Natural Birth or C Section: Which is Better

Natural birth includes three stages. Each stage lasts for a different duration and the last stage ends in the delivery of the placenta after the baby is born. The placenta is a tissue that is formed inside the mother to provide nutritional support to the growing baby. 

After going through the first stage of labour, the baby is delivered without the requirement of pain-numbing medicines like epidural anaesthesia.

Artificial medical techniques such as an episiotomy (the perineum, the area between the vagina and the anus is cut to make room for the baby to come out of the vagina and sutured once the baby is out) and monitoring of the baby is done.

Vaginal delivery might need medical interventions such as the ones mentioned below. These are accompanied by certain risks associated with each method.

• Amniotomy
  In amniotomy, the amniotic sac surrounding the baby which contains the protective amniotic fluid is artificially ruptured before labour. The baby is delivered within one day after the amniotomy is completed to prevent any infection.
• Induced labour
  Labour is initiated artificially by injecting synthetic oxytocin hormone. Labour may be induced for medical reasons like a small-for-age baby and high blood pressure in the mother. Labour induction has risks such as:
  • Changes in the foetal heart rate.
  • Problems in the umbilical cord.
  • Rupture of the uterus.
  • Maybe lethal to the foetus.
  • Increased risk of requiring a caesarean delivery.
  • Infections in the mother or the baby. (Read more: Gestational hypertension signs)
• Foetal monitoring
  Foetal monitoring is done to observe the baby’s heart rate and associated abnormalities either internally or externally. A scalp electrode that is used to monitor the baby can cause a cut on the baby’s head which typically heals quickly. Internal foetal monitoring has a slight risk of causing an infection.
• Vacuum extraction
  A tiny suction cup is placed on the baby’s head during the delivery when the mother can’t push the baby adequately to complete the delivery. The baby is pulled out once a vacuum force is created along with the uterine contractions. A bruise on the baby’s head due to the suction pump is possible but usually resolves within the first 48 hours after birth.
• Forceps delivery
  Doctors use forceps, which is a device made of two large spoon-like arms to hold the baby’s head and help pull it out. The forceps may make some marks on the baby’s face. One in 10 babies who are delivered using forceps may have small cuts on their scalp or face. In rare cases, the forceps might harm the baby’s brain causing permanent damage.

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Caesarean birth is a surgical procedure to take the baby out of the mother’s womb. Also known as C-section, this surgery takes longer to heal than vaginal birth and has many associated risks.

Some C-sections are planned, but many are performed due to unexpected problems that occur during a vaginal delivery like:

• Problems with the baby’s position.
• A possibility of injury to the mother or the baby during delivery.
• Problems with the umbilical cord.
• Premature labour (when labour begins before 37 weeks of pregnancy).

Following is a list of benefits that mothers experience when they deliver a baby normally (through the vagina:

• Mothers who deliver their baby vaginally have a faster recovery both physically as well as psychologically.
• According to the Royal College of Obstetricians and Gynaecologists, mothers are more likely to have successful breastfeeding after a vaginal birth.
• A special hormone called oxytocin is produced during labour. It aids delivery as well as supports the bonding between the mother and baby.

The following are some of the cons of vaginal birth:

• Natural birth can be exhausting and messy. Amniotic fluids, urine, and other body fluids come out once the baby is delivered. Some women also go through rigorous labour due to which they sweat profusely.
• Vaginal birth is generally extremely painful.
• For some women, vaginal birth is embarrassing as a private and intimate process takes place in an unfamiliar surrounding.
• Risks associated with episiotomy, if it is performed (e.g., bleeding, infection, scar formation, and scar rupture).
• Urinary stress incontinence, a condition where there is no control over passing urine when doing activities like laughing, talking, coughing and more. The pressure in the abdomen increases leading to an uncontrolled passage of urine.
• Injuries to the area around or the vagina itself.
• Heavy bleeding after childbirth.

