The debate as to whether natural childbirth or a cesarean section is better continues unabated. Various methods of delivery are evaluated in terms of safety for mother and baby, the ability to establish breastfeeding, and return to everyday life quickly. Obstetricians-gynecologists assess all possible indications and contraindications when deciding whether to allow a woman to give birth independently or to undergo surgery.
Over the past 10 years, the frequency of cesarean section (or C-section) surgeries has increased by 50%: so one in three pregnancies ends up on the operating table. Is this bad or good?
How Natural Childbirth Happens
Today’s knowledge about the moment when labor begins is that it is the baby itself that initiates “the woman’s release of the burden”. When the body matures and the placenta is no longer able to provide oxygen and nutrients in the required volume, the baby releases a specific protein into the amniotic fluid. The substance stimulates the production of oxytocin, and uterine contractions begin.
Labor consists of three periods. During the first, the muscular fibers of the uterus contract and the cervix opens. During the second, the baby passes through the birth canal and involuntarily makes turns. He “groups” by pressing his arms and legs against his body. When moving, the baby feels the pressure of the walls of the birth canal and he himself influences the tissues of the mother. During this period, a woman can be traumatized (perineal tissue tearing). To prevent this, protection techniques or a surgical incision, an episiotomy, are used.
With a physiological birth, mother and baby have time to adjust and “pass” this difficult path without injury. In the third period the delivery of the placenta occurs. The total duration of a natural birth is 6 to 18 hours.
Early breastfeeding and being in the room together form the basis for breastfeeding and the formation of a strong bond between mother and baby.
In some cases the birth does begin and end naturally, but the difficulties that arise in the process overshadow the joyful memories of meeting the baby and cause longer recovery and treatment.
How does a cesarean section operation work?
Cesarean section surgery is a process of surgical delivery. During it, the obstetrician dissects the tissues of the anterior abdominal wall in layers, then makes an incision on the uterus and dilates the opening to the right size. The baby is extracted manually, and the umbilical cord is squeezed and cut. Then the obstetrician examines the uterine cavity, separates the afterbirth, and “cauterizes” the injured vessels to prevent bleeding. Sutures the uterine wall and all layers of the anterior abdominal wall, including the skin.
The duration of the operation is 30-40 minutes. During this time, the expectant mother is under spinal anesthesia or general anesthesia. In the first case, she hears what is happening, feels that the doctors are doing some manipulations, but does not see the process itself, because the operating field is screened off. She is shown the baby immediately after birth.
When a cesarean section is performed under general anesthesia, the mother “wakes up” after the operation in the intensive care unit. If the baby is okay, he or she is brought the same day.
Depending on the circumstances, there are planned and emergency caesarean sections. Planned is assigned to women who are not going to be admitted into labor. Its time tries to be as close as possible to the preliminary date of labor, and in some cases wait for the beginning of contractions. Emergency CPR is performed to save the life and health of the mother and child, when natural childbirth or further continuation of pregnancy is impossible. Surgical intervention does not trigger hormonal changes in a woman’s body, which are typical for the natural process, and the baby does not feel the physiological stress of going through the birth canal.
Pros and cons of natural childbirth
Natural childbirth on time is the best scenario for ending a pregnancy. What are the benefits for the woman and the baby? Here are the main “pluses”:
- A woman can recover quickly and leave the maternity hospital as early as 2-3 days.
- Hormonal “readiness”, fast attaching to the breast, being together trigger lactation. The breastfeeding process is established in a short time.
- The likelihood of postpartum complications is lower than after surgery.
- There are no undesirable effects of drug therapy.
WHO experts indicate that the mortality rate in natural childbirth is 5 times lower than in cesarean section surgery. However, the informational article, which mentions this fact, does not contain data on the initial state of health of the mother and fetus.
Proponents of giving birth exclusively through natural means tend to describe the process as long, joyful, and easy, and describe pain sensations as tolerable. However, complications during childbirth are also possible: peculiarities of the mother and child already existing by the beginning of the process itself, or situations that arise acutely. The first group includes:
- multiple pregnancies.
- Premature pregnancies.
- Premature rupture of water.
- Malpresentation of the baby.
In the interest of the mother and the fetus, the obstetrician can refer a woman for a C-section in advance.
There are no less serious complications that cannot be predicted:
- Abnormal fetal positioning.
- Amniotic fluid embolism.
- miscarriages.
- placenta detachment, hemorrhage.
- uterine rupture.
- umbilical cord prolapse.
Describing the desire to give birth on one’s own as a conscious choice, women are not always prepared to accept its consequences:
- injury to the woman in labor.
- death of the mother, the baby.
- pronounced pain syndrome.
The pros and cons of natural childbirth for the baby can be described in three main points:
- the baby goes through the birth canal and turns out to be more prepared for life in a new environment.
- The digestive tract is repopulated faster with normal flora.
- Injuries to the baby, broken bones, and the formation of hematomas are possible. The risk increases in the case of rapid or impetuous labor, and it is impossible to predict their speed.
