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Pregnancy is a natural, wonderful, and sacred experience that culminates in the emotional, physical, social, and spiritual event of the birth of a child. Having a baby is associated with overwhelming joy but also great physical pain. This dichotomy creates the need for an essential conversation about the birthing process, whether you are a first-time mom or on your fourth delivery.
Most women spend much of their pregnancy learning their options for the birthing process because there are many things to consider and many options available. However, there are only two methods to bring a baby into the world – Cesarean (C-section) and vaginal birth.
There are three types of C-sections planned, elective, and emergency. A planned c-section is scheduled when your physician determines it is the safer method for medical reasons – such as a breech position (baby is feet first instead of headfirst), high blood pressure, heart disease, diabetes, and multiples, to name a few.
There are many reasons women elect to have a C-section. Some have cultural or personal beliefs that make it the preferred method.
Lastly, things can happen during labor that requires an emergency C-section. In most cases, the delivery isn't progressing normally, or the fetus is in distress. However, other problems like placental abruption (when the placenta separates early from the uterus) or a prolapsed umbilical cord (the umbilical cord comes through the vagina before the baby and cuts off oxygen) can occur.
C-section complications are rare, and the surgery is generally considered safe. However, regarding risks to the mother, complications can include infections, excessive bleeding or hemorrhage, injury to the bladder or bowel, adverse reactions to anesthesia, and possible blood clots and pulmonary embolism. In addition, if the woman has had prior C-sections, risk could also include uterine rupture, placenta previa (when the placenta covers the cervix), and placenta accreta (the placenta implants into the uterine muscle instead of the lining). More than 30 percent of babies are delivered via C-section, and for some, it is often the safer route and best choice for mother and baby.
The risk to the baby during a C-section surgery is minimal but could include respiratory issues, especially when a baby is born before 39 weeks. In addition, some babies may have low Apgar scores. Apgar is a test performed on a baby at 1 and 5 minutes after birth to determine how well the baby tolerated the birthing process and how the baby is doing outside the womb, respectively. However, a low score is typically a minor issue and short-lived.
During vaginal birth, the woman will experience labor pains as the cervix widens to 10 cm. The uterine contractions move the baby's head toward the vaginal opening, where the baby will emerge after pushing. Some will choose to use pain management like an epidural; others choose not to use pain medication.
Every labor and delivery is unique and can last up to 14 hours+ for first-time moms but is typically faster for subsequent births. In a vaginal birth, the woman may have perineal tears or need an episiotomy, also known as a perineotomy (a surgical incision made to enlarge the vaginal opening quickly). If required after the placenta is delivered, your physician will stitch the cut or tears shut. Other complications after birth may include bladder control pelvic organ prolapse (when a portion of the vaginal canal protrudes from the vagina).
There are benefits to a vaginal birth as well. During delivery, the baby is exposed to bacteria in the birth canal, which has been shown to help boost the immune system. Additionally, the mother can generally hold and breastfeed the baby sooner, which improves early bonding.
"When you find that you're pregnant, you should look for a physician that will partner with you," said Kathleen Rustici, MD, board-certified in obstetrics and gynecology at SCL Health Medical Group - Central Park OB-Gyn. "You should feel comfortable asking questions and be able to collaborate with your doctor and trust they will make the safest delivery recommendation for you and your baby."
Ultimately, it doesn't matter how the baby comes into the world. However, you can prepare a birth plan and build a team you trust that can help avoid undesirable outcomes. The most important thing is to have a healthy baby and mama.
