Normal delivery vs cesarean

New mum looking at her newborn after a caesarean in the operation theatre
Photo credit: iStock.com / mustafagull
Wondering about the pros and cons of a cesarean and normal delivery? The kind of delivery that's safest for you depends on many things, such as your medical history, your baby's health and if there are any medical concerns. A normal vaginal delivery is safer than a c-section if there are no pregnancy or labour complications. In some cases, a c-section may be necessary and even be life-saving. Still a cesarean is major abdominal surgery, so it's more likely to cause complications for you and your baby. It's best not to choose a cesarean operation over a normal delivery if there is no medical need.

What is the difference between a c-section and normal delivery?

A normal or vaginal delivery is a natural process by which a baby is born. Your cervix thins and opens, and your uterus contracts to push your baby down the birth canal and out of your vagina.

A cesarean section or c-section is a surgical procedure used to deliver a baby through a cut in the mother's abdomen rather than the vagina. It's major abdominal operation. It can be a:
  • Planned or scheduled c-section.
  • Unplanned or emergency c-section.
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Normal delivery or cesarean - which is better?

There's no one answer as this depends on several factors.

Although a cesarean section is a common procedure, it is a major operation and carries its own share of risks. This is why doctors do not recommend one unless it is necessary for medical reasons.

If there are no complications with your pregnancy or your labour, a vaginal birth (normal delivery) is safer than a cesarean birth. This is true not just for your current pregnancy, but also for any more pregnancies you may have. A vaginal delivery is also better for your future fertility.

Sometimes, a cesarean section is needed to save the life of a mum or baby. In these cases, cesarean birth is without question, the safest option for you and your baby.

If your labour has been induced, and is not progressing, your doctor may suggest a cesarean. She will do this after judging your condition and how well your baby is coping. Your doctor can know how your baby is doing by monitoring her heartbeat during labour.

In some cases, your doctor may offer you the choice between being induced and having a cesarean. Having an induced labour can lead to more interventions, such as an assisted birth with vacuum or forceps, and these carry risks too. So you and your doctor will need to weigh these risks against the risks of having a cesarean.

There are times when the decision is not clear-cut. It will be up to you and your doctor to weigh the pros and cons of having a cesarean, and decide what's best for you. This may happen well before you’re due to give birth, or while you’re in labour, so knowing the facts may help you to prepare.

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Your general health and your lifestyle will also influence this decision. You have a higher risk of complications after a cesarean if you:
  • Are overweight or obese.
  • Have had any previous surgery on your tummy.
  • Already have a medical condition, such as a heart disease.

Which is more painful, a normal delivery or cesarean?

It's hard to say exactly what pain feels like until you've given birth yourself – just like pregnancy, childbirth is different for everyone.

You may have heard a lot about the pain of labour, but the main disadvantage of a cesarean birth is pain after the delivery -- not during the procedure.

You'll probably have a drip for a few hours after the surgery so that top-ups of painkiller can be given when you need them.

You're likely to feel pain in your wound for the first few days and discomfort in your tummy for at least the first week or so after the operation, while your body heals.

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You will need pain relief for a while after the operation, and it will take longer to recover than if you'd had a straightforward vaginal birth.

Some women also experience a very bad headache and feel pain in their lower back at the site of the epidural or spinal, as well as in their neck. Do mention any pain you feel to your doctor. She will be able to adjust your medicines to help relieve some of your discomfort.

Many mums ask for a cesarean to avoid labour pain, but bear in mind that the pain in a normal delivery is usually much shorter than the one after a cesarean.

A c-section may also affect your day-to-day activities for some time. For some women, the abdominal discomfort may last for a few months after the surgery.

Will I have a normal delivery or a c-sec if my baby's cord is around his neck?

This depends on the situation.

If your baby's umbilical cord gets wrapped around his neck (nuchal cord) your obstetrician will probably sort it before you even notice. It's quite common, and it's very unlikely to cause any problems for you or your baby.

