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 and your baby’s health, and what might be best for you.
Some health professionals have different views on the best way to give birth. It helps to look for a supportive health professional who’s open to discussing your birth options with you.
In Australia in 2017, two in every three women gave birth vaginally.
A vaginal birth is usually the safest choice if you and your baby are both well and there are no complications.
Common advantages of vaginal birth
Every woman’s experience of vaginal birth will be different and individual, but women who have vaginal births generally:
- have shorter hospital stays
- are less likely to need to go back to hospital in the weeks after birth
- have less need for strong pain relief after birth
- recover more quickly from labour and birth
- have a better chance of starting to breastfeed their babies straight away
- are less likely to have medical problems in future pregnancies
- are more physically able to care for their babies (and other children) soon after birth
- are more physically able to do everyday tasks like driving soon after birth.
Babies born via vaginal birth are less likely to need time in the special care nursery. 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.
Possible disadvantages of vaginal birth
Women who have vaginal births might:
- need stitches if their vaginal openings tear or are cut (episiotomy)
- need to have forceps or vacuum assistance to help their babies be born
- get very tired because labour can take many hours.
Rarely, a woman might have trouble giving birth to the shoulders of her baby if the baby is large or there are problems with the position of the baby or birth position of the mother.
Sometimes when there are complications during vaginal birth, a woman 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 or risks from using a general anaesthetic.
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. 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 with just a few professionals who look after you through your whole pregnancy, labour and birth can increase your chances of vaginal birth. This is called ‘continuity of care’.
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.
A birth plan can include things like:
- who you’d like to be at the birth
- how you want to manage pain
- who’ll 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 before labour 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 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 means you’re more likely to have a vaginal birth.
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.
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 help you to stay relaxed.
A caesarean section is an operation to give birth to your baby. A caesarean section is also called a caesarean, a c-section or a caesar.
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.
You’ll be given an anaesthetic so you don’t feel any pain. It will usually be an epidural or spinal anaesthetic, or sometimes a general anaesthetic. Then a specialist doctor called an obstetrician will cut an opening in your lower tummy area and into your uterus, so your baby and the placenta can be lifted out.
Your partner is usually allowed into the operating theatre with you unless you have a general anaesthetic.
In Australia, both planned and unplanned caesareans are common and fairly safe.
Caesarean birth: problems
A caesarean birth is major surgery. As with any surgery, there’s 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 caesarean births will probably have:
- longer stays in hospital – 3-5 days on average
- pain around their caesarean wounds
- 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 caused by an infection or by other factors related to the surgery
- complications from the anaesthetic, including nausea, drowsiness or dizziness
- increased risk of postnatal depression
- a higher chance of caesarean section for future births
- special health concerns for any future attempts at vaginal birth.
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.
Most women do get to see their babies straight after caesarean birth, and it’s also your right to ask for skin-to-skin contact and the chance to breastfeed straight away. Skin-to-skin contact helps to keep your baby warm and lets you and baby bond physically straight away.
It might be hard to do skin-to-skin contact straight away if the obstetrician is stitching you up and a paediatrician or midwife is checking your baby. But if you have a spinal rather than a general anaesthetic, you should still be able to have this early contact with your baby.
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).
Caesarean rates at public hospitals tend to be lower than at private hospitals. If you want to know what a hospital’s caesarean birth rates are, ask your doctor or midwife. Some hospitals have their caesarean rates available online to the public.
Planned caesarean birth: common reasons
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 (39 weeks onwards) 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 covered 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 like high blood pressure.
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 day and time that your baby will be born. A planned caesarean also means the birth will generally 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 a lower risk of medical problems than unplanned caesarean surgery.
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.
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
- you become unwell
- your baby starts getting distressed in labour – for example, there are changes in your baby’s heartbeat.
Things that can reduce your chances 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 unnecessary induction before 41½ weeks of pregnancy (an induction can increase pain and medical intervention during labour).
You can’t have a caesarean in a birth centre or at home. If you have complications and it looks like you might need a caesarean, you’ll go to the nearest public hospital by car or ambulance, depending on your stage of labour and whether it’s an emergency.
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.