Giving birth counts amongst the more beautiful moments of life. However, the prospect of delivery can be intimidating- from the anticipated pain to the choices expectant parents need to make. With choosing a name, the suited hospital, cloth or disposable diapers, part of the plan also includes discussing the delivery options.
When it comes to drawing up a birth plan, the debate whether to opt for a Cesarean (C-section) or a natural birth has been on the rage for ages. Although it is important to discuss both methods, sometimes the decision is not in your hands, but based on the best interests of you and your baby. “Under all circumstances when everything about the mother and her baby is within normal limits, a natural birth is allowed”, Dr. Varuna Pathak, professor of obstetrics and gynaecology of Gandhi Medical College, Bhopal discusses with us. “However, under any situation when either the delivery by vaginal route is not possible (small bony pelvis, too big a baby) or is too risky for the mother or her baby a C Section is resorted to.”
But when comparing C-section and vaginal delivery, there is not an objectively “better” option- both methods of giving birth can have short and long-term risks and complications. At the end, the goal is the safety and health of the mother and her newborn.
“As is true for everything else in life, there are no absolutes. Neither C- Section nor vaginal birth is completely free of complications. So, it cannot be said that one is out rightly superior to another.”, Dr. Pathak said. She also considers C-sections to be generally safe for the baby because “most of all the fetal complications we hear of are seen to occur during vaginal birth. So, either should be considered on a case to case basis.”
Let’s talk about how both the procedures take place.
Natural delivery
Routine or natural delivery takes place when the baby is born with the help of your body’s natural ability to create uterine contractions which pushes the baby headfirst towards the birth canal. This creates a pressure, making the mother’s cervix dilate. The cervix dilates enough to accommodate the baby’s head and shoulders and travel through to the vaginal opening and come out.
Does it hurt? “Although there’s no pain of cervical dilation, it’s the labor pain or uterine contractions which can be painful. During the process of natural birth if a small cut (Episiotomy) is needed to widen the birth canal, it is always done after injection of local anesthetic agent, which also allows repair.”, Dr. Pathak tells us.
Some women take epidural which is anesthesia injected in the spinal cord for a painless labor.
C-Section
A C-section, on the other hand, is a surgical procedure which requires an incision just above your bikini line, through the wall of the abdomen into the wall of the uterus. The baby is taken out from the uterus and the doctors clip the umbilical cord and placenta and stitch back the abdomen.
Does it hurt? Not exactly. According to Dr. Pathak, “even a C section is performed under anesthesia. Anesthesia for C Section is spinal anesthesia, where a medicine is injected in the spinal cord so that the lower half of the body becomes numb. The effect of regional anesthesia lasts for a few hours, then the sensation can return. The patient is then kept on painkillers round the clock to combat post-surgical pain till the stitches heal.”
The rate of cesarean delivery has significantly gone up over the years. Is it higher than necessary? Many in the health community believe so. WHO says the caesarean delivery rate to be closer to 10-15%. In India, according to the National Family and Heath Survey, the number was 17% during the period from Jan’15 to Dec’16. The rate seems to be higher than seen in countries like Netherlands and Finland. “A lot of factors are responsible for this discrepancy”, believes Dr. Pathak.
“Foremost is the type of facility. If it’s a tertiary care centre or an apex referral centre catering to high risk or complicated referred patients, its C-section rates are bound to be higher. For the rest of the general obstetric units, the risk-taking capacity of both the obstetrician and the patient, with her family becomes a little responsible for skewing the decisions in favour of a C-section.”
But before deciding which method to go for, women need to compare the respective pros and cons. Women should be educated about their childbirth options, to be able to have a nuanced discussion with the doctor and make the most appropriate choice for themselves. Pros and cons of both delivery methods are given below.
Pros & Cons of C-section
Although advantages of a C-section are limited, if a woman knows she will need a C-section, she can schedule the birth in advance, and don’t have to wait to go into labor.
C-sections are generally considered safe, and in certain situations life saving, they do carry additional risks. Potential complications include losing a lot more blood during a C-section than during a vaginal birth, increased risk of infection and blood clots, and infections of the uterine lining & incision. Other risks are injury to the bladder or bowel during surgery, uterine rupture (incision ripping open), and complications in future pregnancies. C-section recovery tends to be longer too.
Pros & Cons of vaginal birth
Women who are eligible for a vaginal delivery avoid undergoing major surgery and its associated risks. Recovery with vaginal births are quicker and if the mother is feeling fine, she can leave the hospital sooner.
Vaginal deliveries come with its risks too. Vaginal deliveries raise the risk of future urinary incontinence due to the damage of pelvic muscles, nerves and ligaments when the baby is pushed out. Giving birth naturally can induce long hours of labor that can be physically grueling for the mother. In rare instances, vaginal birth can also cause brain damage to the baby or even suffer death. After the delivery, some women become prone to leak urine while laughing, sneezing or coughing.
Regardless of how you decide to bring your child into the world, the decision you make for your family and your newborn is the most important. Dr. Pathak believes the efforts also needs to be bilateral. “From obstetricians end, all honest efforts should be employed strictly adhering to the standard protocols, before taking the choice of the knife at the time of delivery.”
“Patients, their families, society in general including the law makers should be more tolerant towards any untoward event in the process of vaginal delivery. The rising trends of medicolegal allegations can never allow any human being, let alone a doctor to be able to justify a risky assignment with a sword hanging on their neck all the time. Not all complications during childbirth can necessarily be only negligent events. Complications happen in life too as accidents, despite of all the careful driving with all safety measures on.”
