Basically, the answer is not simple but can be guided by discussion with your HCP. There are three main ways to deliver – vaginal birth, Caesarian Section (C/S), and Vaginal Birth after C/S (VBAC).
Vaginal birth avoids a major surgical procedure and the WHO statistics suggest that 10% to 15% of births should be by C/S to maintain safety for both mum and baby. In areas in South Africa the rate for C/S is a s high as 70%. More on C/S later.
This is suitable where there are no foetal or maternal contra-indications. Please note that the baby plays a role in the decision making and sometimes prospective parents can forget this. Twins, a breech presentation, and a placenta praevia are all foetal reasons for C/S. Maternal illness or incapacity and some pre-existing medical conditions may make C/S a safer option than vaginal birth for the mother. A vaginal birth can be accompanied by most forms of pain control. The possibility of an assisted birth – either vacuum extraction or forceps – should have been mentioned and explained before labour ensues because when an assisted birth becomes necessary, there is usually very little time to explain and discuss. The trust quotient must be high.
This is safer as a planned procedure than an emergency procedure for lots of reasons, but it again it needs a high trust level if you are hoping for a vaginal birth and your HCP suggests an elective C/S. The main medical reasons for an elective C/S are twins, breech, placenta praevia, a baby “failing to thrive” and certain foetal conditions where vaginal birth would be traumatic. Maternal conditions are specific for each person. Then there is parental preference. Again, a request for an elective C/S should be discussed with the HCP as certain reasons given by the mum are actually met without the need for C/S. See the Blog on “How Should I give Birth?”.
This is s suitable in certain circumstances. See the Blog on “How Should I Give Birth?” More than two previous C/S requires a repeat C/S and so VBAC is deemed unsuitable and unsafe. Many conditions that necessitated a C/S in a previous pregnancy may not be present this time around and VBAC becomes suitable. Again, if twins, breech and placenta praevia were the reason for a first C/S then these may not be present in a future pregnancy. If a C/S was performed because of a big baby, then subsequent babies are likely to be bigger and a VBAC may not be a safe route of birth.
It really comes down to trust and individual circumstances.