides clear instructions on how to use Spinning Babies® for a more comfortable and confident pregnancy and labor.

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Spinning Babies - Comfort in Pregnancy and Easier Birth

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Parenthood Starts with Pregnancy You and your baby are working together! Your job is to dilate, baby's job is to rotate. Empower yourselves with our daily activities, body balancing techniques, and smart birth positions for a more comfortable, confident birth. Proactive Preparation for Easier Birth Join others who are enthusiastic for your life-giving year!

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Information from The National Institute of Clinical Excellence ("NICE")

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It's your right to be involved in making choices about your care. To make a decision, you need to know what your options are and what might happen if you don't want any treatment or care.

Get information on what to do:

before you see your health or care professional

when you see your health or care professional

when involving other people

when you cannot give consent.

Shared decision making is when health professionals and patients work together. It puts you at the centre of decisions about your own treatment and care.

This means that:

different choices available to the patient are discussed

care or treatment options are explored in full, along with the risks and benefits

patients reach a decision with their health and social care professional.

Our guide contains advice to help you access treatments and care that we've recommended. It includes advice on what to do:

if you are not able to obtain treatments that are suitable for you

to access drugs and medicines recommended by our guidance

if you think that your care is not following NICE's recommendations

to find sources of support.

Find out about:

the licensing of medicines

unlicensed medicines and 'off-label' use

accessing drugs and medicines recommended by a technology appraisal

questions that might be useful to ask about medicines

NICE evidence summaries.

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It's your right to be involved in making choices about your care. To make a decision, you need to know what your options are and what might happen if you don't want any treatment or care.

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Connect with The Positive Birth Movement

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We are a global network of individuals and free to attend antenatal groups, linked up by social media. We connect pregnant women together to share stories, expertise and positivity about childbirth. Join us as we meet up, link up and shake up birth!

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Lots of great videos to view

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Birth after Caesarean

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Published: July 2016

Please note that this information will be reviewed every 3 years after publication.

This information is for you if you have had one caesarean birth and want to know more about your birth options when having another baby.

It may also be helpful if you are a partner, relative or friend of someone who is in this situation.

The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

This information covers:

Choices for birth after having one previous caesarean

The chances of a successful vaginal birth after caesarean (VBAC)

The advantages and disadvantages of VBAC and when it isn't advisable

The advantages and disadvantages of an elective (planned) repeat caesarean (ERCS)

What happens during labour if you're planning a VBAC

What happens if you are planning a VBAC but you don't go into labour

What happens if you have an ERCS planned but you go into labour

Within this information, we may use the terms 'woman' and 'women'. However, it is not only people who identify as women who may want to access this information. Your care should be personalised, inclusive and sensitive to your needs, whatever your gender identity.

A glossary of medical terms is available at A-Z of medical terms.

Key points

If you are fit and healthy, both VBAC and ERCS are safe choices with very small risks.

3 out of 4 women who have had one caesarean section and then have a straightforward pregnancy and go into labour naturally give birth vaginally.

9 out of 10 women will have a successful VBAC if they have ever given birth vaginally. Successful VBAC has the fewest complications.

Giving birth vaginally carries small risks for you and your baby but, if you have a successful vaginal birth, future labours are less complicated with fewer risks for you and your baby.

Having a caesarean section makes future births more complicated.

Most women who have a planned caesarean section recover well and have healthy babies, but it takes longer to get back to normal after your baby is born.

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on the RCOG Green-top Clinical Guideline Birth after Previous Caesarean Birth.

This information was reviewed before publication by women attending clinics in Raigmore Hospital, King's College Hospital, Queen's Hospital, St Mary's Hospital, University Hospital Lewisham and Wrexham Maelor Hospital, by the RCOG Women's Network and by the RCOG Women's Voices Involvement Panel.

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Birth after previous caesarean patient information leaflet

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General information from the NHS

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A caesarean section, or C-section, is an operation to deliver your baby through a cut made in your tummy and womb.
The cut is usually made across your tummy, just below your bikini line.

A caesarean is a major operation that carries a number of risks, so it's usually only done if it's the safest option for you and your baby.

Around 1 in 4 pregnant women in the UK has a caesarean birth.

