Normal Labor & Delivery vs. Cesarean Section birth: which is safer – pros & cons

What is labor?

Labor is a physiologic process during which the products of conception (ie, the fetus, membranes, umbilical cord, and placenta) are expelled outside of the uterus. However, Labor is a clinical diagnosis. Currently, cesarean deliveries are performed for a variety of fetal and maternal indications. Though, if there are no complications with your pregnancy or labor, a vaginal birth is safer than a caesarean birth. 

Normal Labor & Delivery vs. Cesarean Section birth: which is safer – pros & cons

The stages of labor and birth in vaginal delivery 

Obstetricians have divided labor into 3 stages that describe milestones in a continuous process. Below are the three stages of the vaginal birth process that you may have to know.

1. The first stage of labor: at the first stage, there are divided into three phases: latent phase, active phase, and transition. This first stage starts with regular uterine contractions and finishes with complete cervical dilatation at 10 centimeters. Generally, the latent phase begins with mild, irregular uterine contractions that soften and shorten the cervix. Continuously, the contractions become progressively more rhythmic and stronger. This is followed by the active phase of labor, which usually begins at about 3 to 4 centimeters of cervical dilation and is characterized by rapid cervical dilation and descent of the presenting fetal part. Notably, during the transition, the cervix fully opens to 10 centimeters. Furthermore, the contractions are very strong, painful, and frequent, which comes every three to four minutes and lasting from 60 to 90 seconds. By the way, according to Friedman, the active phase is further divided into an acceleration phase, a phase of maximum slope, and a deceleration phase. The first stage finished and follows by the second stage. 

2. The second stage of labor: this stage begins with complete cervical opening and ends with the delivery of the fetus from the uterus. However, there are some differences between the first time pregnant women and the experienced pregnant women. In the first time pregnant women, the second stage of labor should be considered prolonged if it exceeds 3 hours with regional anesthesia is administered or 2 hours in the absence of regional anesthesia. However in the experienced pregnant women, the second stage should be considered prolonged if it exceeds 2 hours with regional anesthesia or 1 hour without it.

3. The third stage of labor: the third stage of labor is the period between the delivery of the fetus and the delivery of the placenta and fetal membranes from the uterus. Delivery of the placenta often takes less than 10 minutes, but the third stage of labor may last as long as 30 minutes. Expectant management involves spontaneous delivery of the placenta. The third stage of labor is considered prolonged after 30 minutes, and active intervention is commonly considered. Active management often involves prophylactic administration of oxytocin or other uterotonics (prostaglandins or ergot alkaloids), cord clamping/cutting, and controlled traction of the umbilical cord. 

What are the Pros and cons of normal labor and delivery for mother and baby?

As every woman can choose how they would like their delivery, it is very necessary to understand the risks and advantages of both options. However, there are still many vaginal birth benefits for both women and their babies, while there are also possible disadvantages associated with a natural birth as well. Here are the pros and cons for natural birthing.

Pros of vaginal birth for mother: there are many advantages of vaginal birth for both women and their babies. Women who go through the vaginal delivery sometimes feel it is empowering to know they were actively involved in the process. In addition, vaginal birth also allows the mother and baby to make skin to skin contact immediately after delivery, speeding up the bonding process. Plus, 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. Another reason is that the recovery from a natural vaginal birth is almost immediate and even faster comparing with the cesarean delivery. Generally, a mother can stand up and care for herself and her baby without assistance. Particularly, vaginal delivery seems to provide financial benefits because if the birth was in a hospital, the mother can be discharged soon after the birth.

Pros of vaginal birth for baby: besides offering a lot of benefits for the mother, vaginal birth also gives many advantages to the baby as well. Babies who born by vaginal birth have a considerable lower risk of respiratory problems. The compression of the baby’s thorax expels the amniotic fluid during the birth process and helps to prepare the lungs to breathe air. Moreover, the babies born by vaginal birth exhibit more interest in pre-breastfeeding behaviors such as sucking and massaging the mother’s breasts. They are also reported to nurse for longer periods of the first 90 minutes after birth, which has many benefits for both the mother and the baby. 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. Babies born via vaginal delivery, especially, tend to have less medical complications as well. Notably, 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

Cons of vaginal birth for mother: vaginal delivery can be stressful for you as you will not be completely sure how long your delivery will take. 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. Also, natural approaches may not offer adequate pain management, particularly if you end up with a prolonged labor or a complicated labor that requires a lot of interventions. 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. Another reason is that, after a vaginal delivery, a woman may also experience lingering pain in the perineum, the area between her vagina and anus.

Cons of vaginal birth for baby: still, there are also possible disadvantages associated with a natural birth for the baby as well. A very small percentage may experience injury or brain hemorrhaging from delivery, but this is unlikely in most cases. According to the Stanford School of Medicine, the baby may get injured during the birth process itself, such as having a bruised scalp or a fractured collarbone.

What is the cesarian section?

