Vaginal or caesarean delivery?

Vaginal delivery

Vaginal delivery is the most common method of childbirth. Two thirds of Australian babies are delivered vaginally.

Vaginal birth can begin spontaneously or by induction (drug or devices to bring on labour). Your obstetrician or midwife may recommend induction if your baby’s late, if you have pregnancy complications or if labour starts spontaneously and then later stops.

Benefits

With a vaginal delivery, your hospital stay and recovery time is likely to be shorter than after a caesarean.

You’ll also be avoiding the risks associated with surgery and the longer-lasting pain you’d experience while your body heals. And because you’re likely to be less ‘woozy’ from the effects of surgery, you’re more likely to be able to hold your baby and begin breastfeeding soon after you deliver.

During a vaginal delivery, your muscles squeeze out fluid from your baby’s lungs which reduces the risk of breathing problems at birth. A baby born vaginally also receives an early dose of ‘good bacteria’ as it travels through your birth canal. This may boost your baby’s immune system and protect their intestinal tract.

You’ll be able to drive without the 6-week delay that affects women who have caesarean births.

Drawbacks

Labour pain. Going through labour and having a vaginal delivery is a long process that can be painful and challenging for the mother.

Tearing. During the final stages, there’s a risk that the skin and tissues around the opening to your vagina will stretch and tear. Your obstetrician or midwife may perform an episiotomy (a cut to widen the opening of the vagina, to prevent a tear). After a tear or episiotomy, you may need stitches, and walking can be painful until it heals. There’s also a risk of infection.

Incontinence. Tearing during labour can weaken or injure the muscles that control your bladder and bowel, causing later incontinence. If this happens, you may be more prone to leak urine when you cough, sneeze or laugh. Pelvic floor exercises can help with this.

Uterine prolapse. This condition, where your uterus drops into your vagina, is also a risk and is more common if you’ve had several vaginal births.

Lingering pain. Some women also experience lingering pain in the area between their vagina and anus after a vaginal birth.

Injury to the baby. If you have a difficult labour or if your baby is large, they may be born with a bruised scalp, a fractured skull or collarbone or even paralysis of an arm. These are most likely to be temporary problems.

Other interventions following epidural. If you have an epidural for pain relief, there’s more chance you’ll need other interventions such as a forceps or vacuum extraction.

Caesarean delivery

Around 1 in 3 Australian babies is delivered by caesarean. Risk factors increase with age, meaning older women are more likely to have caesareans. 

Reasons for choosing a caesarean include:

• you had one previously (although you may still be able to have a vaginal birth if you had a caesarean in the past)
• the baby is in a breech position (feet first) or sideways (transverse) and can’t be turned
• you’re having twins and the first one is breech
• you’re having 3 or more babies
• the placenta is blocking your cervix
• you or your baby has developed a problem during your pregnancy or labour and the baby needs to be delivered urgently
• it’s your preference.

Benefits

If you’re able to have a vaginal birth, there aren’t too many advantages to having a caesarean. However, if you know you’ll need a caesarean, it can be scheduled in advance, making it more convenient and predictable than a vaginal birth.

You’ll also avoid the pain and hard work of labour.

The most important advantage is when a mother or baby is suffering acute distress: an emergency caesarean can be life-saving.

Drawbacks

After a caesarean, you’ll probably have a longer hospital stay compared with a vaginal delivery. You’ll most likely have pain at the incision site for some weeks and it can take up to 2 months for full recovery. You’ll be unable to drive for around 6 weeks and your activities will be limited.

Compared to vaginal birth, the surgery carries increased risks of complications. These include:

• blood loss, with a possible need for a blood transfusion
• blood clots in your legs
• infection
• injury to your bladder or bowel
• injury to the baby’s skin from a scalpel nick 
• after-effects of anaesthesia (mainly nausea and vomiting)
• difficulty beginning early breastfeeding (compared to a woman who’s had a vaginal birth)
• need for painkillers and antibiotics which can enter your breast milk and affect your baby.

Overall, women are 3 times more likely to die during a caesarean delivery than a vaginal birth although the risk still is extremely low.

If you’ve had one caesarean, you’re more likely to need to have a caesarean for future deliveries. You may also be at greater risk of future pregnancy complications, such as uterine rupture, which is when the old caesarean scar in the wall of your uterus ruptures from the increased pressure inside. Placenta abnormalities are more common too, with the risk increasing for every caesarean you have. In subsequent pregnancies there may also be a greater risk of stillbirth.

Babies born by caesarean are more likely to be admitted to intensive care, have breathing problems at birth and asthma during childhood.