Why caesareans are carried out

A caesarean may be recommended as a planned (elective) procedure or done in an emergency if it's thought a vaginal birth is too risky.

Planned caesareans are usually done from the 39th week of pregnancy.

A caesarean may be carried out because:

your baby is in the breech position (feet first) and your doctor or midwife has been unable to turn them by applying gentle pressure to your tummy, or you'd prefer they did not try this

you have a low-lying placenta (placenta praevia)

you have pregnancy-related high blood pressure (pre-eclampsia)

you have certain infections, such as a first genital herpes infection occurring late in pregnancy or untreated HIV

your baby is not getting enough oxygen and nutrients - sometimes this may mean the baby needs to be delivered immediately

your labour is not progressing or there's excessive vaginal bleeding

If there's time to plan the procedure, your midwife or doctor will discuss the benefits and risks of a caesarean compared with a vaginal birth.

Asking for a caesarean

Some women choose to have a caesarean for non-medical reasons.

If you ask your midwife or doctor for a caesarean when there are not medical reasons, they'll explain the overall benefits and risks of a caesarean to you and your baby compared with a vaginal birth.

If you're anxious about giving birth, you should be offered the chance to discuss your anxiety with a healthcare professional who can offer support during your pregnancy and labour.

If after discussing all the risks and hearing about all the support on offer you still feel that a vaginal birth is not an acceptable option, you should be offered a planned caesarean. If your doctor is unwilling to perform the operation, they should refer you to a doctor who will.

What happens during a caesarean

Most caesareans are carried out under spinal or epidural anaesthetic.

This mean you'll be awake, but the lower part of your body is numbed so you will not feel any pain.

During the procedure:

a screen is placed across your body so you cannot see what's being done - the doctors and nurses will let you know what's happening

a cut about 10 to 20cm long will usually be made across your lower tummy and womb so your baby can be delivered

you may feel some tugging and pulling during the procedure

you and your birth partner will be able to see and hold your baby as soon as they have been delivered if they're well - a baby born by emergency caesarean because of foetal distress may be taken straight to a paediatrician for resuscitation

The whole operation normally takes about 40 to 50 minutes.

Occasionally, a general anaesthetic (where you're asleep) may be used, particularly if the baby needs to be delivered more quickly.
Find out more about how a caesarean is carried out

Recovering from a caesarean

Recovering from a caesarean usually takes longer than recovering from a vaginal delivery.

Providing there are no complications, most women can go home 1 to 2 days after having a caesarean.

You may experience some discomfort in your tummy for the first few days. You'll be offered painkillers to help with this.

When you go home, you'll need to take things easy at first. You may need to avoid some activities, such as driving, until you have had your postnatal check-up with the doctor at 6 weeks.

The wound in your tummy will eventually form a scar. This may be obvious at first, but it should fade with time and will often be hidden in your pubic hair.
Find out more about recovering from a caesarean

Risks of a caesarean

A caesarean is generally a very safe procedure, but like any type of surgery it carries a certain amount of risk.

It's important to be aware of the possible complications, particularly if you're considering having a caesarean for non-medical reasons.

Possible complications include:

infection of the wound or womb lining

blood clots

excessive bleeding

damage to nearby areas, such as the bladder or the tubes that connect the kidneys and bladder

temporary breathing difficulties in your baby

accidentally cutting your baby when your womb is opened

Find out more about the risks of a caesarean

Future pregnancies after a caesarean

If you have a baby by caesarean, it does not necessarily mean that any babies you have in the future will also have to be delivered this way.

Most women who have had a caesarean section can safely have a vaginal delivery for their next baby, known as vaginal birth after caesarean (VBAC).

But you may need some extra monitoring during labour just to make sure everything is progressing well.

Some women may be advised to have another caesarean if they have another baby.

This depends on whether a caesarean is still the safest option for them and their baby.

For more information, read the Royal College of Obstetricians and Gynaecologists leaflet on birth options after previous caesarean section.

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Find out why caesarean sections are carried out, whether you can ask for one, what they involve, and what the risks are.

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RCOG guide to choosing a Caesarean birth

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Considering a caesarean birth patient information leaflet | RCOG

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This information is for you if you are considering a planned (elective) caesarean birth for your baby. It may also be helpful if you are a partner, relative or friend of someone who is considering a caesarean birth.

