Vaginal birth or caesarean?

This is one of the most common questions in pregnancy, and it often fills up with fear, advice from others and their experiences. The right answer comes from your own situation.

When is a caesarean needed?

A caesarean is major surgery and is usually done when it is the safest way for mother and baby. Common reasons include:

• A breech baby that cannot be turned
• A low-lying placenta
• Certain infections
• A baby not getting enough oxygen and nutrients
• Labour not progressing, or heavy bleeding

The day of a caesarean

Most are done under spinal or epidural anaesthetic. You stay awake and feel no pain, though you may feel tugging. The operation takes about 40 to 50 minutes.

Weigh the benefits and risks

Most women recover well and have healthy babies either way. Points from the Royal College of Obstetricians and Gynaecologists:

Planned caesarean:

• Wound pain and a longer recovery
• A risk of wound or womb infection
• More risk in later pregnancies, including abnormal attachment of the placenta, which rises with each caesarean
• Less urinary incontinence than after a vaginal birth

Planned vaginal birth:

• Faster recovery and an earlier return to daily life
• A chance of tears, an assisted birth or an emergency caesarean, especially in a first pregnancy
• Later labours are usually shorter

These chances differ for each woman. Age, past pregnancies, a past caesarean and the baby’s condition all matter.

If you are afraid of giving birth

Fear of birth should be taken seriously. Raise it with your doctor and ask what support is available. Talking through past experience and ways of controlling pain helps. After hearing the benefits and risks of both, the decision is made with your doctor’s help.

Questions for your visit

• Which way is safer in my situation, and why?
• If I choose a vaginal birth, what might change the plan?
• If I want another child, how does this choice affect that?
• How is pain controlled?