Birth options

No birth is the same and each baby is precious. Giving birth is deeply personal and at Monash Women’s your preferences and choices will be supported.

Some medical conditions in the mother, conditions for the unborn baby, and things that can occur in labour may mean that birth is recommended in a certain way, or happens in an unpredicted one.

Rest assured our staff will always explain the reasons (benefits and risks and alternatives) if they are recommending you consider certain care.

If you would like to have your preferences and intentions for birth recorded in writing, we encourage you to use the template here.

Monash Women’s is proud to have a very robust clinical governance system to ensure we provide safe and up to date, evidence-based care to achieve the best outcomes for you and your baby. We have many evidence-based clinical guidelines underpinning eligibility for a vaginal birth after caesarean (VBAC), water birth, home birth, medically-assisted vaginal birth (using either vacuum or forceps), when a caesarean section is indicated, third stage of labour care options, and even for births when a senior clinician must be present.

Birth suite care

The birth suite is where the majority of families will meet their newborn baby at Monash Women’s.

In the birth suite

In the birth suite, you will have your own personal room for you and your labour supporters, 1:1 midwife care and medical care as needed depending on the complexity of your pregnancy and labour.

You can feel secure in our multidisciplinary team approach to care, with a primary midwife, senior midwife, and junior and senior medical staff being engaged in your care. Our staff will actively encourage you to discuss your goals, aims and any concerns you may have. Your midwife and medical caregivers will support you throughout your labour and keep you up-to-date with progress.

We also have a state-of-the-art electronic fetal surveillance system in all birth suites (for use if ongoing fetal monitoring is indicated). The electronic fetal record is viewable by senior clinicians on screens outside the birth room, for enhanced safety while maintaining your privacy.

Twice daily formal ’rounding’, combined visits with the medical and midwifery senior caregivers also occurs, and we actively invite your input. These rounds are designed to ensure that all clinicians are on the same ‘page’ with what is happening and should happen, and that we are also aware of your goals, aims and any concerns you may have.

Labour care and assessment

You can expect your labour to be regularly assessed to ensure you are safe, your baby is safe and labour is progressing normally by means of monitoring for you, monitoring of your baby’s heartbeat with a handheld Doppler or with an electronic fetal monitor (‘CTG’) and regular vaginal examinations to assess the dilation (opening) of your cervix.

Women with higher risk labours may also be recommended additional monitoring which can include fetal scalp electrodes to measure baby’s heart rate directly, an internal contraction monitor, a small plastic IV cannula for fluids and medications in your arm, or a lifting aid to assist with moving you across the bed.

Our staff will explain why they recommend extra equipment. Please ask us to explain more clearly if you do not understand or want more time to consider your options.

You can request additional pain relief. The options available include nitrous oxide gas to breathe, water-injections (for back pain), a morphine pain-reducing injection or an epidural. You always have the option for pain relief and also to change your mind at any point. We will always do our best to meet your request as rapidly as possible, some procedures (such as epidural) require an anaesthetic doctor to be available.

We welcome discussions about your plans for labour/birth. If safety is a concern, we will discuss modifications to keep you and your baby healthy.

Most women will give birth within 12 to 18 hours upon arriving at the birth suite.

If things change or complications develop

You can also be reassured that we are able to respond promptly to unexpected events in labour including the need for urgent birth by caesarean section, assisted vaginal birth such as forceps or vacuum extraction, and can robustly and safely deal with major medical events, a sick baby or with excessive bleeding after your baby is born.

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Water immersion and/or water birth

Suitable women can labour and birth in water.

Immersion in a warm bath during the first stage of labour can reduce the use of pain-relieving medications (including epidural). However, we can only safely support water birth where we have a few specially designed birthing baths within the birth suite area. This means having a water birth is only available at Casey Hospital, Monash Medical Centre (Clayton) and Sandringham Hospital.

For more information, read the fact sheet below:

• Water immersion in labour and water birth

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Caesarean

Having your baby by caesarean can be either in a planned manner (called ‘elective’) or as an emergency procedure. Elective caesareans generally occur on pre-specified days and times, and emergency procedures can be done any time of the day or night.

Elective caesareans can be performed for a number of reasons including:

• having had a previous caesarean birth and maternal choice to have a repeat caesarean
• because it is not safe for you or your baby to have a labour (such as a placenta that is over the cervix, a very small baby showing signs that labour will not be tolerated, or your own medical conditions that mean labour is not recommended)
• in rare cases where you feel psychologically unable to labour – if this is the case for you, we will generally recommend you receive appropriate help. You will need to see a senior clinician throughout your pregnancy and we will also discuss options that can help you have a comfortable vaginal birth. This is because although caesarean is very safe, a caesarean is a major operation and has short and long term implications for your health and higher risks than vaginal birth for otherwise healthy women.

If you know you are are having an elective caesarean these two fact sheets will be of interest:

• Your planned caesarean, birth and recovery
• Timing of birth with an elective caesarean

Emergency caesareans are performed where there are signs your baby is not coping with labour, if your labour is not progressing or if you develop a complication during labour that means that continuing is no longer safe.