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A nuchal cord often passes completely unnoticed during the birth without any issues. However, if your doctor does find the cord around your baby's neck once his head has been born, she can easily fix it. She'll simply loosen the cord so that your baby's shoulders can pass through, or she'll slip the cord over his head.

There are two rare instances where the cord being wrapped around your baby's neck may be a cause for concern:
  • if the cord is wrapped very tightly around his neck
  • if something is stopping blood from flowing through the cord

If the cord's wrapped around your baby's neck very tightly, your doctor may clamp and cut the cord before his shoulders are born. It's unusual for this to be needed though.

Your doctor will be monitoring your baby closely and will able to tell if there are any issues with blood flow in the cord from your baby's heart rate. During a contraction, the umbilical cord can sometimes be compressed, which may result in his heartbeat decreasing for a brief period.

As long as there are no other problems while he's being monitored, your labour can continue without intervention.

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However, keep in mind that if your baby goes into distress or there are any other complications, an emergency cesearean section is the safest way for your baby to be born quickly. Your doctor will decide the best option for you.

What are the risks to my newborn baby after a cesarean birth?

Your baby is likely to be perfectly well, both during and after the cesarean. However, babies born by cesarean are more likely to need a stay in the neonatal care unit than babies born vaginally.

Some babies do have breathing problems after they're born. Breathing problems after a cesarean are not usually serious, but sometimes babies need special care to help them recover. Breathing problems are more common for:
Sometimes a baby may get an accidental cut from the doctor's scalpel, but this usually heals without causing any harm.

In the long term, being born by cesarean may slightly increase the risk of your baby developing asthma in childhood. Some experts suggest that children born via a c-sec may have a slight risk of becoming overweight, but more research is needed to understand this link.

The medicines and antibiotics you take as you recover from birth can pass onto your baby through your breastmilk. But rest assured, your doctor will only prescribe the safest ones for you and your baby.

What are the risks to a mother after a c-section delivery?

A c-section is major abdominal surgery, so it's more likely to cause complications such as:

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Higher blood loss
You will lose more blood overall with a cesarean than with a vaginal birth.

Most of the bleeding will be at the time of the surgery, so your doctor will manage it. One of the main risks of cesarean birth is bleeding more than expected during the procedure.

Very heavy bleeding is uncommon, but if it happens, it may mean that you need to have a blood transfusion. This may sound scary, but you’re in the right place to be treated quickly.

Infections
Before you go into surgery, you'll be offered a single dose of antibiotics to reduce your risk of infection. However, some women still go on to get an infection after a cesarean birth.

There are three main infections to look out for:
  • Infection in your wound. Signs of wound infection include redness, discharge, worsening pain in the wound, or even splitting open. It's more likely to happen if you have diabetes or are overweight or obese.
  • Infection of the lining of your uterus (womb). This is called endometritis. Symptoms include heavy bleeding, irregular bleeding, smelly discharge or a fever after the birth. It is more likely to happen if your waters broke before your labour started or if you had several vaginal (internal) examinations before your cesarean.
  • Urinary tract infection (UTI). You'll have to have a thin tube, or catheter, inserted during the operation to empty your bladder, and this can be a route for infection. The catheter is usually left in for at least 12 hours or until you are mobile. Symptoms of a UTI include pain low down in your tummy or groin, a high temperature, chills and confusion. You may find that peeing is difficult, painful, and causes a burning sensation.
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Blood clot
Any surgery raises your chances of developing a blood clot. For this reason, you'll also be encouraged to get up on your feet as soon as possible after your cesarean. This will help your circulation and reduce your risk of a clot forming.

A clot can be serious, depending on where it forms. If the clot lodges in your lungs (pulmonary embolism), it can even be life-threatening. Signs of a problem include:
  • a cough
  • shortness of breath
  • pain or swelling in your calf
Call your doctor if you have any of these signs after your cesarean.

Your doctor will prescribe preventive treatments, such as blood-thinning medicines, and elastic support (compression) stockings to improve the blood flow in your legs.

Adhesions
Like any other operation in the tummy or pelvic area, a cesarean carries a risk of adhesions as you heal. Adhesions are bands of scar tissue that can make organs in your abdomen stick to each other, or to the inside of your tummy wall.

