Opt for a vaginal birth or cesarean delivery?

There is a raging debate these days regarding the pros and cons of vaginal delivery versus a cesarean birth. A lot has been said about the alarming rise in the incidence of so called unindicated cesarean births in corporate hospitals. Dr Uma Vaidhyanathan from Fortis Hospital, Shalimar Bagh talks about the details of both so you're better informed.

Being an obstetrician in clinical practice for several years now and having seen both sides, Dr Vaidhyanathan can safely opine it varies from case-to-case and from patient-to-patient!

"There are several factors which come into play for a vaginal delivery--if there are no medical or pregnancy related complications, the baby size is adequate enough to negotiate through the maternal pelvis, and most importantly, if the mother to be is well tuned for labor pains then nothing better than a vaginal delivery. For this the mother should be well counseled throughout the pregnancy about stages of labour,and should be mentally prepared to go through it. It helps if she has a supportive partner and family to boost her morale throughout the process of labor and delivery. It is definitely more natural, recovery and the period of staying in the hospital is definitely shorter," confirms Dr Uma.

She also states that, "Early contact with the baby, early establishment of breastfeeding and natural squeezing out of fluid from the lungs of the baby reduces chances of distress. The return to normal life and normal physical activity too is undoubtedly faster for the mother. Some issues that may present themselves with vaginal birth are tears in the vagina during the passage of the baby during birth which may need stitches. Without stitches, the tearing can negatively affect urine and bowel function which happens more frequently after vaginal birth. A vaginal birth may leave the mother with some pain in the perineum — the area between the vagina and anus."

With regards to a cesarean delivery, the doctor feels, "At times, a cesarean delivery becomes necessary if the mother has a complication such as severe hypertension, twin or triplet pregnancy or placenta related complications. The complications can be a low lying placenta, abnormal position of the baby in utero such as breech or transverse lie, severe growth restriction in the baby wherein the baby may not be able to tolerate the stresses of vaginal birth or the baby may be too big for the maternal pelvis!"

She also confirms that a cesarean may be unplanned, "Especially in cases where there is a sudden dip in the baby's heart rate during labor or if labor is prolonged beyond acceptable international guidelines for the various stages of labor. In such cases a well-planned cesarean birth does help saving both the mother and the baby in a well-equipped set up."

But what are the disadvantages of a cesarean? "The disadvantages of cesarean are increased length of hospital stay, discomfort in stitch line that may last weeks or months, higher risk of blood loss and infection, increased risk of cesarean delivery in a future pregnancy as well as increased risk of placental abnormalities. These days though, with shorter surgical times, better suture materials and good antibiotics and stringent infection control practices in hospitals and good physiotherapy and lactation support post-delivery, we see patients getting mobilized as early as 6-12 hours post cesarean and seeking early discharge within 48-72 hours," she replies.

All in all, a lot depends on counseling, mental preparedness and how comfortable the mother to be is with both modalities of birthing. Every prospective parent should have a detailed discussion with their obstetrician regarding their pregnancy, possible complications and options for birthing and pain relief available. Both modalities have their distinct advantages and disadvantages in select cases, and a well conducted delivery in which both the mother and baby go home safely, is what every obstetrician aspires for!