Expectant mothers frequently share a common concern about the mode of delivery for their upcoming childbirth. Questions like “Will I have a normal delivery or a C-section?”, “Which is better?”, “What is more painful?”, and “How can I handle labor pains?” often dominate these conversations. It is important to have a clear understanding of these important topics to make informed decisions about childbirth.
What Is Normal Delivery?
Normal delivery, also known as vaginal delivery, is the natural process by which a baby is born through the vaginal opening. This approach to childbirth allows for a baby’s passage through the birth canal without surgical intervention.
What Is a Cesarean Section and When Is It Required?
Cesarean section, often referred to as C-section, is a surgical procedure in which a baby is delivered through an incision made in the mother’s abdominal wall and uterus. There are two primary categories of cesarean sections: elective and emergency.
Elective Cesarean Section
An elective cesarean section is a planned surgical delivery performed before the onset of labor. It is scheduled based on specific medical indications. Here are some common reasons for choosing an elective cesarean section:
- Fetal Macrosomia: When the baby is exceptionally large, it may be difficult for a vaginal delivery to accommodate the baby’s size, especially if the maternal pelvis is comparatively small. This condition is medically known as cephalopelvic disproportion.
- Low-Lying Placenta: A placenta that is situated in the lower part of the uterus, close to the cervix, poses a risk of placental detachment and severe bleeding during vaginal delivery.
- Abnormal Fetal Presentation: If the baby is not positioned head down, but rather in a breech, transverse, or other abnormal presentation, a cesarean section may be necessary.
- Previous Cesarean Sections: Women who have undergone two or more previous cesarean sections may opt for a planned cesarean section to minimize the risk of uterine rupture during labor.
- Maternal Infections: In cases where the mother has a contagious infection like herpes for the first time in third trimester, a cesarean section may be recommended to prevent transmission to the baby during vaginal delivery.
- History of Uterine Surgery: Women who have previously undergone uterine surgeries, such as myomectomy (fibroid removal), may opt for a planned cesarean section.
Emergency Cesarean Section
An emergency cesarean section is an unplanned surgical delivery that occurs during labor or the birthing process due to unexpected complications. Common reasons for an emergency cesarean section include:
- Fetal Distress: Sudden changes in the baby’s heart rate or signs of persistent fetal distress during labor, that is not recovering with standard medical interventions may necessitate swift intervention through a cesarean section.
- Meconium Staining: If the baby passes meconium (early stool) inside the womb along with fetal distress, it can lead to meconium aspiration, requiring immediate cesarean section.
- Non-Progress of Labor or obstructed labour: Despite prolonged and intense labor, if the baby fails to descend through the birth canal, it may call for an emergency cesarean section.
- Maternal Bleeding: Unexpected, heavy bleeding during labor can be life-threatening to both mother and baby, warranting surgical delivery.
- Preeclampsia and Eclampsia: High blood pressure conditions such as severe preeclampsia and eclampsia may necessitate the rapid delivery of the baby through a cesarean section to protect both mother and child.
Normal Delivery vs. C-Section Pros & Cons
In most cases, vaginal birth is considerably safer for both women and babies compared to a C-section. However, specific situations necessitate a C-section when vaginal delivery poses risks, such as when the baby is positioned as breech or transversely in the womb or when the placenta covers the cervix (placenta previa). In other scenarios, the potential benefits of a C-section must be carefully weighed against the associated risks. It’s essential for individuals to be fully informed about these potential advantages and disadvantages so they can make informed decisions regarding their birthing plan.
Normal Delivery Advantages
- Less Blood Loss: Normal delivery typically involves less blood loss compared to cesarean section.
- Faster Recovery: Mothers who deliver vaginally tend to experience quicker recoveries with reduced post delivery discomfort.
- Lower Analgesia/Anesthesia Risk: There is a lower risk of anesthesia-related complications in normal delivery.
- Less Risk of Infection: The risk of post delivery infections is generally lower in vaginal births.
- Beneficial for Baby: Normal delivery assists in expelling amniotic fluid from the baby’s lungs, making breathing easier after birth and less risk of breathing difficulties. It also exposes the baby to beneficial bacteria during the passage through the birth canal, which can enhance gut immunity. Additionally, babies born vaginally have lower rates of certain childhood diseases, including asthma, child-onset diabetes, allergies, and obesity, potentially due to exposure to beneficial bacteria during vaginal birth.
Potential Disadvantages of Vaginal Birth
While the skin and tissues around the vagina can stretch to allow for the passage of a baby, some women may experience tears that require sutures. Most of these tears are minor and heal without complications, but a small percentage may have more severe tears that take longer to heal. Stretching and tearing can also result in muscle weakness affecting urine and bowel control, potentially leading to issues with incontinence. Vaginal birth, especially when assisted by forceps, vacuum extraction, or episiotomy, may increase the likelihood of stress incontinence (leaking urine with exertion). Babies born vaginally can also experience nerve and bone injuries, which are more common with vacuum or forceps assistance but often heal with time.