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It's hard to say exactly how many women are affected by adhesions after a c-section, as they often don't cause any symptoms. But the rate of adhesions increases the more cesareans that you have.

Adhesions can be painful, because they limit the movement of your internal organs. Although it's not common, they can sometimes lead to problems with bowel obstruction and fertility if they press on or block neighbouring organs.

Effects of anaesthetic
Most cesareans are now done without a general anaesthetic, which puts you to sleep. Instead, an epidural or a spinal is used that will numb your belly.

An epidural or spinal is safer for you and your baby than a general anaesthetic. However, having any anaesthetic involves a small risk. With epidurals and spinals, you may have:
  • A severe headache. Though rare, it is more likely if you've had more than one type of regional anaesthetic leading up to the birth. You might not notice the headache immediately. It starts gradually and can go on to get very painful. It tends to get worse when you sit up or stand up, making feeding your baby difficult. You might also feel pounding in the head.
  • Nerve damage. This rarely happens, and if it does, it usually only lasts for a few days or weeks. Permanent nerve damage is very rare.

A longer hospital stay
Women who deliver vaginally go home sooner after birth than women who have a c-section, regardless of whether it's a planned c-section or one following labour.

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If you've had a c-section, you may need to stay for anywhere between three to five days after birth. However, in some cases, you may be asked to stay on for longer. This depends on your recovery and how your baby is coping.

Some women may need to stay high-dependency unit (HDU) after a c-section because of complications. Being in a high dependency unit means that hospital staff can give you more one-to-one care than you may have in the ward or room.

What's more, women who have a c-section are more than twice as likely to be re-admitted to the hospital during the postpartum period as women who have a vaginal delivery.

Uneven healing of scars
Usually, your scar will become thinner and flatter and will turn either white, or the colour of your skin. But in some cases, the body over-reacts to the healing process and develops scars that don't heal as smoothly. These are:
  • Keloid scars. Keloids are a type of raised scar that grow to be larger than the original wound, and can appear thick and lumpy. Keloids can be itchy and painful.
  • Hypertrophic scars. Hypertrophic scars are thickened, raised scars that can be itchy and painful. They're similar to keloid scars, but unlike keloids, they stay within the boundaries of the original wound.
Keloid and hypertrophic scars are more common in people with darker skin. If you're prone to either, talk to your doctor about prevention and treatment options.

Can a c-section delivery cause any other serious complications?

If you've had a serious complication during the cesarean, you may need a blood transfusion.

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Thankfully, most serious complications are rare, although they do become more common if you’ve had more than two cesareans. These include:
  • Injury to your bowel or bladder.
  • Injury to the tubes connecting the kidneys to the bladder (ureters). Though this is very rare.
The risk of needing further treatment after a cesarean is also very small, but may include:
  • Being admitted to intensive care after a cesarean.
  • Having an emergency operation to remove the womb (hysterectomy).
  • Needing further surgery at a later date.

What are the benefits of a cesarean birth?

If you had an emergency cesarean, or a planned cesarean for health reasons, then you’ll know that it’s likely to be the safest way for your baby to be born and for you to give birth.

A planned cesarean section may be necessary, especially if your baby is breech, or if the placenta is covering the baby’s exit, the neck of the womb. Occasionally an emergency c-section will be required, especially if your labour is prolonged or your baby is distressed.

If you opted for a planned cesarean, one advantage is that you will know when your baby will arrive. Knowing the date your baby will be born can give you time to plan for maternity leave, family help, and other post-baby needs. However, it's possible you could go into labour before your scheduled c-section date, and recovery from this major surgery could take more time than you anticipate.

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You won't have the pain of contractions to contend with. You also won’t have to worry about tearing to the area between your vagina and back passage (perineum) that happens with a normal delivery.

You won't need an episiotomy (vaginal cut) during delivery, or experience the pain from bruising and stitches to your vagina and perineum.

Will I get more stitches in a c-section delivery or a normal delivery?

It's hard to give a fixed number as this depends on several factors for each type of delivery.