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Important information for women at BOTH sites

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What will the day look like?

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A caesarean birth is an operation to deliver your baby through a cut made in your tummy and womb. About a quarter of babies are born by caesarean birth and two thirds of these deliveries are unexpected. Our information helps you to understand the pain relief choices available to you should you need a caesarean birth.

Watch this video in another language

Elective vs emergency caesarean birth

If you know beforehand you'll be having a caesarean birth, it's called an elective operation. Your appointment will normally be before your baby's due date, so you don't go into labour.

An emergency caesarean is where your obstetrician recommends a caesarean birth, usually when you are already in labour. If it is very urgent (usually because there is a sudden problem with your baby), then some of the preparations we would normally do may be changed or even left out.

Types of pain relief

There are two main types of anaesthetic for your caesarean birth: you will either be awake (regional anaesthetic) or asleep (general anaesthetic).

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A caesarean birth is an operation to deliver your baby through a cut made in your tummy and womb. About a quarter of babies are born by caesarean birth and two thirds of these deliveries are unexpected. Our information helps you to understand the pain relief choices available to you should you need a caesarean birth.

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How caesarean birth should be...

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Baby-friendly caesarean birth | Maidstone and Tunbridge Wells NHS Trust

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Tips for getting back to full health after caesarean birth

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Explanation of common symptoms/ problems

A caesarean section is a major operation and will take several weeks to recover from (it generally takes longer than if you have had a vaginal birth). It is therefore important that you can have time to rest but also know what to do to help your body recover. This webpage will provide you with information to help you with your recovery.

Approximately 25% of women in the UK have their baby by caesarean section. This may be due to:

Your baby being in the breech position in late pregnancy

A low-lying placenta (placenta previa)

High blood pressure in pregnancy (pre-eclampsia)

Certain infections in late pregnancy

Not enough oxygen and nutrients getting to your baby

Labour not progressing

Your choice (due to different concerns about birth or having had a previous caesarean)

In the first week or two after having a caesarean it is common to experience discomfort or even pain when getting in/out of bed, walking any distance, carrying out any activities that cause strain on your tummy and when going to the toilet to pass urine or open your bowels. This is because of the wound in your tummy and womb and how your tummy muscles, bladder and bowel have been moved around during surgery. Having an anesthetic and pain medication can also leave you feeling more tired than usual and can sometimes cause sickness.

Usually the wound heals well and scar tissue will form within 3-4 weeks. A few women may get a wound infection, so if your pain is not settling, the wound becomes hot and red or you notice a discharge from your wound, tell your GP or midwife straight away. As the scar forms it can leave a strange numb feeling over it. For a few women too much scar tissue can form and leave the scar feeling tight and sore.

You may notice or have been told by a midwife or physiotherapist that your tummy muscles have separated during your pregnancy. This is known as diastasis rectus abdominus muscle or DRAM. Having a DRAM as well as a caesarean can leave your tummy muscles along with your pelvic floor muscles feeling very weak. Follow the link to DRAM to find out more and what to do about it.

Self help / Advice

In the first couple of days after your caesarean, whilst you are still in hospital, it is important to start moving as soon as possible. This will help with your circulation and breathing and stop your muscles and joints becoming too stiff and sore. You will be given some pain relief to help you move more easily and it is important to keep taking this at regular intervals.

You will have a catheter in your bladder for approximately 12 hours after your caesarean. It is important that you start eating and drinking normally as soon as you can so that once the catheter is removed you can start passing urine on your own. If you are having problems passing urine in the first few hours after your catheter is removed, tell your midwife.

It is normal to pass urine every three to four hours. Try to avoid going to the toilet 'just in case' see top 10 tips.

Eating and drinking normally will also help your bowels to work although it can be a couple of days after birth before this happens. It is important to avoid constipation as straining to empty your bowels will put pressure on your wound and pelvic floor muscles, which isn't helpful for their recovery. Follow the link for Healthy Bowels.

Your wound dressing will come off after a couple of days. It is fine to have a bath or shower as soon as you feel able to after birth. Wash over your wound with warm water, avoiding too much soap/ body wash over the area. It is important to keep the area clean and dry.

Here are some suggestions for comfortable resting/ sleeping positions.

