To cut or not to cut

Seema Sharma

Childbirth is a momentous occasion in the life of any woman; it is also a process that makes the mother (and other family members) anxious right from the start of pregnancy. The health of the mother and the child is paramount, and thus a number of critical decisions have to be made before and during delivery. The most crucial being choosing between a Caesarean section and a vaginal delivery.

A Caesarean section, also known as C-section, involves making a surgical incision in a pregnant woman’s lower abdomen and uterus. The other option is vaginal delivery, also called ‘normal delivery’. A C-section is a surgical procedure, and is thus considered more dangerous than vaginal birth. However, this may not always be true as both options can be risky to the mother and the child. Though both processes have their respective benefits, too. This has made the choice between the two processes a subject of heated debated among the scientific community.

A C-section can be planned, or may be the last resort during an emergency. In most cases where it is planned, there are usually medical reasons behind the decision. Some common reasons can be that the mother may have had a C-section earlier or that she is carrying more than one foetus. She may also be having other problems such as high blood pressure, problems with the placenta, HIV, herpes, diabetes or an infection — all of which can complicate the delivery. In some cases, if the size or the weight of the baby is more than normal and large in comparison to the mother’s pelvis. The doctor may also advise a C-section if the baby’s head is not in the correct position before birth. Emergency C-sections are usually performed in case the baby is not receiving enough oxygen, or the labour process is happening too slowly. So, basically a C-section is the preferred choice of the doctor in any situation that puts the health of the mother and/or the child in danger. Many women may also choose a C-section for non-medical reasons such as wanting to schedule the time of the delivery.

However, once a C-section is performed, the mother typically has to undergo the same process again during a subsequent delivery. This is because the incision formed during C-section greatly increases the chance of the uterus tearing in case of a vaginal delivery next time. This makes vaginal birth the preferred option for first-time mothers. A C-section is, after all, a major surgery and has a large number of health issues associated with it. Opening up the abdomen and removing the baby from the uterus include consequences such as greater susceptibility to infections, increased risk of blood loss and formation of blood clots. Additionally, the bladder or bowel of the mother can also be injured during the procedure.

A delivery through a C-section means a longer stay in hospital. The recovery period is also longer. Severe bleeding and scarring can be caused by the surgery, along with longer-lasting pain and the possibility of negative reactions to anaesthesia. After the surgery, the mother is unable to breastfeed or hold her baby immediately, as the procedure tends to make her feel weak. Another reason why vaginal delivery is preferred is that the natural process of the mother’s muscles is much more likely to squeeze fluid out of the baby’s lungs, which protects them from having breathing problems like asthma at birth. Children delivered from the vagina also receive bacteria while passing through the birth canal, which boosts their immunity system and strengthens their intestinal tract.

While a C-section involves many risks but this does not mean that vaginal delivery is free from complications. The process can cause damage to the mother’s pelvic floor, which may result in problems in the her sexual activity post-birth. The damage also causes incontinence problems later on, resulting in urine being leaked while coughing or sneezing. In case of severe stretching and tearing of the vaginal tissue, the mother also needs stitches. Women who deliver vaginally also often complain of lingering pain in the area between the vagina and the anus.

The child can also suffer injuries during the birth process if the labour period is long, or if the baby’s head or body is too large. A fractured collarbone or a bruised scalp can be expected in such a case. Studies have even found a small amount of bleeding in and around the brains of one in four babies delivered vaginally, though the haemorrhage does not necessarily mean any long-term damage.

The process of giving birth is complex, regardless of whether one chooses a C-section or vaginal delivery. The surgical process of a C-section can result in many health problems for the mother and the child, making it a less preferred option. At the same time, vaginal birth also has its share of risks. Increasing awareness about the details of both processes will help mothers make informed choices and have healthy, stress-free deliveries. A good ante-natal preparedness with controlled weight gain, healthy eating and exercises can go a long way to improve vaginal delivery rates. Caesarean delivery can be done in an emergency not as an option.

The writer is gynaecologist with Srishti — The Gynae clinic, New Delhi