Birth is a normal physiological process which our body is designed to do.
It’s part of our natural reproductive life cycle.
In most situations, especially when there aren’t any unnecessary interventions, vaginal birth is a perfectly safe, low-risk and preferred method of giving birth.
Pregnancy and birth, although natural processes, aren’t without risks.
Knowing the possible outcomes and benefits of all modes of birth can help you to make truly informed decisions.
It’s also important to remember while vaginal birth does have risks, in many situations, it’s low-risk when compared to a c-section, which is major abdominal surgery.
A c-section is used as an emergency procedure for this very reason — because there is more risk to the mother and baby.
Interventions like an induction of labour and epidurals are big sources of increased risk when giving birth vaginally. Therefore both are best avoided, unless medically necessary.
Here are 6 risks of vaginal birth, as well as some tips to help reduce the chance of them occuring:
#1: Perineal Tears
The perineum is the soft tissue between the vulva and the anus. This soft tissue stretches to accommodate giving birth, but small and even severe tears can occur. Tearing is something many pregnant mothers expect, but are also fearful of.
You can help reduce the risk of tearing by:
- Avoid an unnecessary episiotomy
- Give birth in an upright position. This reduces pressure on both the pelvic floor and perineum
- Make informed decisions about using pain medication. If you’re unable to feel any sensation while pushing, you may increase your risk of tearing, as you’re unable to notice your body’s signals to slow down
- Request perineal support while pushing
- A warm compress on the perineum can help increase blood flow and elasticity of the skin
- Avoid directed pushing (being told when to push) and listen to your body — when you feel the urge to push
- Avoid an unnecessary assisted birth with forceps or vacuum
If a tear does occur, the tips above can help to lessen the severity. In some cases, regardless of precautions taken, tearing still occurs. As unpleasant as a tear can be, fortunately they often heal well, especially when healing measures are taken.
#2: Damage To The Pelvic Floor
In some situations, the pelvic floor (a group of muscles attached to the pelvis), can become damaged while giving birth. For women who experience pelvic floor damage, the result can be temporary or chronic pelvic pain.
While physiotherapy and medications can help, many women go undiagnosed in the postnatal period. They may be told it’s normal to take time to heal, or they are overreacting to normal postnatal healing. For some women, physical trauma to the pelvic floor occurs during the birth, and for others, it’s the result of the weight of pregnancy on the pelvic floor. So even if you have a c-section, you can still have pelvic floor issues (and painful intercourse) after the birth.
Here are some suggestions which can help reduce the risk of damage to the pelvic floor:
- Regular chiropractic care may encourage optimal fetal positioning and ensure a mother’s pelvis is properly aligned for labour
- Pelvic floor strengthening exercises during pregnancy, such as kegels and squats
- Give birth in an upright position
- Avoid an unnecessary episiotomy
- Avoid unnecessary assisted birth with forceps, which can damage pelvic floor muscles (and it requires an episiotomy)
- Make an informed decision regarding pain medication, as it may impact mobility and sensation
If pelvic floor damage does occur, be sure to be an advocate for your care. While it does take time to heal from childbirth, it’s important to receive supportive and proactive care, to help you heal as best as possible.
#3: Pelvic Organ Prolapse
Occasionally as a result of pelvic floor muscle damage, a woman may experience pelvic organ prolapse. This is when the bladder, uterus and/or rectum protrude into the vagina or outside the vaginal opening.
Vaginal birth isn’t the only thing that can cause this type of problem, the weight of pregnancy can too. Smoking and obesity have also been linked to increased rates of pelvic organ prolapse. However, prolonged pushing, assisted birth (e.g. with forceps) and pelvic floor damage can facilitate pelvic organ prolapse.
A cystocele is the term used when the bladder descends into the vagina, and rectocele is the term for when the rectum protrudes into the vagina. There are varying degrees, and with the exception of severe prolapse often time, rest and physiotherapy can help get things back to where they belong.
This is another health concern that often goes underdiagnosed, sometimes due to embarrassment and sometimes due to a clinician’s lack of experience. However, there’s nothing you should feel uncomfortable talking to your midwife or doctor about – they’re there to help, and it’s their job to treat women going through the exact same thing as you.
#4: Persistent Perineal or Vulvar Pain
This can be the result of pelvic floor damage or perineal tears, but sometimes it can occur without any visible trauma to the area. There’s the possibility of some nerve damage, vulvar vestibulitis or scarring from tears and episiotomies.
If you have persistent pain, it’s important to reach out to your healthcare provider. If the pain persists beyond the typical few weeks to a couple of months, it’s particularly important to seek help. There are pelvic specialists who are knowledgeable enough to diagnose less common causes of vulvar or perineal pain that your regular doctor might miss.
While it’s typical for sex to be a bit uncomfortable the first few times postpartum, chronic pain during sex isn’t normal, and it can be treated. Surprisingly though, a recent study found those who had a c-section were twice as likely to experience painful sex after giving birth compared to those who had a vaginal birth.
#5: Umbilical Cord Prolapse
Umbilical cord prolapse is a very rare complication. An umbilical cord prolapse is when the cord comes out before the baby. The cord can become compressed, causing fetal distress. An emergency c-section is often required immediately, unless birth is imminent.
If a mother’s waters break before the baby is engaged (regardless if she planned a vaginal birth or if she will be having a c-section), or if her membranes are artificially ruptured by her care provider (and baby is high), or if baby is in a breech position, she has an increased risk of umbilical cord prolapse.
The incidence of umbilical cord prolapse is very low and ranges from 0.1-0.6% of overall births, and just over 1% for breech births. Putting it into perspective, this means 99% or more births will not have cord prolapse.
#6: Risks For Baby
Babies are designed to be born vaginally and in most cases – again, especially when there’s no unnecessary interventions – they are born without complications.
Occasionally there are complications that can affect baby including:
- Shoulder dystocia varies based on fetal weight, but for an average weight baby (2500g – 4000g) the risk is relatively low at 0.6-1.4%. The risk increases with larger babies born to mothers with gestational or type 1 and type 2 diabetes, with an incidence of 5-9% for babies weighing 4000g – 4500g. You can reduce the risk of shoulder dystocia by reducing your risk of gestational diabetes or controlling diabetes if you’re already diagnosed, and having an active birth where you can easily adjust positions. While it’s a serious complication, having a skilled provider confident in resolving shoulder dystocia may reduce the risks to baby.
- True fetal distress can occur and can be a sign baby is receiving inadequate oxygen. Oxygen deprivation during birth can result in short term and long term physical and cognitive complications for baby.
- Birth injuries can occur. However, having a birth free of unnecessary interventions might reduce the risk. Synthetic oxytocin (Syntocinon or Pitocin) can cause unnaturally strong contractions, forceps and vacuum assisted births have risks, and some modern obstetrical practices can prolong labour – these things might increase the risk of birth injury. It’s important to evaluate the benefit and risk of birth interventions. If your birth has steered from low-risk and uncomplicated, sometimes these interventions are lifesaving.
Our bodies and our babies are designed for vaginal birth. Even with associated risks, vaginal birth is often the safest option for mothers and babies. The World Health Organization recommends a c-section rate of 10-15% which means vaginal birth is thought to be safer in 85-90% of births. It’s also important to remember that a risk is only a risk, it’s not a guarantee that something will occur, it simply means there’s a possibility it can happen.
Be confident in your body, make informed choices, consider a doula for your birth and choose a maternity care provider who is experienced in and supportive of normal physiological birth, to help reduce your risk and help you heal if any complications arise.