It should also be easier to get in and out of bed by gently rolling onto your side ( Follow the link to Fit for the Future leaflet).

Do some deep breathing in the first couple of weeks after having a caesarean (three slow breaths one after the other). This will help to get more air into your lungs and help to relax your tummy muscles. Placing a pillow or towel over your tummy and supporting it will help to make it feel more comfortable when you cough, sneeze or open your bowels.

Where possible avoid doing activities that put strain on your tummy. It is best to lift nothing heavier than your baby for the first 6 weeks. If you have a toddler that does need to be lifted and carried try to do this only when necessary, encourage them to stand on a step or high surface for you to lift them from and bend from your knees keeping your back straight (see diagram).

Once your wound has healed over and the scar tissue has formed you can start to gently massage over it. You can use an oil such as coconut or bio oil whilst massaging. Try to do this every day. It will help to reduce sensitivity and/or tightness of the scar tissue.

Avoid driving for 4-6 weeks. When you do decide to drive, make sure that you are covered by your insurance company and that you feel comfortable performing an emergency stop if it is needed.

It is good to do some gentle exercise in the first 6 weeks after your caesarean. Start your pelvic floor muscles exercises as soon as is comfortable after your catheter is removed. There are also some gentle tummy exercises that you can do (see Fit for the Future booklet) These exercises are suitable to do even if you have a DRAM. And walking is a good form of exercise. Just remember to build speed and distance up gradually as it feels comfortable.

If you are feeling well after your 6-8 week postnatal check with your GP you can start some brisk walking and start swimming. Don't start back with high impact exercises too soon such as running, Zumba, cross fit. (see link to postnatal running guidelines below).

Return to sexual intercourse when you feel ready and have arranged which contraception to use. Start gently and you may find it helpful to use a water-based lubricant for comfort.

Where to go next
Find a Physiotherapist
If you are experiencing any of the problems mentioned on this page discuss them with your GP or midwife. It may be that seeing a specialist women's health physiotherapist will be helpful to you. Your GP or midwife can refer you or in some locations you can refer yourself. The POGP may also be able to put you in touch with a women's health physiotherapist near to where you live.

Other good sources of information:

What to expect from physiotherapy

A women's health physiotherapist can help you with several problems after a caesarean such as:

Low back pain or pelvic girdle pain

Urinary incontinence or faecal incontinence

Pain from your caesarean scar

Problems with returning to sex

General difficulty getting back to daily activities or exercise

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Explanation of common symptoms/ problems A caesarean section is a major operation and will take several weeks to recover from (it generally takes longer than if you have had a vaginal birth). It is therefore important that you can have time to rest but also know what to do to help your body recover.

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What can help

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Youtube video on how to do it

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Information about Caesarean in other languages

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Information about Caesarean in other languages

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Click on your own language for more information

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About our translations

We are now expanding our portfolio of translations of our main publications beyond the 20 most common languages used in the UK following feedback at meetings and our enquiries page. We are really grateful to the charity Translators without Borders who are helping us to reach mothers and families of all nationalities. Newer additional translations have been generously provided by OAA members to help us to support some other languages. Where possible, these have been quality assured by professionals and/or peer colleagues. We trust these translations to be as accurate as possible and hope that they are useful to you.

Can you help grow our range of translations?

We are always looking for volunteers to help us expand the range of translated material we offer. If you are able to help translate our materials into new languages we would love to hear from you.
Get in touch

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We are now expanding our portfolio of translations of our main publications beyond the 20 most common languages used in the UK following feedback at meetings and our enquiries page. We are really grateful to the charity Translators without Borders who are helping us to reach mothers and families of…

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This is not something we encourage or discourage, but the attached may help you decide if it is for you.

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Postpartum belly wraps are a type of abdominal binding. Learn about the risks and benefits of wearing them, what to expect, and more.

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Information from the Royal College of Obstetricians and Gynaecologists

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Ways of staying mobile particularly with an epidural

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Information from the National Childbirth Trust

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What is a VBAC?

A vaginal birth after caesarean (VBAC) is when a woman gives birth vaginally, after having had a caesarean previously. Vaginal birth includes a straightforward vaginal delivery and a birth assisted by forceps or ventouse (RCOG, 2016).

"You might be able to have a VBAC even if you've had more than one previous caesarean."

