elective ceasar v natural? which one

Hi
My fiance and I are having a bit of difficulty with deciding what to do when it comes to the birth. I know it is early but it is something that we were asked to start thinking about.
I thought a ceasar would be good for the baby as I thought that natural birth would be more stressful on bubs.
But natural birth for the emotional side of me that wants to experience giving birth.
I was just wondering if anyone had a preference and why and can you wait till you see the size of the baby later on to make a decision (if its a big baby can u choose a ceasar?).
thanks
Amy

Congrats on your pregnancy! Sounds like your instincts are telling you to go natural.. and that certainly is the best for both you and baby.

I'm sure someone else will either point you to articles or explain the differences and risks better than I can, so I'll leave it to them.

All the best with your pregnancy, and you've come to a great place to learn all about having the most fulfilling birth! I don't know what my pregnancy and birth experience would have been like with out what I'd learnt from here.

Good luck!

Hi Amy. Ultimately the decision is yours, but make sure you are well informed of the choices you have. Check out THESE Birth articles on the BellyBelly main site.

Personally I don't think that a natural birth is more stressfull for bubs. I have had a vaginal birth and a c-section. The vaginal birth wasn't exactly natural because I had an epidural and synto drugs but in the vaginal birth my baby was born in a warm room with normal light into DH and a midwife's hands. As soon as my son was born he was in my arms and cuddling up for a breastfeed, then DH had a cuddle and then he went to sleep and I had a shower and got changed.
In the c-section my son was pushed out of my stomach into a cold operating theatre lit by a huge powerful light surrounded by people with masks. Although DH took him for a snuggle as soon as possible I couldn't breastfeed him for another hour or so. Also he was really mucusy for a few days and seemed to be in alot of discomfort because of the mucus. When I asked the midwife about it she told me that it was much more common in c-sections because a natural birth squeezes the baby a bit which forces the amniotic fluid out but in a c-section this doesn't happen so they have to get it all out in the days after the birth.
Don't forget that your baby is designed to be born naturally - its head will narrow to squeeze out and when its ready to be born a very complex hormonal interaction occurs which will start labour. In a c-section your baby is born when an ob chooses not when the baby chooses. If the ob has your dates wrong its possible that an elective c-section could result in a premature baby since they usually try to do them around the 37/38 week mark.
In regards to the size of the baby - many women give birth to big babies without any medical intervention and the scans are often inaccurate. There are lots of women on bellybelly who have had babies that were a totally differant size than the scans predicted.
Having had a c-section I would really recomend it only as a last resort. It leaves an ugly scar and takes much longer to recover from than a vaginal birth.

A natural (or vaginal birth I think is what you mean) is much less riskier for bubs in most cases. The WHO (world health organisation) has calculated a 10-15% caesarean rate as actually medically necessary, so its not ALWAYS safer to have a vaginal birth if you have certain medical conditions of course.

The actual labour/contractions prime your baby for birth - it doesn't stress them out. If your baby is genuinely stressed during contractions, then it could be position related, health related etc, but the actual real stress is low, more common in the really long labours when bub 'gets tired'. I have seen mum get really sick during labour which was a long one, but bubs didn't skip a heartbeat! 160bpm the WHOLE time! But mum had a fever, lots of blood in urine and it was not nice for her at all. But bubs was peaceful and happy.

There is no 'better' choice for anyone, it's not any good saying one is better than the other, so your best bet is to research and find out what it means for you making either choice.

The main differences are this: a caesarean is a major abdominal surgery and that comes with it's own risks without saying. Also there is risk of infection (common to get a wound or other infection requiring antibiotics), six weeks recovery time, pressure to have a caesarean next time (but this is not necessarily what you have to choose and you may have to fight for it), baby has a risk of unexpected prematurity and respiratory problems. During a caesarean, their lungs are not able to be massaged by the vaginal walls as they would with a normal birth and yes their heartrate can drop before birth but this is usually NORMAL as it's baby's way of preparing for birth. The body is an amazing thing. You can imagine like your contractions, a slow buildup is managable, as is the slow labour, but with a caesarean, birth is instantaneous. One minute they are in the uterus, the next they are out. The fluid is still filled in their lungs as the contractions haven't squeezed it out - they can sometimes get 'wet lung'.

A vaginal birth might involve pain of labour for a day, but a caesarean is a six week recovery period and can involve much more pain for more than that. In most cases, you get a brief glimpse of your baby before it is born, then baby is taken while you are stitched up and spend a couple of hours on your own and in recovery. So it can be hard waiting all that time not being able to be with your baby while everyone else is. If you have a vaginal birth, baby can be put right onto you and begin feeding right away. You can usually get up quite soon after and feel completely normal and go have a shower, go to the toilet etc. I don't want to turn this into a who got what symptoms and problems with their caesarean but this is just a handful of what you might find, without overdramatising - these are facts.

