Vaginal birth or C-section? Pros and cons

You can bring a baby into this world in one of two ways: via vaginal birth or Caesarean section (C-section).

Overall, about 10 per cent of women have a planned C-section because of medical reasons making a vaginal birth too risky. Some doctors would recommend this in advance, while others decide during labour - known as an emergency C-section.

Each procedure comes with its own benefits as well as various risks; however, both have the same aim of safely delivering a healthy baby. Mr Keith Duncan, a consultant obstetrician who has delivered well over 3,000 babies during his career, describes the pros and cons of each procedure for any uncertain mother-to-be.

When is a C-section recommended by specialists?

The most common reason a doctor would recommend a C-section, also known as a Caesarean, is if there is something wrong with the baby’s placenta during pregnancy. This condition is known as placenta previa and occurs when the placenta covers the mother’s cervix. It can cause serious bleeding during pregnancy and delivery. When a placenta previa forms, your baby is also more likely to be in the breech position making a vaginal delivery more complicated for the baby and the mother.

Additionally, a C-section may be recommended for mothers expecting multiple births - as in twins or triplets - as there is a higher chance of complications occurring in this case.

In the case of an emergency C-section, the rates are around 15 per cent. If you need an emergency C-section, your doctor has decided that you or your baby are in distress and immediate delivery is the only option. They would decide this if your labour isn't progressing as it should or for other medical reasons, such as a prolapsed umbilical cord, maternal haemorrhage, or placenta abruption.

What are the pros and cons of a vaginal birth?

Going through labour and giving birth is a long and exhausting process. Some women choose to go through it naturally to feel more connected to their new baby and the birthing experience, while others can't for medical reasons or they don’t want to experience the pain.

• Pros of a vaginal birth

There is often minimal bleeding during vaginal births and the mother doesn’t experience all the associated risks of surgery, such as scarring, infections, bleeding, and long-lasting pain. If the vaginal birth is straight forward, the mother can leave the hospital and return to normal activities quickly.

Immediately after birth, the baby is usually placed on the mother’s chest so she can hold the baby and begin breastfeeding as soon as possible. It’s important for the baby to receive initial skin-to-skin connect with the mother.

In general, vaginal births become less complicated the more a mother has, which is good news if you are planning a large family!

• Cons of a vaginal birth

The downside of a vaginal birth is that a percentage of women will need an instrumental birth which involves a cut in the vagina. 5 per cent of women will also have significant tearing of the pelvic floor or a large amount of bleeding. The mother may also need stitches, and might temporarily lose control of her urine and bowel function.

What are the pros and cons of a planned C-section?

Simply put, a C-section is a surgical procedure, in which the baby is brought into the world through the mother’s abdomen. As it is considered major surgery, it comes with both benefits and risks to both the mother and baby.

• Pros of having a C-section

A planned C-section is pretty straight forward. The mother is typically awake during the procedure so she can view the baby being born and the whole procedure is pretty quick. Although every women’s situation is different, the delivery typically takes up to 15 minutes and then an additional 45 minutes for stitching up the uterus and incision.

Convenience may also be a reason to choose a C-section birth: Women have more control over the birth date of the baby and the procedure is much more predictable. There are also risks associated with a natural birth that women are avoiding such as oxygen deprivation which poses a significant risk for babies and can have long-term effects.

Most C-sections are done under regional anaesthesia, numbing only the lower part of the body. Sometimes, general anaesthesia is needed; however, the conversion to general anaesthesia is very low at less than 1 per cent.

Doctors are increasingly encouraging initial skin to skin contact between the mother and baby after the procedure, and breastfeeding is advised as soon as possible so the baby gets the correct microbiome.

• Cons of having a C-section

Women that have C-sections typically stay in hospital much longer and the recovery period is more prolonged. Nowadays though, newer techniques are being introduced to shorten the recovery period so women can leave the hospital quicker. One of these procedures is known as Cohen’s approach, in which the tissues and organs are moved around rather than being cut. 

As it is major surgery, there are much higher risks of infection, blood loss, blood clots and pain following the procedure. The mother will also be left with an incision scar which typically needs around two months to fully heal. Moreover, you will need to wait up to a year until you have your next baby.

Does a C-section affect the ability to breastfeed?

In the past it was difficult to breastfeed immediately after a C-section, however, we take it seriously now and it’s important for mother and baby bonding. We get the baby to breastfeed almost immediately now.

You may find it more difficult to find a comfortable position to breastfeed after a C-section though due to the pain from the incision wound making it harder for you to move around. The milk might also take a while to come in, however, once breastfeeding is established successfully, you are just as likely to continue breastfeeding as you would following a vaginal birth.

Are babies born by C-section at a higher risk of health problems?

Some studies show that C-section babies have a higher risk of allergies, obesity and breathing problems later in life. This is difficult to establish though and doesn't apply to every case. Some studies also discriminate between emergency and planned C-sections.

If you are considering a C-section delivery and would like to talk to a specialist, visit Mr Keith Duncan’s Top Doctors profile and book a consultation with him.