There has been an ongoing shift in the past several years to a "planned C-section birth" option for women giving birth, as opposed to waiting for labor to begin and having a natural vaginal delivery. Some professional women want the ability to schedule the birth of their child, while other women fear the pain, long hours of labor and other events typically involved in a vaginal delivery. Even though you can easily request an epidural to help control and minimize pain, some women just want to control and plan the event. The problem is that there may be increased risks for mother and child with a C-section and so there have recently been studies and scrutiny of these two very different approaches to delivery.
It's important to note that there are occasions when a C-section is necessary. The bottom line seems to be that after reviewing the best studies, cesarean deliveries (emergency) seem to present significantly more risks than vaginal deliveries (though clearly this may be your only option to ensure a safe delivery for the newborn and for mom). What are some of the elevated risks?
- Physical problems like scarring and adhesions at the site of the incision (and internally); post surgical bleeding; clots; bowel obstruction; ongoing pelvic pain post surgery; pain from twisted bowel.
- Longer hospitalization and greater risk for re-hospitalization
- A seemingly higher rate of mental health/emotional problems
- Less early contact with your newborn as you initially recover
- Delayed breastfeeding/breastfeeding complications
- The baby can be cut during the surgery (usually minor), have breathing difficulties at the time of birth, develop asthma later on
- Higher risk of future reproductive problems including ectopic pregnancy, reduced fertility, placenta previa, placenta abruption, uterine rupture.
- Babies of future pregnancies may be at higher risk for preterm delivery, low birth weight, physical abnormalities or injuries, die before or shortly after birth.
If the C-section is planned there are fewer surgical injuries, fewer infections, and the emotional impact seems to be similar to a vaginal delivery. There are still the risks that are associated with surgery - internal adhesions, a uterine scar, a surface scar (on your lower abdomen) and some of the other issues described above. Risks associated with vaginal delivery include:
- Vaginal/perineal pain
- Incontinence (but it should be noted that pregnancy itself can cause this)
- Nerve injury to the baby being born at the shoulder, arm or hand level.
- Pelvic floor injury (risk is lowered if you have an episiotomy)
If you have had a C-section (planned or unplanned) then your decision about a follow-up cesarean or deciding to have a vaginal delivery may be complicated. Until recent years, most doctors involved in obstetrics would certainly recommend a repeat C-section and not necessarily want to take the "risk of a vaginal delivery post cesarean." Many of them drew a hard line in the sand so to speak and would only offer a repeat cesarean. Doctors were concerned that the uterus could rupture during a vaginal delivery and cause serious complications, even death to the mother or child. VBAC or vaginal birth after cesarean can, however, be done safely and there is a growing body of research supporting its safety. One significant technique that can make VBAC safe is to change the location of the cut made in a cesarean surgery so that a future VBAC is safer and less likely to cause uterine rupture. Current statistics seem to indicate that 27 in 10,000 VBACs will result in a uterine rupture. Death of a baby is 1.4 in 10,000 VBACs and the risk of needing a hysterectomy is 3.4 in 10,000 VBACs.