What are the advantages and risks of having a VBAC?

What are the advantages of a VBAC?

VBAC is an option for most women, and research shows that when a VBAC is successful it has fewer complications than an elective repeat caesarean section (ERCS). Most women are able to have a successful VBAC without any complications (NHS Choices, 2017).

The advantages of a successful vaginal birth are:

A greater chance of a vaginal birth in future pregnancies.

Recovery and returning to everyday activities is likely to be quicker.

Your stay in hospital might be shorter.

You are more likely to be able to have skin-to-skin contact with your baby immediately after birth, which might help you to establish breastfeeding successfully.

By having a VBAC you avoid the risks of an operation.

Your baby will have less chance of initial breathing problems. (RCOG, 2016)

What are the risks of VBAC?

The risks vary and depend on your obstetric history, the reasons for any previous caesarean(s), and whether you have previously given birth vaginally.

Risks of VBAC include the scar from the previous caesarean birth opening up (uterine rupture). This affects around one in 200 women trying for a VBAC. That risk is increased two to three fold if labour is induced.

Not everyone who plans a VBAC will succeed in having one. Out of 100 women attempting a VBAC, 25 will need an emergency caesarean.

Sometimes opting for a VBAC isn't advised. For example, if you've previously had a uterine rupture, significant uterine stretching or uterine surgery, or have a vertical scar on your uterus or placenta praevia. (RCOG, 2016; NHS Choices, 2017)

Will I need extra monitoring during a VBAC?

If you're having a VBAC, you will usually be offered extra monitoring during labour (NHS Choices, 2016). This will include the baby's heartbeat being monitored continuously once you're having regular contractions (RCOG, 2016). Extra monitoring checks everything is progressing well and detects any early signs of problems with your previous caesarean scar (RCOG, 2016).

Due to the risks, you'll be advised to give birth in a hospital labour ward with facilities for immediate caesarean and blood transfusion (NICE, 2012).

What if my midwife says I shouldn't have a VBAC?

If you choose to plan a vaginal birth after previously giving birth by caesarean, your preferences and priorities should be taken into account (NICE, 2012). A woman in the UK who is deemed to have capacity to consent has the right to refuse a caesarean, and this should be respected (NICE, 2012).

Where it is difficult to agree a mutually acceptable solution between you and your healthcare professionals, you might choose to request a second opinion (NHS Choices, 2016b). Depending on your local area, you might be able to request a discussion with a specialist midwife to discuss your birth plan (NICE, 2012).

Can I have a VBAC if I've had more than one caesarean birth?

Even if you've had up to four previous caesarean sections, there is no difference in the risk of fever or injuries between a VBAC and a planned caesarean. Your risk of risk of uterine rupture is higher but it's still rare (NICE, 2012).

There is a slightly increased risk of hysterectomy and blood transfusion in women having a VBAC after two previous caesarean births, compared with one previous caesarean birth (RCOG, 2015b). If you're considering a vaginal birth after more than one caesarean birth, do discuss the potential risks, benefits and success rates with a senior obstetrician (RCOG, 2015b).

Can I plan for a VBAC home birth?

It'll be recommended that you give birth in hospital because you'd have immediate access to caesarean section and on-site blood transfusion facilities if you needed it (North Lincolnshire NHS Trust, 2011; NICE, 2012). You can ask to discuss whether a home birth might be suitable for your particular situation with your midwife and obstetrician (North Lincolnshire NHS Trust, 2011).

How likely am I to have a successful vaginal birth after a caesarean?

Research suggests that the chances of a successful VBAC are:

85% to 90% if you have had a previous baby vaginally in the past

58% to 75% after one or two previous caesarean births.(RCOG, 2015a; NMPA, 2018)

Statistics for local maternity services including VABC success rates can be found via WHICH Birth Choice and are listed for each NHS maternity site at the end of the NMPA report.

The success rates for VBAC are lower if you have:

your labour induced or speeded up

only ever given birth by caesarean

a BMI greater than 30 at that start of pregnancy

previously had a caesarean section because of a difficult labour. (RCOG, 2015a)

If all four of these apply to you, the chance of having a successful VBAC is reduced to 40% (RCOG, 2015a).

