Objective To compare the indications for elective lower segment caesarean section (ElLSCS) in a tertiary centre (TC) and a district general hospital (DGH) over six months. To determine the proportion of women having ElLSCS with previous traumatic birth experiences.

Design A retrospective study comparing the number of women choosing ElLSCS in a TC and a DGH after previous traumatic birth. Traumatic birth was defined as:

previous early neonatal death/stillbirth,

previous complicated vaginal delivery

3^rd/4^th degree tear,

instrumental delivery,

shoulder dystocia.

Methods ElLSCS indications were retrieved from both hospitals' ElLSCS diaries (May–October 2011), and compared. In the TC, documented indications for traumatic births were compared to annual rates. Data on annual DGH rates was not available.

Results 669 deliveries were recorded (TC=463, DGH=206). 42% of all ElLSCS in the TC and 50% in the DGH were for “Previous CS”. 14% of ElLSCS in the TC, and 8% in the DGH were for ‘traumatic birth’. The TC (10%) had five times more CS for maternal request than the DGH (2%). In the TC:

79%(23/29 women) of women chose ElLSCS after a neonatal death/stillbirth,

16% (18/115 women) after a 3^rd/4^th degree tear,

2% (11/562 women) after an instrumental delivery,

10% (3/30 women) after a shoulder dystocia.

Conclusions The data suggests the poorer the obstetric outcome, the more likely women are to choose future ElLSCS. The best mode of delivery is that chosen by women who have been offered counselling after a traumatic birth to assist them in making an informed decision.