Vaginal birth and cesarean: what you should know

How your baby will be born is one of the things you think about most during pregnancy. Both vaginal birth and cesarean have benefits and risks. The best way forward is to decide together with your doctor, who knows your situation.

Vaginal birth

If there's no medical reason against it for you or your baby, vaginal birth is usually the recommended route, and recovery afterward is often quicker. The World Health Organization stresses that if labor is progressing normally and mother and baby are well, no extra interventions are needed to speed it up.

Even when a vaginal birth is planned, help is sometimes needed: labor may progress slowly, a vacuum or forceps may be used, or the plan may change to a cesarean because of the baby's condition. Slow progress in labor and concern about the baby's condition are among the most common reasons for an emergency cesarean.

When is a cesarean needed?

A cesarean is an operation in which the baby is delivered through a cut in the belly and uterus. It can be planned in advance or decided on as an emergency during labor; a planned cesarean is usually done from 39 weeks. When vaginal birth would be risky for the mother or baby, a cesarean saves lives. The main reasons include:

• A breech baby that can't be turned
• A placenta lying very low (placenta previa)
• Preeclampsia
• Certain infections, such as genital herpes appearing for the first time late in pregnancy
• Signs that the baby isn't getting enough oxygen or nutrients
• Labor not progressing, or heavy vaginal bleeding

Risks and recovery after a cesarean

A cesarean is generally a safe operation, but like any surgery it carries risks. The mother may have a wound or uterine infection, blood clots, heavy bleeding and, rarely, an injury to the bladder. The baby may have temporary breathing difficulties; this is more common in babies born before 39 weeks and usually improves within a few days. Recovery after a cesarean usually takes longer than after a vaginal birth. The World Health Organization notes that a cesarean done without medical need can raise the chance of bleeding, infection, slower recovery and complications in future pregnancies.

Most women who have had a cesarean have no problems in later pregnancies, and many can safely try a vaginal birth next time; in that case, closer monitoring is needed during labor. Still, one cesarean can increase the chance of needing another in a later pregnancy. Rarely, problems such as the uterine scar opening up or the placenta attaching abnormally to the uterine wall can occur.

“Whichever way it happens, a good birth is one where you and your baby are safe and you're part of the decisions.”

Decide together

It's important to talk about how you'll give birth with your doctor from early in pregnancy, ask your questions and share your worries. Your doctor should explain the benefits and risks, taking into account your health, your priorities and whether you'd like more pregnancies. If you're afraid of giving birth, say so openly; support is available. You can note your preference in your birth plan, but the final decision is made based on the situation at the time of birth, with your and your baby's health in mind.

You could ask your doctor: Which way of giving birth is recommended in my case, and why? Does the hospital where I'll give birth have an anesthesiologist and emergency cesarean available around the clock? If I have a cesarean, what will my recovery be like, and how will it affect future pregnancies? Whatever kind of birth you're planning, if your water breaks, you have bleeding or your baby moves less, go to the hospital without waiting.