Some women find it hard to decide what to plan for or find it very emotional, after having a caesarean birth, especially if it was an emergency caesarean. There is plenty of perinatal support available if you need it.

It's a good idea to talk through your birth options with your partner. You can also discuss any medical concerns with your midwife, health visitor or GP.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

NHS Choices has an article that you might find useful, called How do I get a second opinion?

You can look at the statistics for your local hospital on caesarean section rates and VBAC rates on the Which? Website.

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Vaginal birth after a caesarean | Labour & birth, Different types of birth articles & support | NCT

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We discuss the advantages and risks of a vaginal birth after a caesarean and answer questions you might have about vaginal births after caesarean.

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All your options - explained (also in other languages)

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About our translations

We are now expanding our portfolio of translations of our main publications beyond the 20 most common languages used in the UK following feedback at meetings and our enquiries page. We are really grateful to the charity Translators without Borders who are helping us to reach mothers and families of all nationalities. Newer additional translations have been generously provided by OAA members to help us to support some other languages. Where possible, these have been quality assured by professionals and/or peer colleagues. We trust these translations to be as accurate as possible and hope that they are useful to you.

Can you help grow our range of translations?

We are always looking for volunteers to help us expand the range of translated material we offer. If you are able to help translate our materials into new languages we would love to hear from you.
Get in touch

# data[].attributes.attachment_link.description
We are now expanding our portfolio of translations of our main publications beyond the 20 most common languages used in the UK following feedback at meetings and our enquiries page. We are really grateful to the charity Translators without Borders who are helping us to reach mothers and families of…

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What you need to know about having an epidural

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An epidural is an injection in your back to stop you feeling pain in part of your body. Here, you'll find useful information and frequently asked questions on epidural anaesthesia for pain relief in childbirth.

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What are epidurals?

Epidurals are the most complicated method of labour pain relief and are given by an anaesthetist. An anaesthetist is a doctor who is specially trained to give anaesthetics and pain relief.

Facts about epidurals:

Epidurals can be the most effective method of pain relief for labour.

For an epidural, the anaesthetist inserts a needle into the lower part of your back and uses it to place an epidural catheter (a very thin tube) near the nerves in your spine. The epidural catheter is left in place when the needle is taken out so you can be given painkillers through it during your labour. The painkillers may be a local anaesthetic to numb your nerves, small doses of opioids, or a mixture of both.

An epidural may take 40 minutes to work to give pain relief (including the time it takes to put in the epidural catheter).

An epidural should not make you feel drowsy or sick.

Having an epidural may increase the chance that your obstetrician will need to use a ventouse (a suction cap on your baby's head) or forceps to deliver your baby.

An epidural can usually be topped up to provide anaesthesia and pain relief if you need a ventouse, forceps or a caesarean birth.

An epidural will have very little effect on your baby.

Epidurals can be slow to work, especially if you have been given on one late in labour. If the painkillers are injected into the bag of fluid surrounding the nerves in your back, they work much faster. This is called a spinal. Unlike an epidural, it is given as a one-off injection without a catheter. If an epidural catheter is put in at the same time, this is called a combined spinal-epidural.

In some hospitals, a combined spinal-epidural may be given to most women who ask for an epidural for stronger pain relief. In other hospitals, a combined spinal-epidural is only used for a selected number of women who may benefit most from this particular type of epidural.

Most people can have an epidural, but certain medical conditions (such as spina bifida, a previous operation on your back or problems with blood clotting) may mean that it is not suitable for you. The best time to find out about this is before you are in labour. If you have a complicated or long labour, your midwife or obstetrician may suggest that you should have an epidural as it may help you or your baby.

If you are overweight, it may take longer to put in an epidural. Once it is in and working, you can have all the benefits.

First, a cannula (a fine plastic tube) will be put in a vein in your hand or arm, and you will usually have a drip (intravenous fluid) running as well (you may also need a drip in labour for other reasons, such as to give you medication to speed up your labour or to treat you if you are feeling sick).

You will be asked to curl up on your side or sit bending forwards, and your anaesthetist will clean your back with an antiseptic solution. Your anaesthetist will inject local anaesthetic under your skin, so that putting in the epidural does not usually hurt much.