Speaking of “common” conditions accompanying natural childbirth, obstetricians and gynecologists describe damage to the genitals and pelvic floor muscles in women. Thus, a large fetus or low elasticity of the connective tissue causes ruptures. To facilitate the passage of the baby, the obstetrician performs an episiotomy, after which recovery is faster than with a mechanical tear. But in both cases, the perineum is stitched. The mother’s quality of life deteriorates. Until healing, she is forbidden to sit up, she “adapts” to feed the baby standing or lying down. Subsequently, there may be cosmetic defects in the perineal area.
Stretching of the pelvic floor muscles causes stress urinary incontinence in 10% of women who have gone through natural childbirth.
It is also worth noting that the first period is the most painful stage of labor. The opening of the cervix may be accompanied by nausea, vomiting, and chills. Lack of preparation can cause a woman to get “lost” in pain, panic, and the baby’s blood supply suffers. An epidural anesthesia is increasingly being prescribed to alleviate the condition, but it is not approved for everyone.
This article will help you more Preparing for childbirth | Important tips
Pros and cons of cesarean section surgery
Not all women are ready to experience all the sensations that come with natural childbirth. Some people tune in for an operation and try to find an indication for a planned C-section. What are the pros and cons of such an operation for the mother and the baby? Among the most common are:
- The ability to prepare for or “plan” the surgery for a certain date.
- Absence of pain characteristic of contractions.
- Prevention of perineal trauma, prevention of hemorrhoids. Stress urinary incontinence after KC occurs in only 5% of women.
- The operation takes less than an hour, most of which is spent on stitches.
- Less traumatization of the baby.
- The possibility to rely on the actions of doctors and not to worry about doing something “wrong” and causing harm to the baby.
But if operative delivery consisted of only pluses, the frequency of CCs would probably be higher. What do obstetricians and gynecologists say about the “cons”:
- A woman loses a larger volume of blood, and may need to administer replacement solutions or blood products.
- The patient undergoes anesthesia, the recovery from which is incomparable to the recovery after childbirth.
- after surgery the woman receives antibiotic therapy and cannot immediately attach the baby to the breast, the lack of timely “switching on” of lactation can lead to difficulties with breastfeeding in the future.
- Postoperative bleeding and the formation of hematomas in the area of stitches.
- The formation of adhesions in the abdomen.
- Longer recovery time.
- a limited number of CSs: obstetricians recommend no more than three operations during life, as the risk of uterine rupture, abnormal attachment of the placenta grows.
- difficulties with the maturation of the gastrointestinal tract of the child due to the fact that it was not timely inhabited by the microflora of the mother.
- impaired adaptation of the baby to new conditions, respiratory distress syndrome.
Mom’s emotions during a natural birth or cesarean section
Choosing a medical facility, a doctor, making a plan – these are the things that instill confidence in the heart of an expectant mother. A positive attitude, preparation, studying the appropriate literature can give the feeling that everything should end well.
But a real birth can cause unexpected negative feelings: too scary, too painful, the midwife does not give a fitball, and puts an IV. A baby is born, but the exhausted mother cannot rejoice in her new family member, but constantly returns to traumatic memories.
Or the birth situation changes, the woman undergoes an emergency cesarean section. She faces pain in the area of stitches, cannot breastfeed, and most importantly, worries about the “incompleteness” of the pregnancy itself.
Speaking of negative emotions after any method of delivery, psychologists summarize women’s experiences with one phrase: “something went wrong”. Unfortunately, neither a cesarean section, nor a completely natural birth will guarantee that a young mother will remember them with joy.
Indications for caesarean section
When considering what is best, it should be remembered that before the invention of this operation, the most common cause of death for women was death in childbirth. Cesarean section saves the life of the mother and child. And it is performed strictly on indications. They are divided into absolute and relative.
The absolute indications include:
- Clinically narrow pelvis (the situation occurs in labor, it is impossible to predict).
- Placenta detachment or placenta previa.
- threatened or already started uterine wall rupture.
- Incomplete scar of the uterine body.
- Pelvic tumors that interfere with the baby’s progress through the birth canal.
- cervical cancer in a woman.
- severe cervical ruptures.
- Preeclampsia, eclampsia.
- Severe somatic diseases.
- pelvic and vaginal varicose veins.
There are also relative indications, which also decide on operative delivery. Obstetricians are inclined to choose a CC if two or more of the following conditions are present:
- Abnormal, transverse fetal positioning.
- Malposition and malposition of the head.
- multiple pregnancies.
- Carried over pregnancy.
- pregnancy after a long period of infertility;
- fetal breech presentation.
- Chronic uterine-placental blood flow disorders.
- malformations of the female reproductive organs.
- somatic diseases, including myopia.
It is incorrect to compare what is better – natural childbirth or cesarean section. The operation is a forced measure that saves the life of the mother and child. Self-delivery is a physiological process, the participants of which are not protected from injuries and complications.
