Cesarean versus vaginal delivery – which to go for and why?

Dear Dr. Mo: I’m due soon and I’ve been considering to ask for a cesarean birth – what would you medically recommend a woman should go for, normal or cesarean?

No matter how you deliver, this is your future

No matter how you deliver, this is your future

Dear reader: What you are considering is what we term a Cesarean delivery (C-section) on maternal request, in which case you would undergo a planned C-section delivery before the natural onset of labor, without you or your baby really medically needing it and in such scenarios, I tend to advise against it.

But here’s the thing:

The reality is that there’s no good evidence to facilitate a textbook counselling in this case and most of the available data comparing the two delivery routes (planned C-section versus planned vaginal delivery or what you refer to as ‘normal’) is weak and ought to be interpreted cautiously.

Things to consider:

When you desire a cesarean delivery, your doctor should consider your specific (risk) factors, such as age, body mass index (i.e. if you’ve gained a lot of pregnancy weight, any surgery is more risky), accuracy of estimated gestational age (i.e. C-section on maternal request should not be performed before a gestational age of 39 weeks which is full term), reproductive plans for the future, personal values, and cultural context. I know that sometimes, some past experiences (e.g, violence, trauma, or poor obstetric outcomes) and anxiety about the whole birth process may be what’s prompting such requests and if any of these are what concerns you, bring it up with your doctor.

If your main worry is pain during delivery, then prenatal childbirth education, emotional support in labor (i.e. your partner or someone else close to you could attend), and anesthesia for childbirth (epidural) should be offered and could eliminate this issue entirely.

Like any surgery, C-section carries some risks:

Potential risks of C-section delivery include your longer hospital stay and the unpleasantness of waking up from anesthesia, an increased risk of respiratory (breathing) problems for the newborn baby and greater complications in subsequent pregnancies, including rupture of the uterus, placental problems and potential need for complete removal of the uterus, which can all negatively affect your reproductive plans for the future. In addition, it is thought that not going through the birth canal but rather being born in a sterile birth environment (C-section) can adversely affect baby’s immune response.

Also, I always mention that precious moment when a mother takes her baby seconds after birth, which is an emotional and important moment and which is not there if you do C-section.

The bottom line is this: 

If you and your baby are fine, a plan for vaginal delivery is safe and appropriate and should be recommended even if the baby is larger than average, which is another reason that could have promoted your valid considerations.

Whatever your choice turns out to be, I wish you all the happiness and joy with your child.

Yours in health,

Dr. Mo

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