C-section vs Natural Birth: What You Need to Know to Choose

Oct 2018 Pregnancy

Contributed by: Dr Watt Wing Fong

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As many mothers will remember, the delivery of their child is perhaps one of the most memorable events in their life. While natural birth has always been the popular choice among mothers, many are starting to choose elective caesarean sections.  Read on to find out about the pros and cons of each mode of delivery.

What are the Ways You can Deliver Your Baby by?

There are 3 ways a pregnant mother can deliver her baby:

  1. Natural or Vaginal Birth

    Vaginal BirthThis is the most common way of delivery, where the mother has to go through a labour process. The duration of labour varies among individuals and comprises of 3 stages:

    • 1st stage: Regular painful contractions with progressive cervical dilation till 10cm
    • 2nd stage: Delivery of the baby (effort i.e. “pushing” needed)
    • 3rd stage: Delivery of the placenta
  2. Assisted Vaginal Delivery

    Forcep Assisted DeliveryIn this process, your obstetrician will be using either forceps or Ventouse (also known as vacuum delivery) to aid the mother in her delivery of the baby. Assisted vaginal delivery is usually performed when:

    • There is a need to deliver the baby quickly, e.g. fetal distress, or maternal conditions such as heart disease
    • There is maternal exhaustion from prolonged pushing

    In order for your obstetrician to attempt an assisted delivery, there are several criteria that needs to be satisfied:

    • The cervix of the mother must be fully dilated
    • The baby’s head must be low enough in the birth canal
    • The mommy must be able to push

    However, it is important to note that assisted delivery does not mean forcefully pulling the baby out!

  3. Caesarean Section also known as C-section

    This is a surgery done to deliver the baby via the abdomen of the pregnant mother, where a horizontal incision is made at the bikini line. It could be elective/planned or emergency/unplanned. An elective c-section takes place when a mother indicates her decision to do so prior to delivery, or if the obstetrician deems that a c-section is necessary for the mother due to certain risk factors. An unplanned or emergency c-section occurs when natural delivery is tried but failed or if the patient goes into labour earlier than estimated.

    During C-section, the pregnant mother will require regional anaesthesia, either through and epidural, spinal or combined spinal-epidural anaesthesia. While general anaesthesia may be used, most of the time, regional anaesthesia is preferred during Caesarean section.

What are the Advantages of Natural Birth over C-section?

Natural BirthCaesarean Section
Post-delivery painLessMore
Recovery time and length of hospital stayShorterLonger
CostLowerHigher
CertainityUnpredictable in terms of:

  • Labour duration
  • Actual time of birth
  • Need for conversion to c-section during emergency
Certain as delivery is planned; “horoscopic” delivery possible
Effects on babyBenefits

  • Can initiate breastfeeding earlier to improve bonding
  • Less risk of breathing problems for the baby as fluid is “squeezed out” of the baby’s lungs during delivery process
  • Better immune system and lower risks of allergies for baby due to acquisition of good bacteria as it passes through the mother’s birth canal

Disadvantages

  • Higher risk of fetal distress
  • Higher risk of birth trauma
Benefits

  • Lower risk of fetal distress
  • Lower risk of birth trauma

Disadvantages

  • Small chance of a nick to baby during surgery
  • Higher risk of breathing problems
  • Higher risk of asthma/allergies
Risk to mothers
  • Trauma to the tissues around the birth canal
  • Risk of heavy bleeding (post partum haemorrhage)
  • Risk of infection
  • Urinary/ bowel incontinence
  • Anaesthetic risk
  • Risks of bleeding
  • Risks of injury to other organs e.g. bladder, bowel
  • Risk of wound infection
  • Risk of blood clots (deep vein thrombosis)
  • Risk of adhesions
  • Risk of keloid/hypertrophic scar
Potential impact on next pregnancyNoYes

  • Increase chance of repeat C-section
  • Increase risk of scar ectopic
  • Increase risk of scar dehiscence/uterine rupture
  • Increase risk of placenta accreta
  • High risk of bleeding, may require hysterectomy
  • Risk of placenta problems increases with each subsequent C-section
Natural BirthCaesarean Section
Post-delivery painLessMore
Recovery time and
length of hospital stay
ShorterLonger
CostLowerHigher
CertainityUnpredictable in terms of:

  • Labour duration
  • Actual time of birth
  • Need for conversion to c-section during emergency
Certain as delivery is planned; “horoscopic” delivery possible
Effects on babyBenefits

  • Can initiate breastfeeding earlier to improve bonding
  • Less risk of breathing problems for the baby as fluid is “squeezed out” of the baby’s lungs during delivery process
  • Better immune system and lower risks of allergies for baby due to acquisition of good bacteria as it passes through the mother’s birth canal

Disadvantages

  • Higher risk of fetal distress
  • Higher risk of birth trauma
Benefits

  • Lower risk of fetal distress
  • Lower risk of birth trauma

Disadvantages

  • Small chance of a nick to baby during surgery
  • Higher risk of breathing problems
  • Higher risk of asthma/allergies
Risk to mothers
  • Trauma to the tissues around the birth canal
  • Risk of heavy bleeding (post partum haemorrhage)
  • Risk of infection
  • Urinary/ bowel incontinence
  • Anaesthetic risk
  • Risks of bleeding
  • Risks of injury to other organs e.g. bladder, bowel
  • Risk of wound infection
  • Risk of blood clots (deep vein thrombosis)
  • Risk of adhesions
  • Risk of keloid/hypertrophic scar
Potential impact
on next pregnancy
NoYes

  • Increase chance of repeat C-section
  • Increase risk of scar ectopic
  • Increase risk of scar dehiscence/uterine rupture
  • Increase risk of placenta accreta
  • High risk of bleeding, may require hysterectomy
  • Risk of placenta problems increases with each subsequent C-section

Should You Choose Natural Birth or Caesarean Section?

In uncomplicated cases without medical/obstetric reasons, vaginal delivery is always strongly advised as it is safer and has less impact on the next pregnancy. However, if the pregnant mother prefers C-section, the obstetrician will still respect her wishes. There are certain circumstances though, where vaginal delivery is not advised, when it is associated with greater risks over a Caesarean section. For example, when there are placenta problems, if the baby’s position is not suitable, presence of certain conditions in the mother, fetal distress, if the baby is too big in size, if the mother had previous c-sections.

To all pregnant mummies, discuss with your obstetrician on your preferred mode of delivery and look forward to the birth of your baby!

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About Author
Dr Watt Wing Fong has a strong passion for the care of pregnant patients, and is experienced in the management of medical disorders in pregnancy and peripartum care. Her love for obstetrics stretches into her previous involvement in the development of guidelines and protocols for labour wards, as well as the training of labour ward nurses. She also shares her knowledge about pregnancy care to the general public through talks, forums and media engagements.

 

Dr Watt’s Place of Practice

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