The process of bringing a baby into the World is a miracle, no matter how it happens!
The decision of choosing Vaginal or Cesarean birth nonetheless depends on a number of factors that are not just medical, but often quite particular to the personal needs and beliefs of the mother. As an Obstetrician, I believe in taking those personal preferences, as well as medical factors, into account before making this important decision together with you. Below is an brief introduction to making this momentous decision.
First of all…What IS a Cesarean Birth, really?
The Cesarean section procedure, or C-section as it is often called, dates back to a place and time far away from modernSaint Louis—the Roman era, when childbirth mortality rates were high. Although the notion that Julius Caesar himself was delivered by C-section has been clearly refuted by historians, the name nevertheless remains often associated with the Roman leader. A more credible explanation of the origin of the term relates it to the Latin word “Caedo—“to cut,” from which root it is believed both the Cesarean section procedure and the eponymous emperor’s family name are derived.
At any rate, the procedure entails first giving the mother general anesthesia, an epidural block or a spinal block. A four to six inch incision is then made in the mother’s abdomen and uterus, either vertically or transversely (a ‘bikini line’ incision). The baby, umbilical cord and placenta are then carefully drawn through this incision. The uterus is closed using self-dissolving stitches, after which time stitches or staples are used to close the outer incision of the abdomen.
When should I choose to have a Cesarean section?
There are certain circumstances where as your OBGYN, I may strongly recommend Cesarean birth. Those include instances where complications arise during labor, where your baby’s health is in danger due to umbilical cord obstruction, abnormal heart rate, placenta misplacement or breech positioning, where there are multiple fetuses or an abnormally large one, or where the mother has conditions of concern such as diabetes or high blood pressure, HIV or Herpes infection, damage from previous births or simply a pelvis too small to give birth vaginally.
What are the downsides of a C-Section?
The Cesarean section is extremely common in Saint Louis and nationwide, with about 1/3 of all births coming by way of Cesarean. Although it is an extremely safe procedure, there are risks inherent to any surgical procedure, including the C-section. Risks and complications may include blood loss, blood clots, infection, complications from anesthesia and injury to uterus, rectum, bowel or bladder. In addition, some research correlates babies born by C-section with higher rates of respiratory infection and adult obesity.
How long does it take to recover from Cesarean Section?
Besides the inherent surgical risks, women who give birth by Cesarean section are required to stay in hospital for 2-4 days following the birth and may experience pain from the incision, cramping and bleeding or discharge for 4-6 weeks following the surgery. They should also expect to be less mobile during this time, which may pose challenges for mothers tending to their babies’ early needs, especially breastfeeding.
Does my insurance company cover C-Sections?
Whether your insurance company covers Cesarean section or not depends principally on two factors—the specifics of your plan, and whether the procedure is considered “medically necessary” or “elective.” In most cases, the professional recommendation of your OBGYN is the proof required to demonstrate that a C-Section is medically necessary. However in some cases, such as breech delivery or early birth, your insurance company may consider a C-Section to be “elective.” For a list of insurance providers we honor, click here.
When should I choose to have Vaginal Childbirth?
Except for those cases described above, the American College of Obstetricians and Gynecologists recommends vaginal birth unless there is a medical reason for a Cesarean—especially if the woman is planning on having multiple children, as natural, vaginal birth becomes more challenging once a woman has had a C-section. In addition to avoidance of the downsides of Cesarean birth described above, new research indicates that exposure to beneficial microbes in the vaginal birth canal during vaginal birth leads to lower incidence of allergies and other health conditions, as compared to babies born through Cesarean section.
Apart from medical factors, many mothers report experiencing a greater connection with their baby via the miracle of vaginal birth. They are also able to have earlier contact with the baby and begin breastfeeding early.
How painful is Natural Childbirth?
The pain and discomfort associated with natural, vaginal birth differs from woman to woman, from birth to birth and even from phase to phase of the birthing process. The size of the baby relative to the mother’s pelvis matters, as does the length of labor period, amount of cervical dilation, whether this is her first child or not and when the amniotic sac is broken. Some experience intense cramping, pressure, burning or stabbing pain at one or more phases of the birth, while others enjoy easy, fast, relatively painless births. Childbirth is an extremely unique and famously unpredictable process, so as your OBGYN, I’ll set the expectations for your birth together with you on an individual basis.
What are the other downsides of Vaginal Childbirth?
Vaginal childbirth is, whether easy or hard, a very taxing process on the mother’s body. The skin and tissue around the vagina may tear, requiring stitches. Pain from vaginal birth may linger around the mother’s perineum, and some studies show higher incidences of bowel or urinary incontinence in women who have given birth vaginally over their counterparts who have had C-sections. Moreover, vaginal birth is not without dangers to the baby, especially when labor is difficult or protracted. Babies may experience bruising or bone fracture and are exposed to a higher chance of asphyxiation or other danger requiring emergency C-Section.
What about Vaginal Birth after Cesarean (VBAC)?
In the past it was standard practice that once a mother gave birth by C-Section, any subsequent births would also need to be done by Cesarean, as the pressure of vaginal birth could cause rupture of the abdomen where the previous incision was made. Nowadays, vaginal birth after Cesarean (VBAC) is an increasingly common procedure, particularly in cases where a low transverse incision was made for the C-Section. There are other factors that come into play, which as your OBGYN I will discuss with you. For more information about the popularization of VBAC, see this article from the St. Louis Post Dispatch:
So—How CAN I choose between Vaginal Birth and Cesarean Section?
Absent medical factors where Cesarean birth is recommended, the decision between vaginal or cesarean birth is a deeply personal one, subject to your concerns and preferences as the mother. As your Saint Louis OBGYN, I see my role to support your personal preferences and plans. I will go through the options with you and let you decide how you wish to give birth, based on your unique character and circumstances. We will establish a birth plan together, and my team will do everything possible to ensure that your special day unfolds as you envision it. That all said, you may find this comparison table useful in making this beautiful and important decision:
|VAGINAL||For Mother||Closer/more personal experience||May be quite painful/difficult|
|Earlier contact with baby||Risk of injury to vagina, rectum or uterus|
|Shorter hospital stay||Risk of bowel or urinary incontinence|
|Greater ability to give birth vaginally in future||Possibility of complications requiring emergency C-section|
|Reduced risk of complications from surgery|
|No surgical scar from C-section|
|For Baby||Possible benefits to child’s respiratory and immunity health||Possibility of bruising, fractures or other complications|
|CESAREAN||For Mother||Avoidance of pain and uncertainty of natural birth||Risk of blood loss, infection or other surgical complications|
|Safety and health benefits in case of medical issues requiring C-section||Reduced ability to give birth naturally in future|
|Longer hospital stay|
|Painful recovery period|
|For Baby||Reduced chance of injury or asphyxiation in the birth canal||Minor chance of nicking baby during surgery|
|Safety and health benefits in case of medical issues requiring C-section||Reduced exposure to beneficial microbes in the birth canal|
|Possible higher incidence of respiratory problems or obesity|
A birth plan is a written document expressing your birthing preferences under various circumstances, such as how you wish to handle pain management, whether you prefer to be sitting or lying and of course whether you plan cesarean or vaginal birth. This plan is useful to inform the delivery room nursing staff and to remind your OBGYN of your preferences.For more information about Cesarean Sections, see this FAQ from the American College of Obstetricians and Gynecologists.