By Raising Children Network
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Some people think that women have less chance of incontinence issues with caesarean birth. In fact, after having babies, you have the same chance of postnatal incontinence problems with both vaginal birth and caesarean birth.
 
If you have no serious problems with your pregnancy or labour, a vaginal birth is the safest way for your baby to be born. But sometimes health problems for you or the baby might make a caesarean birth the safest choice. Caesarean is an operation to give birth to your baby.

Birth choices and advice

If you’re wondering about which kind of birth to have, it’s good to talk with your midwife or doctor about your health, your baby’s health and what might be best for you.

Your health professional can give you information about how different kinds of birth might affect your future ability to get pregnant and have a healthy pregnancy and birth.

Vaginal birth

In Australia in 2010, two in every three women gave birth vaginally.

Every woman’s experience of vaginal birth will be different and individual, but there are some common advantages of giving birth to your baby vaginally.

For example, women who have a vaginal birth generally:

  • have a shorter hospital stay
  • are less likely to need to go back to hospital in the weeks after the birth
  • have less need for strong pain relief after the birth
  • recover more quickly from labour and birth
  • are more likely to touch and cuddle their baby straight after birth
  • have a better chance of starting to breastfeed their baby straight away
  • are less likely to have medical problems in future pregnancy
  • are more physically able to care for their baby (and other children) soon after birth
  • are more physically able to do everyday tasks, such as driving, soon after birth.

Many women say they feel well after a vaginal birth. And women who have a vaginal birth often feel happier with their whole birth experience.

Babies born via vaginal birth are less likely to need time in the special care nursery.  Some studies have shown that babies born vaginally tend to develop stronger immune systems and are less likely to have allergies than babies born by caesarean. This is thought to be because of hormones released during vaginal birth, and the important bacteria babies get through vaginal birth. They can usually have early cuddles and bonding too – good for the baby and good for you.

There are also some possible disadvantages of vaginal birth.

Women who have a vaginal birth might:

  • need stitches if the opening of their vagina tears or is cut (episiotomy)
  • need to have forceps or vacuum assistance to help their baby be born
  • get very tired because labour can take many hours.

Very occasionally, women might have trouble giving birth to the shoulders of the baby if the baby is large or there are problems with the position of the baby or birth position of the mother.

    Sometimes women whose vaginal birth doesn’t go well might need to have an unplanned (emergency) caesarean. An unplanned caesarean can have more problems than a planned (elective) caesarean – for example, an increased risk of infection.

    Women who have had a caesarean birth might be able to try for a vaginal birth if they have another baby. This is commonly called a vaginal birth after caesarean, or VBAC. Most of the time women who start a VBAC will have a vaginal birth – about 80% of women on average. Those who don’t will have an unplanned caesarean birth – about 20% of women on average. Ask your doctor or midwife about whether VBAC is an option for you.

    Increasing your chances of vaginal birth

    Delivering your baby vaginally depends on many things, including your health, your baby’s health and what happens during labour. It’s always a good idea to talk with your health professionals about your birth options. 

    There are also a few things you can do to increase your chances of having a vaginal birth.

    Pregnancy care
    Pregnancy care with just a few professionals who look after you – for example, midwifery-led care – through your whole pregnancy, labour and birth can increase your chances of vaginal birth.

    Women and babies are healthier, and women are more happy with their birth experience, when they have the same person, or group of people, looking after them right through. Many hospitals offer midwifery-led care. This is when a few midwives look after you. You can get to know them and they get to know you before your labour.

    Birth classes
    Birth classes give you detailed information about labour, birth, pain relief choices and more. When you know what to expect during labour and birth, you’re more likely to stay calm on the day. And staying calm and relaxed increases your chances of vaginal birth. 

    Birth plan
    A birth plan can include things like:

    • who you’d like to be at the birth
    • how you want to manage pain
    • who will cut the cord.

    But keep in mind that your baby’s plan might be different from yours. Also, what you need and want might change on the day, so think of the birth plan as a guide and stay flexible. It’s a good idea to share your birth plan with the midwife or doctor who’ll be looking after you, so they understand your preferences and can work with you to achieve them.

    Your birth environment
    Your birth environment can affect how you labour and give birth to your baby. The ideal labour environment is one where you:

    • feel safe, calm and positive
    • have access to pain relief
    • have privacy
    • feel secure and well supported.

    With a bit of planning and preparation, you can usually create the environment you’d like in the hospital birthing suite or birth centre. For example, you might want to bring music, aromatherapy, cushions, food or other things from home.

    This kind of environment will help you stay calm during labour, which makes it more likely that you’ll be able to give birth to your baby vaginally.

    Being calm during labour can help increase the oxytocin in your blood. Oxytocin makes your uterus contract, so higher levels of oxytocin can mean better contractions during labour and a shorter labour. Staying calm can also decrease the adrenaline in your blood – adrenaline stops oxytocin from working.

    Support people
    You’re less likely to have a caesarean if you have continuous one-to-one labour support from people you feel comfortable with. This might be from your partner, family, midwife or a doula.

    Labour choices
    In the birthing suite, staying active and using upright positions might help your labour to progress and help you avoid interventions. This is because gravity helps move your baby down and relaxes your muscles. This means baby can move through the birth canal more easily.

    Using mats, beanbags, cushions, water or birth balls can also help. Comfortable clothing and relaxing music might also be helpful in keeping you relaxed.

    A healthy pregnancy
    Healthy eating and keeping active during pregnancy helps you stay fit and well. Good health boosts your chances of vaginal birth.

