You can usually choose how to deliver your baby. Most mothers give birth vaginally, recover well, and have healthy babies. Most of those who have a planned caesarean section will also recover well and have healthy babies. So the important message is that both vaginal birth and elective caesarean section are safe. But if you compare vaginal birth that goes well and an elective caesarean section, vaginal birth is far safer for you and your baby. The doctor will not recommend a caesarean section unless it is necessary for medical reasons.
PROS AND CONS OF NATURAL BIRTH
• Shorter recovery times and hospital stay.
• Feels more natural, giving you a greater sense of empowerment and accomplishment.
• Lower risk of health issues for the baby: risks for asthma, food allergies and lactose intolerance are less.
• Labour may be shorter and move quicker with future births.
• Babies are able to breast feed sooner, speeding up the bonding process.
• Unpredictable, unforeseen complications can occur during labour and delivery.
• Baby can face a risk of oxygen deprivation.
• Baby can experience physical trauma while passing through the birth canal.
• Mothers have higher rates of urinary incontinence (urine leak).
RISKS OF ASSISTED DELIVERY
Assisted delivery accounts for 10–15% of vaginal deliveries.
Risks for the mother
Both forceps-assisted delivery and vacuum-assisted delivery are associated with a small increased risk of injury to the tissues of the vagina, perineum, and anus. A very small number of women may have urinary or faecal incontinence as a result of these injuries. Incontinence may go away on its own, or treatment may be needed. Fourth-degree tear (tearing of the anal sphincter) occurs in 1 in 100 vaginal births, 4 in 100 in ventouse (vacuum-assisted) births, 8–12 in 100 in forceps-assisted births.
Risks for the baby
Although the overall rate of injury to the baby as a result of assisted vaginal delivery is low, there is still a risk of certain complications for the baby. These include injuries to the baby’s scalp, head, and eyes; bleeding inside the skull; and problems with the nerves located in the arm and face. There is no evidence that assisted vaginal delivery has any effect on a child’s development.
REASONS FOR A CAESAREAN SECTION
It is important to explore the reasons why you are thinking of having a caesarean-section birth.
• You may have anxieties about having a vaginal birth for the first time. Often talking through what happens during labour and birth, your choices for pain relief and hearing what support you will have, may be enough to reassure you to think about a vaginal birth
• You may think it is safer to have a caesarean section or have concerns that vaginal birth is more likely to damage your pelvic floor.
• You may have concerns about when you are likely to have your baby. For example, if your husband works away from home for long periods, you may think your only option is a caesarean section. In this situation you could consider having your labour started (which is known as being induced) instead. If you choose this option, your doctor will talk to you about the implications for you and your baby.
• You may have had a complicated vaginal birth in the past. But not all labours are the same. Going through your doctor about what happened last time and talking through what happened last time can help you make up your mind.
• You may have a fear of having a vaginal birth or vaginal examinations. You may have had a previous traumatic experience. You should have the opportunity to talk to a specialist who will help you manage your anxiety and therefore increase your ability to cope if you wish to try for a vaginal birth. These skills can be used to help you feel more in control.
PROS AND CONS OF CAESAREAN SECTION
• You don’t have to enter the long hours of labour.
• Usually scheduled for when you want to give birth.
• Women are at decreased risk of pelvic-floor injury and birth trauma.
• Avoids post-term pregnancies and its associated complications.
• The baby’s risk of being infected with any infection the mother may have is greatly reduced.
In elective caesarean section some complications occur in a small number of women and are easily treated.
• Risk of infection (1 in 100) common.
• Injury to baby (2 in 100) common.
• Bleeding (5 in 1000) uncommon.
• Injury to organs like the bladder (1 in 1000) rare.
• Blood clots in legs, pelvic organs and lungs, (4–16 in 10,000) rare.
• Iatrogetic (doctor-caused) prematurity (when the baby is delivered too early).
• Reaction to medications or to the anaesthesia that is used.
• You will probably need a caesarean-section birth in future.
• A longer hospital stay is necessary, and the procedure is more expensive.
• Risk of emergency caesarean section is more than elective (24 v 16 in every 100 women).
We would like to emphasise that the hallmark of pregnancy management in the twenty-first century should be individualised care. If there is a medical indication for it, we will go for a planned caesarean section. If you take an informed decision about elective caesarean section, we will do it. And if you go into labour, and we expect a successful safe vaginal delivery, we still have the ability to intervene with a caesarean delivery if needed. At the end of the day we want a healthy mother and healthy baby.