There's lots of things to think about - but most importantly inform yourself, make the decision that feels right for you and you if you can do that without anyone else's influence you will have a great experience as it was an informed one.
I'd strongly recommend reading some books like 'New Active Birth' by Janet Balaskas, don't bother with 'what to expect when you are expecting' if you truly want to be informed and empowered.

ps. I have seen and heard of 10-11lb babies born without a single tear. They had active births and pushed in an upright position (this is not about fitness or doing laps in labour but moving around in different positions to help the progress of labour) and had great birth support (i.e. doula or birth attendant). The worst position you can be in is flat on your back, against gravity and less circulation for oxygen for baby. Sounds like you need lots of possitive affirmation and confidence, and some good birth education. Private birth education can be so much more beneficial than hospital based education, so perhaps look into that.

I definitely agree with Kelly! I've done both and wouldn't recommend a c/s. My natural birth was the greatest experience I've ever known. And Seth was a big baby and I didn't need a single stitch. And I also had fantastic birth support ;)

Goodluck! But don't be worried about stress on bubs as I would say Seth was alot more calmer straight from birth than Paris my c/s baby.

*hugs*
Cailin

Ive had 6 vaginal births and have never seen them as stressful on the baby. Vaginal birth is the way we were designed to give birth and through modern science we are now able to have c/s if there are problems. Its entirely your decision but I think a vaginal birth is safer for you and baby unless complications arise (which I hope they don't).
Good luck with your pregnancy:)

not going against the grain here but just letting you know of my experience. Jaykob was 10 pound born so not huge but he had a 39 cm head and I did make the choice to have a c-section, i also think it depends on the doctors/ midwifes but I did elect to do it that way and was just as happy as any other mum :)

Good Luck with your pg and choices! :)

That's not going against the grain at all Colleen :) I think you are going with the grain making your own decisions - like I say, no one's birth is 'better' for anyone as long as mum feels adequately informed. I think all we can do is tell women to make sure they are informed with information from good sources and then they will have a more satisfying birth experience. If you do something and then later realise it wasn't the case or wrong, that's when issues can arise with mum and she may experience feelings of disappointment, sadness or betrayal. I think as long as you do what is right for you, with a consideration to baby, you'll be fine - after all, they are human too :)

I agree with making an informed choise :) I know it sounds a bit fence sitting, but I guess having had a c/s after a long labour...well actually a normal time frame of labour, I would think that labour would be less stressfull on the body and the baby. Only because during a natural birth, the body lets certain hormones flow & control things along the way, the pelvis opens as the babies head goes through & the baby turns according to where they are. During a c/s the baby is taking from the womb without preparation for either body with natural hormones. Many women who have c/s have difficulty with breastfeeding and bonding because they aren't able to hold/feed their babies straight away and that is actually more traumatising than the birth itself.

Check out all your options, read books going for both sides & make a decision based on what you decide is best for you & your baby.

It really is with what you are comfortable with, you are lucky we live in a era that you can make an abundance amount of research. In my mothers day it wasn't like that, you basically did what the doctor wanted you to do. For example mum had me (1st born alive) via ceserean not because of any complications, but because her 1st born was still born at 32 weeks with a cord around her neck so the doctor said to my mum ceserean, then had her 2nd child ceserean, by the time the 3rd child came there was a 10 yr difference and just because it was easier for him it was ceserean again when my mum really wanted a natural birth!!! Infact my mum always regrets it!!!!! Just bear in mind that if your choose ceserean many obs will not give you the chance to have a vaginal delivery for the second.
As all the girls have said you must make yourself informed and then make your own decision with what you feel is the right birth for YOU!
Goodluck.

Roslyn

I know exactly how you feel Amy! I'm going to be attempting a VBAC this time and am a little nervous about it. Gemma was an emergency c/s after a 23 hour labour in which it was discovered that she was posterior. During the labour though she was not stressed at all and was actually asleep for most of it! I am however scared this time round as my labour did stress me out as it was so long and intense(I was induced) and now that I have spoken to the head of doctors at our hospital I do feel a bit better as he has encouraged 'us' to make the decision we want and said he will not induce me as I asked not to be, even if I go overdue.I was quite surprised by how nice he was about it. Although he said he wouldn't let me labour long which bothers me!He also said I can change my mind right up until the last minute if I like.