The epidural catheter is put into your back to be near the nerves in your spine. Your anaesthetist has to be careful not to puncture the bag of fluid that surrounds your spinal cord so to avoid you getting a headache afterwards. It is important to keep still while the anaesthetist is putting in the epidural, but after the epidural catheter is stuck into place with a dressing and tape you will be free to move. Once the epidural catheter is in place, you will be given painkillers through it.

During labour, you can have extra doses of painkillers through the epidural catheter either as a quick injection (a top-up), a slow, steady flow using a pump, or with a patient-controlled epidural analgesia (PCEA) pump. With patient-controlled epidural analgesia, you can give yourself doses of the painkiller when you need them by pressing a button attached to the pump.

In each hospital there will usually only be one, or possibly two, of these methods for keeping the epidural pain relief going.

After each epidural top-up, the midwife will take your blood pressure regularly in the same way as when the epidural was started.

Having an epidural should not affect the condition of your baby when it is born, in fact newborns are less likely to have acid in their blood. Having an epidural does not make it any harder to breastfeed.

Sources:

Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2005, Issue 4. Article number: CD000331. Date of issue: 10.1002/14651858.CD000331.pub2.

Reynolds F, Sharma S, Seed PT. Analgesia in labour and funic acid-base balance: a meta-analysis comparing epidural with systemic opioid analgesia. British Journal of Obstetrics and Gynaecology 2002; 109: 1344-1353.

Wilson MJA, MacArthur C, Cooper, GM, Bick D, Moore PAS, Shennan A. Epidural Analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non-epidural comparison group. Anaesthesia 2010 65: 145-153.

No, with an epidural, you do not have a higher chance of needing a caesarean birth. There is also no greater chance of long-term backache. Backache is common during pregnancy and often continues afterwards. You may have a tender spot in your back after an epidural which, on rare occasions, may last for months. There is no increased chance of long-term backache.

Sources:

Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2005, Issue 4. Article number: CD000331. Date of issue: 10.1002/14651858.CD000331.pub2.

16 Russell R, Dundas R, Reynolds F. Long term backache after childbirth: prospective search for causative factors. British Medical Journal 1996; 312: 1384-1388.

One in every 100 women who have an epidural may get a headache. You can read more about this on our headache after an epidural or spinal injection page.

Permanent nerve damage is very rare with an epidural, affecting about 1 in 13,000 women. Find more information on our Epidural Information Card.

For 1 in 8 women, the epidural might not work well enough to reduce labour pain so you need to use other ways of reducing the pain.

Strong solutions of local anaesthetic in your epidural can increase the risk of instrumental delivery but there is no evidence that this is the case for most commonly used "low dose" epidurals.

With an epidural, the second stage of labour (when your cervix is fully dilated) is longer and you are more likely to need medication (oxytocin) to make your contractions stronger.

You have more chance of having low blood pressure.

Your legs may feel weak while the epidural is working.

You will find it difficult to urinate. You will probably need to have a tube passed into your bladder (a bladder catheter) to drain the urine.

You may feel itchy or develop a slight fever.

To get more information on the side effects of epidurals and spinals, please see our Epidural Information Card.

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An epidural is an injection in your back to stop you feeling pain in part of your body. Here, you’ll find useful information and frequently asked questions on epidural anaesthesia for pain relief in childbirth.

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An explanation of how we are working to minimise tearing in labour

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Things to consider ....

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Positive birth stories

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VBAC — Positive Birth Stories From Our Community - Read Now

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The Positive Birth Company is on a mission to support you from the moment you start thinking about planning for a baby, to the day they eventually go to school. We do this through life-changing online courses, incredible online communities and access to some of the best minds in the fields of birth, health and psychology. Our resources are affordable and accessible to all, no matter where you are or how busy your life is.

We are The Positive Birth Company and we are your virtual village.

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A guide to perineal massage. This is not something that you HAVE to do, but some studies have shown that it can be helpful for vaginal birth.

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Information on how and why we listen to your baby's heartbeat during labour

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What does the birthing room look like?

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Birth Centre Postnatal Room Tour (Chelwest)

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Birth Centre Postnatal Room Tour (Chelwest)

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Where will I stay after the birth?