Most caesareans are done with a numbing medication injection in your back or under epidural if you already have one, this will mean you feel touching but no pain during your operation. Occasionally, you will need to have a general anaesthetic (asleep) for your operation. You can have a support person with you for your caesarean unless you need to go to sleep for your procedure.

You will have a catheter in your bladder to drain urine which will be removed as soon as 6 hours after surgery, once you are able to stand and walk.

If your baby is well and your caesarean proceeds normally, you will be able to hold your baby while your operation finishes and in recovery, including direct skin-to-skin contact and breastfeeding if this is your plan.

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Vaginal birth after caesarean (VBAC)

A caesarean section is a safe operation. This may be indicated to be necessary for many reasons such as:

• your baby is in a breech (bottom down) position
• a very large or very small baby
• your labour does not progress
• your baby does not tolerate the labour contractions well

Many babies are born by caesarean section.

Having one caesarean does not mean your next birth must also be a caesarean and you have the choice of planned caesarean birth (elective caesarean) or a trial of labour in your next pregnancy.

Is it safe to try for a vaginal birth after caesarean section?

In nearly all cases, yes. Trialling a labour (also called a ‘VBAC’ or vaginal birth after caesarean) after one previous caesarean section is safe unless you have:

• had a caesarean section with a cut in the upper part of your uterus (a classical scar). This is likely with a very preterm caesarean as the area where the normal incision is made has not developed yet.
• had a caesarean section for a reason that remains when you are not pregnant such as a fibroid that is blocking the lower part of the uterus, or an abnormally small pelvis
• a medical condition that makes it unsafe for you to labour
• a pregnancy complication that requires caesarean birth in your current pregnancy such as placenta praevia (a low placenta)

Carefully-selected women who have had two caesarean sections may also be suitable for a trial of labour after their caesarean births, however, this decision needs to be made in consultation with a senior obstetrician.

Of every 200 women who labour after caesarean section, one will have a serious complication where the uterine scar separates (uterine rupture). Of the one in 200 where the scar separates, there is a one in ten chance of a serious injury to mother and/or her baby – this overall chance is 1:2000, which is similar to the odds of major adverse outcome in a woman having her first natural labour.

The chance of complications however increases to between 1 and 2 in 100 pregnancies if your labour is started ‘artificially’ (induction of labour).

How likely am I to achieve a vaginal birth after caesarean section?

Overall, around three quarters of women who trial a labour after caesarean birth will be successful. Factors that make this more likely include:

• Previous vaginal birth; if you have had a previous vaginal birth you are very likely to successfully have a vaginal birth subsequently
• If your caesarean was for a reason unrelated to your labour such as an unwell baby and your labour itself was progressing normally
• Having a medically healthy pregnancy without diabetes or other complication
• Having a normal body mass index
• Having a baby that is normally sized, neither large for gestational age or small for gestational age
• Having a natural onset of labour

What are the benefits of repeat caesarean section?

The benefits of a repeat caesarean section are:

• essentially no chance of uterine rupture (rate is around 1 in 1000)
• knowledge of date and time of your birth
• opportunity for tubal ligation if you wish for no future pregnancies and your decision is permanent

One in ten women will go into labour before the planned caesarean and you can either choose to proceed with your planned caesarean birth or continue with a trial of labour.

What are the benefits of a trial of labour?

If you are successful, you will have in general an easier recovery, faster mobility and you do not have the chance of organ injury, surgical bleeding or blood clots in your legs, all of which are slightly higher with caesarean birth.

Additionally, if you have one vaginal birth after a caesarean, your other births will also probably be vaginal and this is important if you are considering a large family as repeat caesarean sections have increased pregnancy and surgical risks including major complications such as placenta accrete, organ injury and transfusion.

How and when do I decide how my baby after a caesarean section is born?

We will introduce the discussion from early in your pregnancy so you can consider all options and which is best for you and your family.

Monash Women’s is dedicated to providing individualised counselling in the maternity clinic to help you make your choice.

You can however change your mind at any time and this is okay. There is no ‘rule’ about when a decision should be made but for planning purposes it is helpful to know your preference by the end of the second trimester (28 weeks) if possible.

Are there any other changes to my pregnancy care after caesarean section?

There are minor changes including generally not being eligible for midwife care (i.e. requiring collaborative or specialty care).

Careful attention is also paid to the site of your placenta to ensure it is not low on the anterior wall of your uterus as this increases your chance of a placenta accreta. If you have a low anterior placenta, you will have additional specialist scans to rule this condition out.

You may be asked to consider what you would like to do if you are planning for a labour and your pregnancy goes past 41 weeks. Options include:

• continue to wait for labour to start naturally
• have your labour induced (this will increase the risk of scar rupture and lowers the chance of a vaginal birth)
• decide on an elective repeat caesarean

Are there any changes to my labour care after caesarean?

We will also recommend:

• continuous fetal monitoring (CTG)
• an IV cannula in a vein in your arm (drip)

For safety, your labour is monitored to ensure it progresses normally without any concerns about yourself or your baby.

For more information, read our fact sheet on Vaginal birth after a caesarean.

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