For a c-section the number of stitches depends on:
  • the type of incision you get (horizontal or vertical)
  • the size of the mother and baby

For a normal delivery it depends on:
  • the size of your baby
  • if an episiotomy (vaginal cut) was done
  • the severity of any tears. Severe tears are described as third-degree or fourth-degree tears, depending how far the tear goes into the tissues around your vagina and anus (perineum).

Will recovery after a c-section take longer than a normal delivery?

This depends on your health and if there were any complications. The good news is that you're likely to recover well from your cesarean if you're fit, healthy and not overweight.

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Your main concern when you are recovering from a cesarean section will be managing the pain that naturally results from an operation. But your doctor will prescribe pain-relieving medicines that are safe for you to take even if you are breastfeeding.

Sometimes complications, such as bleeding and infection, can make recovery more difficult and result in a longer hospital stay. Some women may need to be re-admitted to hospital for these reasons.

You may have heard scare stories about postnatal depression, or that it is difficult to breastfeed after a cesarean. Try not to let these worry you. Though early postnatal depression is more common in women who've had a cesarean than in women who've had a vaginal birth, after two months, the rates are about the same.

You might find breastfeeding more of a challenge than a mum who has delivered vaginally but only because it might be difficult for you to find a comfortable position to feed in.

If you want to breastfeed your baby, it is important to get help from the outset. Ask the nurse attending to you at the hospital for assistance and tips. And speak to your doctor about good positions to breastfeed. Rest assured that once you've started, your chances of breastfeeding successfully are the same as for a woman who's given birth vaginally.

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That being said, recovering from a cesarean is different to recovering from a vaginal birth, but some things stay the same.

You will have postnatal bleeding, known as lochia, after a cesarean, just like after a vaginal birth.

You might also experience postnatal urinary incontinence (urine leaks), which is a common complaint for many new mums after giving birth. So it's important to do your pelvic floor exercises during pregnancy as well as afterwards, however you gave birth.

Read more about recovery after a c-section delivery.

Do c-sections affect future pregnancies?

Possibly. Once you've had one cesarean:
  • You're much more likely to have another cesarean in future pregnancies. However, this isn't the case always, and a vaginal birth after cesarean (VBAC) may be possible.
  • It slightly increases your risk of having a low-lying placenta (placenta praevia) in future pregnancies.
  • Having a low-lying placenta in future pregnancies increases your risk of the placenta embedding too deeply (placenta accreta), particularly if you've had two or more cesareans before. This complication can result in losing a lot of blood at the birth, a greater need for blood transfusion and possibly hysterectomy.
  • There is a very small risk of the scar on your uterus opening up again in future pregnancies or births, but this rarely happens. This is known as uterine rupture. If it happens, uterine rupture can be a serious risk to your and your baby's life.
Sadly, and for reasons we don’t yet understand, the chance of stillbirth in a future pregnancy also increases if you've had a cesarean, although it is still very uncommon.

How can I avoid a cesarean delivery?

The kind of delivery that's best for you depends on several factors such as:
  • Your health and medical history.
  • Your baby's health.
  • Your baby's position in the womb.
  • The number of babies you're carrying (The more babies you're carrying, the more likely it is you'll need a c-section.).
  • Any pregnancy or labour complications.
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However, there are some things you can try to avoid a c-sec and increase your chances of a normal delivery:
  • Don't miss any of your prenatal appointments.
  • Eat well and stay active so you can have a healthy pregnancy.
  • Make your emotional and physical wellbeing a priority.
  • Read up, stay informed and sign up for antenatal classes that can prepare you for labour and birth.
Be aware, though, that in some circumstances, your doctor may recommend a cesarean as the only safe option for you or your baby.

Don't hesitate to share your thoughts and concerns with your doctor. She will be able to give all the information you need to help you make the right decision for yourself and your baby.

हिंदी में पढ़ें! सीजेरियन ऑपरेशन: जोखिम और फायदे


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Priya Solomon Bellani
Priya Solomon Bellani is BabyCenter India's Deputy Editor.