I have not intention though of going the elcetive c/s as it is major abdominal surgery and scares the crap out of me!The recovery was harsh and I couldn't even bath Gemma for the first 2 weeks of her life, I didn't get to cuddle her as soon as she was born(I met her about an hour later!) and just doing simple things like lifting her were hard work.

Goodluck with your decision!I know its a tough one!

Just adding this article to this post which is a labour & birth FAQ listed topic.

:

---

Voluntary C-Sections Result in More Baby Deaths

LARGE STUDY shows significant evidence
Article published in the New York Times
By NICHOLAS BAKALAR
Published: September 5, 2006

A recent study of nearly six million births has found that the risk of death to newborns delivered by voluntary Caesarean section is much higher than previously believed.

Researchers have found that the neonatal mortality rate for Caesarean delivery among low-risk women is 1.77 deaths per 1,000 live births, while the rate for vaginal delivery is 0.62 deaths per 1,000. Their findings were published in this month's issue of Birth: Issues in Perinatal Care.

The percentage of Caesarean births in the United States increased to 29.1 percent in 2004 from 20.7 percent in 1996, according to background information in the report.

Mortality in Caesarean deliveries has consistently been about 1½ times that of vaginal delivery, but it had been assumed that the difference was due to the higher risk profile of mothers who undergo the operation.

This study, according to the authors, is the first to examine the risk of Caesarean delivery among low-risk mothers who have no known medical reason for the operation.

Congenital malformations were the leading cause of neonatal death regardless of the type of delivery. But the risk in first Caesarean deliveries persisted even when deaths from congenital malformation were excluded from the calculation.

Intrauterine hypoxia — lack of oxygen — can be both a reason for performing a Caesarean section and a cause of death, but even eliminating those deaths left a neonatal mortality rate for Caesarean deliveries in the cases studied at more than twice that for vaginal births.

"Neonatal deaths are rare for low-risk women — on the order of about one death per 1,000 live births — but even after we adjusted for socioeconomic and medical risk factors, the difference persisted," said Marian F. MacDorman, a statistician with the Centers for Disease Control and Prevention and the lead author of the study.

"This is nothing to get people really alarmed, but it is of concern given that we're seeing a rapid increase in Caesarean births to women with no risks," Dr. MacDorman said.

Part of the reason for the increased mortality may be that labor, unpleasant as it sometimes is for the mother, is beneficial to the baby in releasing hormones that promote healthy lung function. The physical compression of the baby during labor is also useful in removing fluid from the lungs and helping the baby prepare to breathe air.

The researchers suggest that other risks of Caesarean delivery, like possible cuts to the baby during the operation or delayed establishment of breast-feeding, may also contribute to the increased death rate.

The study included 5,762,037 live births and 11,897 infant deaths in the United States from 1998 through 2001, a sample large enough to draw statistically significant conclusions even though neonatal death is a rare event.

There were 311,927 Caesarean deliveries among low-risk women in the analysis.

The authors acknowledge that the study has certain limitations, including concerns about the accuracy of medical information reported on birth certificates.

That data is highly reliable for information like method of delivery and birth weight, but may underreport individual medical risk factors.

It is possible, though unlikely, that the Caesarean birth group was inherently at higher risk, the authors said.

Dr. Michael H. Malloy, a co-author of the article and a professor of pediatrics at the University of Texas Medical Branch at Galveston, said that doctors might want to consider these findings in advising their patients.

"Despite attempts to control for a number of factors that might have accounted for a greater risk in mortality associated with C-sections, we continued to observe enough risk to prompt concern," he said.

"When obstetricians review this information, perhaps it will promote greater discussion within the obstetrical community about the pros and cons of offering C-sections for convenience and promote more research into understanding why this increased risk persists."

---

I havent had a baby yet, so I will probably feel different on this after I have!!
But the way I think of it is that our bodies are designed to give birth vaginally and so I'd like to do it that way. If a caeserean becomes necessary and the midwives/doctors advise me it is the best option in my case then I would do it that way if it would work out better for baby and me. I dont have a problem with c-section, its just that I would prefer not to have some pretty big surgery. It doesnt scare me at this stage, and neither does vaginal birth, but I just would rather avoid surgery unless its really needed.

My GP who is also trained in obstetrics told me recently that because I am small framed, the hospital might try to tell me my pelvis is "too small" and I'll have difficulty birthing vaginally.. and they might try to suggest I dont do it that way.

Congrats on your decision. I would recommend reading 'New Active Birth' by Janet Balaskas....

Just adding the study which was referenced in the article above.