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One of our lovely birthing rooms

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A post shared by 🌕 𝐿𝓊𝓃𝒶𝓇 𝐵𝒾𝓇𝓉𝒽 𝒞𝑒𝓃𝓉𝓇𝑒 (@lunarbirthcentre)

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Photos of Chelsea & Westminster and West Middlesex Maternity Units

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Some of the evidence mentioned in the BAC Workshop can be found here

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Caesarean section rates have increased in many countries, including the UK, where around 30% of all births now occur by caesarean. This has led to increasing numbers of pregnant women with a history of previous caesarean section. Pregnant women who have had previous caesarean section should be offered the opportunity to discuss whether, in light of their own clinical circumstances, to:

plan another birth by caesarean (known as an Elective Repeat Caesarean Section or ERCS)
or

plan a vaginal birth (known as a planned Vaginal Birth After previous Caesarean or VBAC)

Clinical guidelines advise that women should be counselled about the benefits and harms of planning another caesarean compared to planning a vaginal birth. However, more research is needed to fully understand what the short and longer-term benefits and harms of these two options are for women and their children.

What was the aim of this research?

For women who have had a caesarean section in the past, this research aimed to find out the short and longer-term effects of planning a vaginal birth compared to planning another caesarean section on women and their children.

In doing so, the research aimed to provide information to help women make an informed decision about this aspect of their maternity care.

How was the research done?

The research used existing information on up to 74,043 births to women who have had one or more previous caesarean sections in Scotland. Information about the mother and child was obtained from a number of existing Scottish national data sources including:

Birth records

Death records

Records of hospital care

Records of medicines that have been prescribed and dispensed

Records of child health reviews carried out on pre-school children

School records

The information from these data sources was linked together by an independent organisation with expertise in linking these records, working to strict data security regulations and under contract to the Information Services Division (ISD) Scotland. Personal identifiable information such as names were removed before the researchers were given access to the data.

Findings from this research

Findings from this research have been published:

Fitzpatrick KE, Kurinczuk JJ, Bhattacharya S, Quigley MA (2019) Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland. PLoS Med 16(9): e1002913. https://doi.org/ 10.1371/journal.pmed.1002913
View the publication
Fitzpatrick KE, Quigley MA, Smith DJ, Kurinczuk JJ. Planned mode of birth after previous caesarean section and women's use of psychotropic medication in the first year postpartum: a population-based record linkage cohort study. Psychological Medicine 2021; 1-12. doi: 10.1017/S003329172995322
View the publication
Fitzpatrick KE, Kurinczuk JJ, Quigley MA. Planned mode of birth after previous caesarean section and special educational needs in childhood: a population-based record linkage cohort study. BJOG: An International Journal of Obstetrics and Gynaecology 2021; https//doi.org/10.1111/1471-0528.16828
View the publication
Fitzpatrick KE, Abdel-Fattah M, Hemelaar J, Kurinczuk JJ, Quigley MA (2022) Planned mode of birth after previous cesarean section and risk of undergoing pelvic floor surgery: A Scottish population-based record linkage cohort study. PLoS Med 19(11): e1004119. https://doi.org/ 10.1371/journal.pmed.1004119
View the publication
Who lead and funded this research?

This research was led by Kate Fitzpatrick at the NPEU, University of Oxford.

She was funded by a National Institute for Health Research ( NIHR) Doctoral Research Fellowship (DRF-2016-09-078) for this research project.

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The National Perinatal Epidemiology Unit (NPEU) is a multidisciplinary research unit based at the University of Oxford. Our work involves running randomised con

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Advice from the Northwest London Health Board

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Preparing for and recovering from caesarean birth and postnatal scar massage :: North West London ICS

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This is a series of short videos created by expert health professionals with advice and guidance on the physical preparation and recovery for caesarean birth. A short video to guide postnatal perineal scar massage is also included.

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Please also see dedicated Induction of Labour padlet in final column or join our workshop (details below)

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Please also see dedicated Induction of Labour padlet in final column or join our workshop (details below)

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Our Induction of Labour Workshop runs every Thursday morning at 9am-10am and can be booked via Eventbrite here:

https://www.eventbrite.co.uk/e/induction-of-labour-workshop-tickets-755432658417?aff=oddtdtcreator

More resources and decision making aids for those women/birthing people considering or booked for an induction of labour available in our Induction of Labour padlet and in our dedicated online class (the class is ideally for women whose induction has already been confirmed)