Cesarean Section Advantages
- Controlled Conditions: Cesarean sections are performed under controlled conditions, allowing healthcare providers to address specific medical concerns.
- Safety in Complicated Cases: In situations where vaginal delivery could jeopardize the health of the mother or baby, a cesarean section is the safer option.
- Lower Risk of Birth Trauma: Cesarean sections can reduce the risk of birth injuries, particularly in cases of difficult or obstructed vaginal deliveries requiring forceps or vacuum extraction.
- Predictable Timing: Planned cesarean sections offer predictable timing for both the mother and healthcare team.
Risks Associated with a C-Section
Like any surgical procedure, a C-section carries inherent risks. The likelihood of complications is slightly higher with C-sections compared to vaginal deliveries. These potential complications include:
- Hemorrhage (excessive blood loss).
- Embolism (a blood clot that can dislodge and enter the bloodstream).
- Injury to the bowel or bladder.
- Weakening of the uterine wall due to the surgical incision.
- Increased risk of placental abnormalities in future pregnancies.
- Risks associated with general anesthesia.
- Fetal injuries during the surgical process.
Additional drawbacks of C-sections include:
- A potentially more challenging recovery compared to vaginal delivery.
- Increased chances of experiencing chronic pelvic pain.
- Elevated likelihood of needing C-sections in subsequent pregnancies.
- Potential difficulties with breastfeeding.
- Higher risk of respiratory problems for the newborn.
Achieving a Normal Delivery
For mothers who aspire to have a normal delivery, there are proactive steps you can take to enhance your chances:
- Antenatal Care: Initiate early and regular antenatal care with a healthcare provider.
- Balanced Nutrition: Ensure a well-balanced diet tailored to your pregnancy needs. Avoid excessive calorie consumption.
- Manage Chronic Conditions: If you have preexisting conditions like diabetes or high blood pressure, work with your healthcare team to keep them under control.
- Stay Active: Engage in daily physical activity, starting with 15 minutes and gradually increasing to 30 minutes or more.
- Prenatal Classes: Enroll in antenatal or birthing classes to prepare yourself physically and emotionally.
- Pain Management: Familiarize yourself with pain management options, such as breathing techniques and epidural analgesia.
- Birth Plan: Consider creating a birth plan that outlines your preferences for labor and delivery.
- Support System: Surround yourself with a supportive birthing partner, whether it’s your spouse, mother, sister, or friend.
Vaginal Birth After Cesarean (VBAC)
Many individuals who have undergone a C-section can consider a vaginal delivery in future pregnancies. The likelihood of a successful vaginal birth after cesarean (VBAC) significantly increases if:
- The initial C-section involved a low transverse incision.
- Your pelvis can accommodate an average-sized baby.
- You are not expecting multiples (e.g., twins).
- The first C-section was performed solely due to a non recurring cause like a breech presentation of the baby.
- In first delivery labour started and cervical dilatation till 6cm was achieved.
Safely Preventing Unnecessary C-Sections
It is possible to prevent many unnecessary C-sections. Active participation in decision-making when a C-section is offered is one way to avoid a procedure that may not be required. Numerous strategies can help reduce the likelihood of a C-section without compromising safety:
- Select a healthcare provider with a low C-section rate, as cesarean rates can vary widely among providers.
- Stay physically active and exercise during pregnancy to prepare for the demands of labor.
- Arrange for continuous labor support from an experienced individual, such as a doula, to assist with comfort and labor progress.
- Prioritize rest towards the end of pregnancy to prepare for labor challenges.
- Avoid inducing labor unless medically necessary.
- If planning a hospital birth, work with your care provider to delay hospital admission until active labor.
- During labor, remain upright and mobile (best achieved with drug-free pain relief) and request handheld fetal monitoring.
- If you had a previous C-section, collaborate with a supportive care provider and birth setting to explore vaginal birth after cesarean (VBAC) options.
- If your baby presents in a breech or feet-first position near the end of pregnancy, consult your doctor or midwife about options to facilitate a head-first position (external version).
If you are scheduled for a C-section, aim to wait until at least 39 weeks, unless there is a medically necessary reason to deliver sooner. The final weeks of pregnancy are crucial for the development of the baby’s lungs, brain, and other organs. Babies born before 39 weeks may require special care and face ongoing health challenges if born prematurely.
Trust Your Body and Your Doctor
In the journey towards childbirth, it’s crucial to trust your body and your healthcare provider. Your body is equipped to undergo the miraculous process of childbirth, and your doctor is there to ensure a safe and healthy experience for both you and your baby.
In summary, the choice between normal delivery and cesarean section should be guided by medical necessity. While normal delivery offers various advantages, including a faster recovery and beneficial effects for the baby, cesarean sections are essential in cases of medical complications. Prioritize early and comprehensive antenatal care, maintain a healthy lifestyle, and trust your healthcare team to support you in your quest for a safe and positive childbirth experience.