:

---

Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with ‘‘No Indicated Risk’’
United States, 1998–2001 Birth Cohorts

Marian F. MacDorman, PhD, Eugene Declercq, PhD, Fay Menacker, DrPH, CPNP, and Michael H. Malloy, MD, MS

ABSTRACT:

Background: The percentage of United States’ births delivered by cesarean section has increased rapidly in recent years, even for women considered to be at low risk for a cesarean section. The purpose of this paper is to examine infant and neonatal mortality risks associated with primary cesarean section compared with vaginal delivery for singleton full-term (37–41 weeks’
gestation) women with no indicated medical risks or complications.

Methods: National linked birth and infant death data for the 1998–2001 birth cohorts (5,762,037 live births and 11,897 infant deaths) were analyzed to assess the risk of infant and neonatal mortality for women with no indicated risk by method of delivery and cause of death. Multivariable logistic regression was used to model neonatal survival probabilities as a function of delivery method, and sociodemographic and medical risk factors.

Results: Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death.

Conclusions: Understanding the causes of these differentials is important, given the rapid growth in the number of primary cesareans without a reported medical indication. (BIRTH 33:3 September 2006)

---

Hi Amy, I thought I'd just add my experience of a CS for you.

My DS was born via emergency CS after 14 hours of pretty full on labour. Yes he was distressed but there were a whole range of reasons for this, my waters were very heavily meconium stained, he was 2 weeks over his due date, my BP was high, he was posterior and he got stuck so it was pretty stressful for us both! Breastfeeding was difficult and very painful and I didn't get that special first skin to skin cuddle as my spinal block didn't work so had the op under a general anasthetic.

This pregnancy is going beautifully. Bub is in a great position (not posterior so far), my BP is great and I am planning a vaginal birth.

I have a very active 19 month old DS at home so cannot imagine the 6 weeks recovery period, Although in reality you feel better after 2 or 3 weeks but you are not supposed to drive for 6.

My reasons behind wanting a vaginal birth are simple ones - this will be my last baby so I want the "natural" experience, I want a skin to skin cuddle straight after and to look into her eyes and have her know that I'm right there for her, I want to breast feed straight away, and I want to be up and about caring for both of my precious children (my DS will need extra cuddles from his Mummy very much after his sister arrives) without the discomfort of the CS incision.

Having said all that, don't let anyone tell you what you should do or what is the "right" way to meet your baby. Do what you feel is right for you, if that's a CS then go for it and don't look back. Your birth experience is a very personal one and not something that anyone else can decide for you.

Good luck with everything.

I was very pro natural birth and had planned on Hypnobirthing my baby. However, he was breech and staying that way, so I ended up having a ceasar. I was absolutely petrified of this, but as it turned out had a very good experience in terms of healing/pain etc.

However I did have problems breast feeding Ben afterwards as my milk didn't come and I had one very hungry bubba. After 4 days of the poor baby crying I finally got him on to comp feeding and I am proud to say now that we have sorted it out and he is fully breast fed.

I truely beleive that my milk issues had to do with the c/s as my body didn't go through the same process as it would have had I birthed naturally.

Would I have the c/s again? I am not sure. Considering I did have such a good op experience I am now abit afraid of natural, but I will make that decision in a couple of years.

Good luck with the birth of your beautiful bubba! I am sure you will make the right decision for you. :D

Mel

I requested a c/s for my second birth and it was absolutely the right & empowered choice for me - easier and less traumatic than my first birth, (which was very poorly managed and probably not a reflection on how most vbs go). DD2 had much better apgar scores and bounced back from the birth much better than DD1 did. However even though my experience was really good and the staff followed my birth plan and I was able to attempt BFing in theatre and then again in recovery, this is not how all CS's go. And you never know what sort of recovery you will get. I was doing really well for the first few days (discharged early etc) but then a wound infection set in and that has added several weeks onto the recovery time (not to mention another stay in hospital). I have been lucky to have DH at home on leave the entire time but without that it would have been an impossibly hard slog. '

BFing wise - I had similar attachment problems after both the VB and CS and don't believe there was any difference there, except that the hospital I was in for the CS provided much better BFing support - plenty of LCs there when I needed them. Also my milk came in earlier after the CS but that may be because my body had already lactated once before.

So in balance it would be hard for me to say which is better - I was physically much more able after my first VB but emotionally wrecked for months afterwards, but after my CS - physically much harder recovery - and 6-8 weeks is a loooooong time - but emotionally much happier and healed inside myself. So you never really know how it'll turn out. The important thing is to arm yourself with as much info as you can, and take an empowered decision not a fear-based one. If you feel empowered in your decision you are far more likely to be happy with the outcomes no matter what actually happens during the birth.

Good luck with it all!