Repeat caesarean

We discuss the advantages and risks of elective repeat caesarean sections. We also answer some frequently asked questions about them...

What is an ERCS?

An ERCS is an elective repeat caesarean section. They’re planned and you’d normally have an ERCS after 39 weeks of pregnancy. Babies born by caesarean earlier than this are more likely to need help with their breathing (RCOG, 2016).

Is it safer to have an ERCS or a vaginal birth after caesarean (VBAC)?

There are benefits and risks with both planned elective repeat caesarean section and planned VBAC for women with a prior caesarean birth. If you are fit and healthy, VBAC and ERCS are usually safe choices, with very small risks (RCOG, 2015a; RCOG, 2016; Norman and Stock, 2018).

Giving birth vaginally carries small risks for you and your baby, but a successful vaginal birth means future births might be less complicated with fewer risks (RCOG, 2016).

When would an ERCS be advised?

A number of circumstances mean an ERCS is likely to be advised:

  • You’ve had three or more previous caesarean deliveries.
  • You had a uterine rupture during a previous labour.
  • Your previous caesarean incision involved the upper part of the uterus.
  • If the baby is breech and attempts to turn it (a process called external cephalic version) have been unsuccessful or are unsuitable.
  • If the placenta is covering or within 2cm of the cervix (placenta praevia).   
  • You have a twin pregnancy where the first baby is breech. (NICE, 2012; RCOG, 2016)

What are the advantages and risks of an ERCS?

The following highlight the advantages and disadvantages of planning an ERCS (RCOG, 2016).

Advantages of an ERCS

• It carries a smaller risk of uterine scar rupture (one in 1000).

• It avoids the risks of labour and the rare serious risks to your baby (two in 1000).

• You’ll have more certainty of date of planned birth, although one in 10 women go into labour before this date. (RCOG, 2016)

Risks of an ERCS

• A repeat caesarean section usually takes longer and is more difficult than a first operation because of scar tissue.

• It carries a possibility of wound infection and blood transfusion.

• A higher risk of developing a blood clot (thrombosis) in the legs or lungs.

• You’d have a longer recovery period and you might need extra help at home, including being unable to drive for about six weeks after surgery.  

• Increased risk of the placenta growing into the scar, making it difficult to remove during any future deliveries (can cause bleeding and might require a hysterectomy).

• A higher likelihood of needing a planned caesarean section in future pregnancies. All serious risks increase with every caesarean section.

• Baby’s skin might be cut during the caesarean section – this happens in two out of every 100 babies delivered by caesarean section.

• Breathing problems for your baby are quite common after caesarean section but usually do not last long. Four to five in 100 babies born by planned caesarean section at or after 39 weeks have breathing problems compared with two to three in 100 following VBAC. The risks are higher if you have a planned caesarean section earlier than 39 weeks (six in 100 babies at 38 weeks). (RCOG, 2016)

Can I choose to have an ERCS?

Healthcare professionals will help you with weighing up the benefits and risks of ERCS and VBAC. They should also listen to your preferences and priorities when they advise you about the type of birth you can have after a caesarean (NICE, 2012).

If you’re anxious about having a vaginal birth, you should be offered a referral to a health professional who can help you to cope with any anxiety (NICE, 2012). If, after discussion and any support offered, you decide that you’d like a caesarean then you should be offered one.

If the first doctor you see isn’t willing to perform the caesarean, they should refer you to a doctor who will be (NICE, 2012).

Will I need another caesarean after this one if I get pregnant again?

You’re more likely to need a planned caesarean section in future pregnancies if you have had one already (RCOG, 2016). Yet it is still possible to have a vaginal birth after several caesareans.

The risks are similar for a planned caesarean section and a planned vaginal birth even in women who have had up to four previous caesareans (NICE, 2013). Although if you have a vaginal birth (VBAC) after two previous caesarean births you would have an increased risk than if you’d only had one previous caesarean (RCOG, 2015b).

So if you’ve had more than one caesarean birth, have a detailed discussion with your healthcare professional about the pros and cons of VBAC.

What can I do to prepare for and have a successful ERCS?

You’d prepare for an ERCS in the same way as you would for a first planned caesarean. You should be able to express preferences and supported to personalise your birth experience where possible.

Examples of what women might ask for include:

  • having music played in theatre
  • lowering the screen to see your baby being born
  • having silence so that the mum’s voice is the first the baby hears
  • having early skin-to-skin contact with your baby
  • extra support to help to start breastfeeding as soon as possible after the birth. (NICE, 2012)

Deciding what type of birth to plan for after having had a previous caesarean birth can be hard, especially if it was an emergency caesarean. There is plenty of emotional 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 questions you may have about ERCS with your midwife, health visitor or GP.

Still aren’t sure whether to plan for a VBAC or ERCS? Read our article on birth choices after a caesarean birth.

This page was last reviewed in June 2018

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.

Caesarean birth and VBAC information – discussion and Q&A

Statistics for your local hospital on caesarean section rates:

This film offers ideas on making caesarean births better for women and their babies and is an approach which may be new for some doctors but is the norm for others:  

NICE. (2011) Caesarean section. Available from: https://www.nice.org.uk/guidance/cg132/resources/caesarean-section-pdf-239511516613. [Last accessed 19 September 2018].

NICE. (2011) Guidelines for caesarean sections. Available from: https://www.nice.org.uk/guidance/cg132/ifp/chapter/About-this-information [Last accessed 21 August 2018].

Norman JE, Stock SJ. (2018).  Birth options after a caesarean section. BMJ. 360:j5737.  Available from:  https://www.bmj.com/content/360/bmj.j5737 [Last accessed 24 June 2018]

RCOG. (2015a) Information for you: Choosing to have a caesarean section. Available from: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-choosing-to-have-a-c-section.pdf. [Last accessed 8 June 2018].

RCOG. (2015b) Birth after previous caesarean birth. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 45. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf [Last accessed 8 June 2018].

Further reading

Dodd JM, Crowther CA, Huertas E, Guise JM, Horey D. (2013) Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth. Cochrane Database of Systematic Reviews. 12:CD004224.  Available from:  http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD004224.pub3/full  [Last accessed 24 June 2018]. 

The Royal College of Midwives. (2016) VBAC more likely with midwife-led antenatal care. Available from: https://www.rcm.org.uk/news-views-and-analysis/news/vbac-more-likely-with-midwife-led-antenatal-care. [Last accessed 4 July 2018].

WHICH. (2018) Having a c-section: what you need to know. Available from: https://www.which.co.uk/birth-choice/safety-and-interventions/having-a-c-section-what-you-need-to-know [Last accessed 28 June 2018].

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