Babies can enter this world in one of two ways: Pregnant women can have either a vaginal birth or a surgical delivery by Caesarean section, but the ultimate goal is to safely give birth to a healthy baby.
In some cases, C-sections are planned because of medical reasons that make a vaginal birth risky. A woman may know in advance that she will need a C-section and schedule it because she is expecting twins or other multiples, or because the mother may have a medical condition, such as diabetes or high blood pressure, an infection that complicates pregnancy, such as HIV or herpes, or she may be experiencing problems with the placenta during her pregnancy.
A C-section may also be necessary in certain situations, such as delivering a very large baby in a mother with a small pelvis, or if the baby is not in a heads-down position and efforts to turn the baby before a woman gives birth have been unsuccessful.
Sometimes the decision by an obstetrician to perform a C-section is unplanned, and it is done for emergency reasons because the health of the mother, the baby, or both of them is in jeopardy. This may occur because of a problem during pregnancy or after a woman has gone into labor, such as if labor is happening too slowly or if the baby is not getting enough oxygen.
Some C-sections are considered elective, meaning they are requested by the mother for non-medical reasons before she goes into labor. A woman may choose to have a C-section if she wants to plan when she delivers or if she previously had a complicated vaginal delivery.
Although C-sections are generally considered safe and, in some situations life saving, they carry additional risks compared with a vaginal birth. They are a major surgery and involve opening up a pregnant woman’s abdomen and removing the baby from her uterus because a vaginal birth is considered too dangerous or difficult.
Because C-sections in first-time mothers often lead to repeat C-sections in future pregnancies, a vaginal birth is generally the preferred method of delivery. It’s the way two in three babies in the United States are born.
In general, women say that giving birth vaginally feels like more of a natural experience, said Dr. Allison Bryant, a maternal fetal medicine specialist at Massachusetts General Hospital in Boston. Women may feel as if they are giving birth the way nature intended them to, she added.
Regardless of how they decide to give birth, “women should be as informed as possible about their childbirth options, so they can have a voice in the process, advocate for what they want and make the most informed choice,” Bryant said. Here is more information about the pros and cons of the two birthing methods.
Pros of vaginal birth for the mother
Going through labor and having a vaginal delivery is a long process that can be physically grueling and hard work for the mother. But one of the benefits of having a vaginal birth is that it has a shorter hospital stay and recovery time compared with a C-section.
Although state laws vary, the typical length of a hospital stay for a woman following a vaginal delivery is between 24 and 48 hours. If a woman is feeling up to it, she may elect to leave the hospital sooner than the allowable time period permitted in her state.
Women who undergo vaginal births avoid major surgery and its associated risks, such as severe bleeding, scarring, infections, reactions to anesthesia and more longer-lasting pain. And because a mother will be less woozy from surgery, she could hold her baby and begin breastfeeding sooner after she delivers.
Cons of vaginal birth for the mother
During a vaginal delivery, there is a risk that the skin and tissues around the vagina can stretch and tear while the fetus moves through the birth canal. If stretching and tearing is severe, a woman may need stitches or this could cause weakness or injury to pelvic muscles that control her urine and bowel function.
Some studies have found that women who have delivered vaginally are more likely to have problems with bowel or urinary incontinence than women who have had C-sections. They may also be more prone to leak urine when they cough, sneeze or laugh.
After a vaginal delivery, a woman may also experience lingering pain in the perineum, the area between her vagina and anus.
Pros and cons of vaginal birth for the baby
One advantage for the baby of a vaginal delivery is that a mother will have more early contact with her baby than a woman who has undergone surgery, and she can initiate breastfeeding sooner, Bryant said.
During a vaginal delivery, muscles involved in the process are more likely to squeeze out fluid found in a newborn’s lungs, Bryant said, which is a benefit because it makes babies less likely to suffer breathing problems at birth. Babies born vaginally also receive an early dose of good bacteria as they travel through their mother’s birth canal, which may boost their immune systems and protect their intestinal tracts.
If a woman has had a long labor or if the baby is large and delivered vaginally, the baby may get injured during the birth process itself, such as having a bruised scalp or a fractured collarbone, according to the Stanford School of Medicine.
Pros of C-section for the mother
There are not a lot of advantages to having a C-section if a woman is eligible to have a vaginal delivery, Bryant said.
However, if a pregnant woman knows that she will need a C-section, a surgical birth can be scheduled in advance, making it more convenient and predictable than a vaginal birth and going through a long labor.
Cons of C-section for the mother
A woman who has had a C-section typically stays in the hospital longer, two to four days on average, compared with a woman who has a vaginal delivery. Having a C-section also increases a woman’s risk for more physical complaints following delivery, such as pain at the site of the incision and longer-lasting soreness.
Because a woman is undergoing surgery, a C-section involves an increased risk of blood loss and a greater risk of infection, Bryant said. The bowel or bladder can be injured during the operation or a blood clot may form, she said.
A review study found that women who have had a C-section are less likely to begin early breastfeeding than women who had a vaginal birth.
The recovery period after delivering is also longer because a woman may have more pain and discomfort in her abdomen as the skin and nerves surrounding her surgical scar need time to heal, often at least two months.
Women are three times more likely to die during Caesarean delivery than a vaginal birth, due mostly to blood clots, infections and complications from anesthesia, according to a French study.
Once a woman has had her first C-section, she is more likely to have a C-section in her future deliveries, Bryant said. She may also be at greater risk of future pregnancy complications, such as uterine rupture, which is when the C-section scar in her uterus ruptures, and placenta abnormalities. The risk for placenta problems continues to increase with every C-section a woman has.
Pros and cons of C-section for the baby
Babies born by Caesarean section may be more likely to have breathing problems at birth and even during childhood, such as asthma. They may also be at greater risk for stillbirth.
During a C-section, there is a small risk that a baby can get nicked during the surgery, Bryant said. Some studies have also suggested a link between babies delivered by C-section and a greater risk of becoming obese as children and even as adults for reasons that remain unclear. One possibility is that women who are obese or have pregnancy-related diabetes may be more likely to have a C-section.