Just as every pregnancy is unique, every birth is, too. Some women use pain medication in labor, while others do not. Some women labor for a couple of hours, while other women labor for a few days. Similarly, some women give birth vaginally, while others give birth by Cesarean section (C-section). Some women choose to have a C-section, while others are recommended to have one for their health or the health of their baby. In the U.S., the C-section rate is about 30%. In Wisconsin in 2019, the rate of C-sections was 26%.
Most first time moms feel anxious about how their labor and delivery course will go after nine months of waiting! It’s okay to feel this emotion and to ask questions throughout prenatal care and labor. We are here to guide your decisions and offer candid advice about delivery.
Why Do Women Need C-Sections?
Our preference is that women have vaginal deliveries! Some common myths about C-sections are that doctors get paid significantly more for performing them, they get to go home sooner, that we are impatient and don’t allow natural labor, etc. None of that is true! We evaluate each situation carefully and our job is to make sure mom and baby are safe. Sometimes a C-section is safer than a vaginal delivery and at the point we see that risk:benefit ratio shift, we will discuss the recommendation.
Some women may elect to have a C-section without a medical need. This is their right and an option for all women after appropriate counseling.
The most common medical indications for a C-section are:
- If labor stops progressing:
Called arrest of dilation or descent ,this means that either the cervix isn’t dilating or the baby is not descending into the birth canal after a significant amount of time. Usually, this is because of fit—the baby is simply too large to pass through the birth canal.
- If the baby is breech:
When a baby is in breech presentation, his or her bottom or feet are presenting first. We do not recommend breech delivery of a singleton pregnancy due to significant risk for the baby.
- If the baby is showing signs of stress during labor:
A fetal heart rate monitor will help your OBGYN see how your baby is handling labor and if intervention is needed.
- If the placenta is covering her cervix (placenta previa):
This could cause bleeding during pregnancy and unsafe, severe bleeding during labor.
- If she previously had surgery on her uterus: For example, to remove large fibroids.
- If she previously had C-sections: Sometimes a woman can deliver vaginally after a C-section, but sometimes the risks are too great.
Which is safer, C-section or vaginal birth?
Both forms of delivery can be safe, and both can carry different types of risk.
C-sections can prevent trauma to your pelvic floor and are a safe way to meet your baby quickly if he or she is stressed or not fitting through the pelvis (cephalopelvic disproportion). Women are most often awake during a C-section to meet their baby with good pain control from spinal or epidural medication. These numb your abdomen from pain, although you generally feel touch and pressure. If a baby would benefit from being delivered sooner than these medications can be administered, it may be recommended to have a C-section under general anesthesia.
Even though C-sections are one of the most common surgical procedures in the U.S., the fact that they are abdominal surgeries means they do carry some risk. Some risks include blood loss (generally about twice as much as vaginal delivery) and the risk of infection. Each C-section also increases the risk of developing scar tissue and the risk of abnormal placenta implantation in future pregnancies.
While sometimes babies benefit most from a C-section if labor and delivery could Injure them, there are benefits to babies being born vaginally. Babies have less trouble clearing amniotic fluid from their lungs due to the squeeze they get coming through the birth canal during a vagainal delivery. They are also exposed to a good dose of healthy bacteria during this process.
For moms, vaginal deliveries are safest if she wants to have several children to avoid the risks of multiple surgeries.
Pain relief during vaginal delivery is possible by using medications or non-medicated methods.
Vaginal birth also comes with the risk of blood loss and infection, but less so than with C-sections. Most women experience a tear with a vaginal delivery that requires suture repair. While there is a significant recovery period after a vaginal delivery, it is generally a much quicker process than if you have a C-section.
A vaginal birth after C-section (VBAC) is possible in many scenarios. The biggest risk of associated with the is the scar on the uterus opening, called a uterine rupture. While it is rare, occurring in 0.7-1.5% of women, it is dangerous. Your OBGYN will monitor you closely during labor.
Many factors play into whether VBAC is a safe option, including the reason(s) for your previous C-section, where the incision was made, and how many C-sections you’ve had to name a few. Your OBGYN will discuss these factors with you to determine the safety of a VBAC in your situation.
What about recovery?
Just like nearly everything about pregnancy, the answer to this question is “it depends.” Here are some points to consider:
Because a C-section is a surgery, more pan medications are generally required for good pain control. Most commonly, women take ibuprofen, Tylenol, and a narcotic medication. Any pain medications prescribed are generally very safe for breastfeeding.
Activity after a C-section is more limited. A woman who has a C-section shouldn’t lift anything heavier than 15 lbs for about six weeks. She may need more help around the house and caring for any other young children. She shouldn’t drive for about two weeks or while taking narcotics. C-sections themselves don’t affect weight loss after birth, however a longer time of remaining less active will make weight loss more challenging.
Vaginal Birth Recovery
Soreness and discomfort usually last for a few weeks but can be treated with over-the-counter pain medication, such as ibuprofen and Tylenol. Your OBGYN typically will recommend that you do not perform strenuous exercise for six weeks. Taking it easy for six helps your pelvic floor heal.
Talk to your OBGYN about C-Sections and Vaginal Deliveries
At Madison Women’s Health, we want you to feel comfortable and well-informed about your labor decisions.
During prenatal care, we can talk about all delivery options and guide you with recommendations based on your health history.
If it becomes medically necessary to change the course of your original birth plan, our goal is to explain the reasons behind our recommendations clearly so you can continue to feel supported throughout labor and delivery. Our primary goal is to have safe and healthy moms and baby’s.
Dr. Ashley Durward has been providing healthcare to women in Madison since 2015 and joined Madison Women’s Health in 2019, specializing in high and low risk obstetrics, contraception and preconception counseling, management of abnormal uterine bleeding, pelvic floor disorders, and minimally invasive gynecologic surgery.