Childbirth: What type of delivery is right for me?

In this detailed guide for those planning for childbirth, highly respected consultant in maternal-fetal medicine and obstetrics Dr Srividhya Sankaran shares her expert insight on the different approaches used to deliver babies, including the individual advantages and potential risks associated with each method.

What are the different types of delivery?

There are two types of delivery in pregnancy: vaginal and abdominal delivery. Abdominal delivery is often called a caesarean section or C-section and may be a planned procedure or an emergency operation. Vaginal delivery may follow the natural onset of labour or result from a labour that is induced.

Vaginal delivery can be spontaneous, where the mother pushes the baby out during contractions. In other cases, the obstetrician helps with the delivery of the baby, which is known as instrumental or assisted vaginal delivery. When the head is coming first, the delivery is assisted by the use of instruments called forceps or ventouse. On the other hand, if the baby is coming in a breach position, the baby will be delivered with the help of an obstetrician and this is known as assisted vaginal breach delivery.

What is the safest way to deliver a baby?

It’s not easy to say which type of delivery is the safest or the most dangerous as each has its own benefits and risks. We reach the decision about which type of delivery is best by having a conversation with the woman, explaining the benefits and risks and taking into account the individual circumstances. Where the benefits outweigh the risks, we opt for that type of delivery.

In vaginal deliveries, where there are no complications, one of the advantages is that recovery is quicker. The risks are the uncertainties that come with vaginal delivery. For instance, there is a chance that the vaginal delivery may not progress as expected and as a result, an emergency delivery may be required. Additionally, in some cases the baby may not be happy during delivery and for that reason, a caesarean section needs to be performed urgently. Very occasionally, other complications may occur, for example, should the cord or placenta come out before the baby. This is known as cord prolapse or placental abruption. Additionally, in rare cases the baby may suffer a lack of oxygen during the delivery or the baby’s head can tear the muscles in front of the mother’s back passage. Fortunately, however, most of these complications can either be prevented or managed safely if detected.

Caesarean sections can be performed as a planned or emergency form of delivery. Planned caesarean sections are co-ordinated to suit both the woman and the obstetrician and take place in an operating theatre. This has the advantage that the delivery is performed in a planned way, which removes a lot of uncertainty and anxiety. However, a caesarean section is type of operation, meaning it carries risks related to anaesthesia and surgery. As such, bleeding is more prevalent than in vaginal deliveries, as is the chance of infection. There is also a small risk of injury to the mother’s bladder or bowel, or of a small unintended cut on the baby’s skin. All of these risks can be minimised by performing the surgery safely, especially in experienced hands. In the unlikely event that something should go wrong, this also means it can be managed well.

The most important complications of an abdominal delivery relate to future pregnancy, as once a caesarean section has been performed, this increases the chances of the woman requiring another caesarean section should she become pregnant again. Additionally, it increases the chances of placenta being in a low position or becoming stuck to the caesarean scar, which can escalate the risk of any future pregnancy and may mean that very intensive care will be required.

In experienced hands, you can decide which is the best mode of delivery for you through a discussion with your obstetrician. Fortunately, in the majority of cases, deliveries are safe.

Can some types of childbirth delivery have long-term side effects?

In an uncomplicated vaginal or abdominal delivery, we do not expect any long-term side effects. Should there be any complications, most of these can be managed safely and followed up effectively.

Complications in vaginal delivery can affect both mother and baby. For example, should a mother suffer injury to the muscle in front of the back passage during delivery and this is detected and repaired well, it should heal. Occasionally, however, the injury may not heal well, leading to problems with incontinence. This is not very common and happens in less than ten per cent of vaginal deliveries. In other cases, where the mother experiences excessive blood loss, they may require iron or a blood transfusion but this should not cause any long-term side effects.

Occasionally, delays during delivery may cause the baby to experience a lack of oxygen or they may suffer from an infection. Should this occur, this may require admission to baby care and treatment. Most babies will recover very well but some may suffer from a lack of oxygen in the longer term.

As previously discussed, with caesarean sections there are some long-term side effects from the operation. This may relate to the scar tissue and adhesions and discomfort or it can result in the placenta becoming stuck to the scar, known as placenta accreta.

If you are pregnant and preparing for childbirth and wish to schedule a consultation with Dr Srividhya Sankaran, you can do so by visiting her Top Doctors profile.