    For more information on pregnancy care choices and birth settings, you can explore our birth setting interactive guide. It also introduces you to the main types of health care professionals who will look after you and your baby in different birth settings.

    Caesarean birth

    A caesarean section is an operation to give birth to your baby.

    If you need a caesarean, you’ll be taken to the hospital’s operating theatre. There’ll be quite a few people in the theatre with you, including the obstetrician, an assistant surgeon, an anaesthetist, theatre nurses, a midwife and sometimes a paediatrician.

    Your partner is usually allowed into the operating theatre with you unless you have a general anaesthetic.

    You’ll be given an anaesthetic so you don’t feel any pain. It might be an epidural, spinal anaesthetic or a general anaesthetic. Then a specialist doctor called an obstetrician will cut an opening in your lower tummy area and into the uterus, so your baby and the placenta can be lifted out.

    In Australia, both planned and unplanned caesareans are common and fairly safe.

    A vaginal birth is usually the safest choice for you and your baby. 

    Caesarean birth: problems
    A caesarean birth is major surgery. As with any surgery, there is a chance of medical problems. If you have a caesarean birth, you’ll need a longer hospital stay than for a vaginal birth and a longer recovery period once you’re home.

    Women who have a caesarean birth will probably have:

    • a longer stay in hospital – 3-5 days on average
    • pain around the wound
    • problems with any future attempts at a vaginal birth
    • restricted activities for up to six weeks – for example, limits on lifting, housework and driving.

    Some women might also have one or more of the following:

    • above-average blood loss (haemorrhage)
    • blood clots in the legs
    • infection of the wound and bladder or in the lining of the uterus
    • fever – for example, caused by an infection or by other factors related to the surgery
    • caesarean section for future births
    • complications from the anaesthetic – for example, nausea, drowsiness or dizziness
    • increased risk of postnatal depression, which might be because of slower recovery, feelings after the birth or problems with breastfeeding.

    Babies born via caesarean birth are more likely to need time in the special care nursery, but they’re usually ready to go home when you are.

    After a caesarean birth, you might have to wait a while before you get to cuddle your baby, while your obstetrician finishes the surgery or while a paediatrician or midwife checks your baby. But most women do get to see their baby straight after a caesarean birth.

    The medicines you’ve been given might make your baby sleepy. Skin-to-skin contact and giving your baby a breastfeed straight away might be harder too. But if you have a spinal rather than a general anaesthetic, you should be able to have early physical contact with your baby in the operating theatre.

    After you’ve had a caesarean, there’s a higher risk of medical problems for each caesarean you have after that. For example, there’s an increased chance of the placenta growing into or over the scar inside your uterus. There’s also a higher risk of the uterus tearing or rupturing in future pregnancies. In rare cases this can lead to a hysterectomy (removal of the uterus).

    Planned caesarean birth

    You might have a planned or elective caesarean birth for medical reasons or because there are signs late in your pregnancy that you or your baby might have problems with a vaginal birth. Planning your caesarean for later in your pregnancy can be better for your baby’s health, but talk with your doctor and midwife about what’s best for your situation.

    The most common reasons you and your doctor might decide on a planned caesarean are:

    • you’ve had a caesarean before
    • your baby is breech – that is, positioned bottom or feet first – and can’t be turned
    • your cervix is blocked by the placenta – this is called placenta praevia
    • your baby is lying sideways (transverse) or not head down and can’t be turned
    • you’re having twins, and your first baby is positioned bottom or feet first
    • you’re having triplets, quintuplets or more
    • you have a health problem such as high blood pressure, which means there’s a higher chance of problems during labour for you and your baby.

    Not all women have, or need to have, caesareans in these circumstances. For example, if your baby is breech you can ask about a vaginal breech birth. You can make the decision based on your doctor’s advice about your particular situation.

    More information about planned caesareans
    With a planned caesarean you’ll know the time and day that your baby will be born. A planned caesarean also means the birth will happen before you go into labour.

    If you have a planned caesarean, you won’t have tearing or need stitches in your vagina, but you will have an abdominal scar.

    Planned caesarean surgery does have less chance of medical problems than unplanned caesarean surgery. For example, if a baby is in severe distress, doctors might need to do an unplanned caesarean very quickly using a general anaesthetic. General anaesthetics have more risks than spinal anaesthetics.

    Unplanned caesarean birth: common reasons

    Unplanned (emergency) caesareans can happen when there are problems either with your health or your baby’s health in your pregnancy and during your labour, such as an increase in your blood pressure or your baby going into distress.

    You might need an unplanned caesarean if:

    • your baby’s head doesn’t move down or ‘fit’ through your pelvis during labour
    • your cervix opens too slowly, or doesn’t open at all
    • your blood pressure goes too high or you become unwell
    • your baby starts getting distressed in labour – for example, there are changes in your baby’s heartbeat.

    You might also need an unplanned caesarean if the umbilical cord falls down (prolapses) through the cervix and into the vagina after your waters have broken. This is very rare.

    Things that can reduce your chance of needing an unplanned caesarean include:

    • having a support person with you in labour to help you stay calm
    • having a midwife with you all the time during labour (midwifery-led care)
    • keeping active and relaxed during labour
    • involving your doctor and midwife in decisions about your birth
    • avoiding an induction before 41½ weeks of pregnancy (because for many women an induction increases pain and medical intervention during labour).
    You have a right to be involved in and make decisions about your care. A caesarean can be done only if you give your written permission. Your partner or next of kin can give written permission if you can’t.
     
     
     
    • Last updated or reviewed 25-07-2013
    • Acknowledgements This article draws on material from the Royal Women’s Hospital, Melbourne, Australia.