(Read more: When do periods start after pregnancy)

Following is a list of benefits that babies experience when they are delivered naturally:

• The baby's body can cope better with the changes that occur after coming out of the womb when delivered naturally. Some of these changes that need to be regulated are:
  • Temperature
  • Blood sugar
  • Breathing
  • Blood circulation to the brain
  • Exploratory behaviour, the tendency to explore or investigate new surroundings
• As compared to caesarean birth, vaginal birth supports long-term health, growth, and development of the baby.
• A generally accepted fact is that labour contractions help prepare the baby’s lungs to breathe air well.
• Babies go through psychological distress when forceps or vacuum are used as aids to ease the delivery process.

The following are some of the benefits of a C section for the mother:

• More efficient and a less messy method.
• Quicker than the natural vaginal birth.
• Some women feel more comfortable.
• Unlike labour pains during natural delivery, anaesthesia is provided to the mother during a caesarean surgery which makes it a pain-free procedure.
• Caesarean surgery is a cleaner procedure than vaginal delivery. No mess is created due to blood, lumps of faeces, and amniotic fluid in the operation theatre.
• Caesarean births can be scheduled which helps mothers choose the date of the baby’s birth.
• C-section is not physically taxing like vaginal delivery.

​The following are some of the disadvantages of a C-section:

• Caesarean mothers tend to fart or break wind more often. They experience abdominal or stomach pain and discomfort while passing gas.
• Longer stay at the hospital.
• Risk of infection after the operation. Treatment of the infections can be stressful and can increase the recovery time.
• Higher risk of maternal deaths as compared to vaginal birth
• Scar tissue can cause bowel obstruction, long-term pain, miscarriage or infertility in the future. All of these may make repeat surgery difficult.
• Higher risks of the following in the subsequent pregnancies:
  • Ectopic pregnancy
    Ectopic pregnancy refers to a condition in which the fertilised egg implants outside the uterus.
  • Placenta previa
    In case of placenta previa, the placenta lies low in the uterus and blocks the birth canal opening.
  • Placenta accreta 
    In this condition, yhe placenta attaches very deep into the uterine wall.
• Heart attack. 
• Bleeding can take place after giving birth which would require removal of the womb (hysterectomy). 
• Women who are given general anaesthesia during the surgery may vomit while they are unconscious. There is a risk of the vomit getting into the lungs. This happens in rare cases but is life-threatening. 
• Women who have a spinal block or epidural (anaesthesia that numbs the body below the waist) occasionally, experience a significant drop in blood pressure. 
• Women also experience a certain type of headache after the epidural injections. 
• A visible scar below the pubic hairline made during the surgery to remove the baby persists for life. 
• After the caesarean surgery, there are possibilities of keloid formation (extra scar tissue grows at the site of the scar).
• In some cases of caesarean section surgeries, the uterus ruptures. There is a higher risk of uterine rupture in vertical incision caesarean surgeries than in transverse or horizontal incision caesarean surgeries. Uterine ruptures mostly take place as a result of the previous caesarean section. 
• The upper half of the pubic hair is shaved before the surgery. Women may experience itching once this hair starts to grow back. Scratching becomes difficult due to the sensitive area near the scar.
• Women do not feel strong enough to ride/drive vehicles and manage household tasks for a while after the surgery.
• In 2 out of 100 pregnant women, bladder or bowel injuries are possible.
• An internal scar tissue might form in the pelvic area where the cut was made, which can cause pain and bowel blockage.
• Anaesthesia is given to the mother during a C-section. There is a possibility of negative response by the mother's body to the anaesthesia. Adverse reaction to the painkillers given after the surgery is also possible.
• Infections can occur in the uterus, other pelvic organs like the bladder or at the incision site.

• Babies born through caesarean surgery are more prone to respiratory problems at birth and in adult life. 
• Sometimes the babies born through caesarean surgery are wounded by the surgeon’s scalpel. 
• The risk of admitting babies in the intensive care unit is more in planned caesarean section. 
• If the gestational age is not calculated accurately, a caesarean baby could be delivered before time which would result in a low weight baby. (Read more: Tips to increase your baby's weight)
• Low scores in the APGAR scoring system (a scoring system to determine the well-being of the baby after birth) are more likely in caesarean babies (50%) than in babies born through normal deliveries.