Cesarean delivery or cesarean section is defined as the delivery of a fetus through surgical incisions made through the abdominal wall (laparotomy) and the uterine wall (hysterotomy). Cesarean section, especially if planned, is a quite common and safe procedure. While in most cases vaginal delivery is the most natural and uncomplicated way to deliver a baby, more and more women are opting for Cesarean Sections.

When should cesarean delivery be indicated? 

Cesarean deliveries were firstly performed to separate the mother and the fetus in an attempt to save the fetus of a moribund patient.They subsequently developed to resolve maternal or fetal complications not amenable to vaginal delivery, either for mechanical limitations or to temporize delivery for the maternal or fetal benefit. Indications for cesarean delivery that practice for the mother and the fetus include the following:

• Obstructive lesions in the lower genital tract, including malignancies, large vulvovaginal condylomas, obstructive vaginal septa, and leiomyomas of the lower uterine segment that interfere with engagement of the fetal head
• Malpresentations (eg, preterm breech presentations, non-frank breech term fetuses)
• Certain congenital malformations or skeletal disorders
• Infection
• Prolonged acidemia
• Repeat cesarean delivery
• Pelvic abnormalities that preclude engagement or interfere with descent of the fetal presentation in labor
• Situations in which neonatal morbidity and mortality could be decreased by the prevention of trauma
• Abnormal placentation (eg, placenta previa, placenta accreta)
• Abnormal labor due to cephalopelvic disproportion
• Situations in which labor is contraindicated

When cesarean section should not be done?

In some cases, choosing the type of birth is not so easy. Sometimes, a caesarean birth is needed to save the life of a mom or baby. However, there are few contraindications to performing a cesarean delivery. In some conditions, a cesarean delivery should be avoided, such as the following:

• When maternal status may be compromised (eg, mother has severe pulmonary disease)
• If the fetus has a known karyotypic abnormality (trisomy 13 or 18) or known congenital anomaly that may lead to death (anencephaly)
• Coagulation defect
• Extreme premature
• Intrauterine fetal death

What are the complications of cesarean delivery?

As cited in the Medscape, the complications of cesarean delivery may include the following:

• Approximately 2-fold increase in maternal mortality and morbidity with cesarean delivery relative to a vaginal delivery[13] : Partly related to the procedure itself, and partly related to conditions that may have led to needing to perform a cesarean delivery
• Infection (eg, postpartum endometritis, fascial dehiscence, wound, urinary tract)
• Thromboembolic disease (eg, deep venous thrombosis, septic pelvic thrombophlebitis)
• Anesthetic complications: Most cesareans are carried out with an epidural or a spinal to numb your tummy, as it’s safer than having a general anesthetic. But having any anesthetic involves a small risk. After an epidural, you may have: a severe headache: This affects about one percent of women and is more likely if you’ve had more than one type of regional anesthetic leading up to the birth. Nerve damage: Though this rarely happens, and usually only lasts for a few days or weeks. Permanent nerve damage is very rare.
• Surgical injury (eg, uterine lacerations; bladder, bowel, ureteral injuries)
• Uterine atony
• Delayed return of bowel function
• Problems in future pregnancies ( scare rupture, repeat cesarean)

What are the pros and cons of cesarean delivery for mother and baby?

In some cases, choosing the type of birth is not so easy. Sometimes the woman in labor and the doctor need to weigh all the advantages and disadvantages of the cesarean section in order to make the best decision.

Pros of cesarean delivery for mother: having a planned caesarean means you know when your baby will be born. You won’t have the contractions, or feel the pain between your vagina and back passage (perineum) that happens with a vaginal birth. Many women opt for Cesarean sections so that they do not need to go through long hours of labor. In the long term, having a caesarean may help to protect against the slight risk of your uterus slipping into your vagina (prolapse). Especially, cesarean delivery seems to give more control over when the birth occurs and allow more predictability.

Pros of cesarean delivery for baby: one advantage is that they can program the exact day and hour when the child will be born. Another advantage is in case your baby is large, also known as macrosomia, or you are having twins, a C-section may be the best option for delivery.

Cons of cesarean birth for mother: as Cesarean Sections are major surgeries, you will have a longer recovery time than that of a vaginal delivery. Hence, this means that you to stay longer in the hospital compared with a woman who has a vaginal delivery. By the way, women who have had a cesarean section are less likely to begin early breastfeeding than women who had a vaginal birth. and mothers will not be able to have immediate contact with their babies. For women who have had a cesarean section, there are also major risks of infection.

Cons of cesarean birth for baby: some babies have respiratory problems when delivered by Cesarean section. Notably, Cesarean section also provokes problems with anesthesia or possibly nicking the baby.

Normal Labor & Delivery vs. Cesarean Section birth: which is safer

In some situations, choosing the type of birth is not so easy. If there are no complications with your pregnancy or labour, a vaginal birth is safer than a caesarean  birth. Sometimes the woman in labor and the doctor need to weigh all the advantages and disadvantages of the cesarean section in order to make the best decision. However, if you prefer a cesarean birth, it should be scheduled in advance to make it more convenient and predictable.