What childbirth options are available to you?

The natural way – a vaginal delivery

For a very long time in human history, this was the only option. Delivering a baby vaginally is still the most common means of birth and is considered the safest option too. There are a few ways you can deliver vaginally – naturally (without the assistance of pain-relieving medications) or with an epidural (with medication assistance).

• Natural: With this option, you can expect to feel just about everything that happens during the process of delivering your baby. There are a variety of physical sensations your body will go through, but the two most prominent things you are likely to be aware of are pain and pressure. Initially, you will be very aware of pressure when experiencing contractions, which begins to alleviate once you get to the pushing stages of delivery. Once the baby descends into the birth canal, pressure begins to increase and become more constant. Many women have described this sensation as feeling a strong urge to have a bowel movement. This is because the baby is likely pressing down on the same nerves that stool would as he or she descends into the birth canal.
• Epidural: If you opt for an epidural, there’s little way to predict just how much you are likely to feel during birth. What you feel and how strongly will depend on the effectiveness of the epidural block. An epidural effectively numbs nerves in this area of the body. You may feel some pressure. You may feel very little at all, if anything. If you do feel anything at all, it is likely to be mildly uncomfortable. The degree of discomfort will be relative to how well you can tolerate sensations of pressure. Many women do not feel their vagina stretching (as you would during a natural birth) or even an episiotomy (a surgical incision which is made in the muscular area between the vagina and perineum (anus) to enlarge the vaginal opening just before a baby is born).

Once a baby descends into the birth canal and enters the vagina, muscles and skin (the labia and perineum) begin to stretch. Once the maximum point of stretching is reached, you may notice a burning sensation in the skin as tissues expand around the baby’s head. This is sometimes referred to at a ‘ring of fire’. This is often the moment a doctor will perform an episiotomy. Whether you have an epidural or not, you may not feel the incision. The tightly stretched area can lose sensation at this point.

Pressure alleviates once the baby’s head emerges, but you can still feel a fair amount of discomfort. At this point you may be asked to stop pushing while the baby’s nose and mouth are suctioned to clear any mucus and amniotic fluid. It’s important that you do stop pushing when asked as this can affect a baby’s first breath.

Your doctor will then rotate the head of the baby, just a quarter of a turn, so that it is aligned with the remainder of the body which is still in the process of being delivered. Your doctor will then request that you begin pushing once again. You can expect to push the top shoulder out, then push again to deliver the second, and finally one last push for the remainder of the body.

Your delivery process, however, does not end there. The amniotic sac and placenta which has protected and supported your baby during your pregnancy is still in the uterus. Delivering the placenta can happen spontaneously or it may take as long as half an hour.

Your doctor may begin to rub your abdomen, just below your belly button. This is done to assist with tightening the uterus, which also loosens the placenta, effectively enabling easier delivery. Your uterus is more or less the size of a large grapefruit at this stage. You may feel some pressure building as the placenta passes through and is expelled. Pressure or pain during this delivery process is not nearly as much as when you were delivering your baby.

Your medical team will assess the expelled placenta to ensure that it was all delivered in full. If any remains in the uterus, your doctor may reach into your uterus and remove it. If any remains, you can experience heavy bleeding which can lead to serious consequences.

Childbirth by vaginal delivery is not always a straightforward, predictable process. Anything can still happen to disrupt the natural flow of delivery and complications can arise. That said, it’s not entirely impossible to prepare yourself for labour and delivery. If all goes according to the natural flow, you’ll be glad you did. If any complications do arise, you can trust that the right professionals are on hand to promptly assist, ensuring a safe delivery and a healthy mom and baby too.

In the case of necessary assistance while giving birth, your doctor may help things along with a forceps delivery or a vacuum delivery. If forceps are needed to help you deliver, you doctor will use instruments (which resemble large spoons) to cup your baby’s head and guide the little one as you push and he or she moves through the birth canal. Similar to forceps, a plastic cup can be applied to the baby’s head instead and using suction (vacuum) can help to gently guide and pull the baby.

It can happen that at the last minute (or during labour just before delivery time) a vaginal delivery is simply not possible. In this case, a doctor will opt for a surgical option – a Caesarean delivery (C-section). If safety to both mother and unborn baby is compromised for any reason, this will be necessary irrespective of your preferred choices for birth. Some reasons this can happen include:

• If a baby is breech (not positioned head-down)
• If a baby has grown too large for a woman’s pelvis size (and it’s not safe to attempt passing through)
• A baby is in distress

A planned C-section

A Caesarean is not always reserved for complicated, dangerous or compromised natural deliveries. In some medical facilities around the world, you may opt for this method of birth well before time. You can select this option for a variety of different reasons, many of which may be medically related (sometimes not at all) or if your gynaecologist believes that this is the safest option for you and your baby.

In any instance that this option is selected, it is a good idea to remember that a C-section is a surgical procedure and carries its own set of risks. An elected C-section may be decided on because there is a definite medical reason that has been determined and this option may prevent serious complications which can affect both mother and baby, or if your baby is breech and facing the wrong way near time of delivery. Sometimes a baby is simply just too large to be delivered vaginally. It can also be that you’ve delivered by C-section before and a natural delivery places you at risk of rupturing your uterus.

In other instances, a C-section may be opted for purely as a preferred choice of birth method. Many women favour this option so that they can select a specific date they wish to deliver their baby and / or to avoid a vaginal delivery altogether.

Generally, a C-section is not recommended before 39 weeks (unless an emergency situation arises) and in many countries, it may be discouraged altogether if you wish to have more than one child in your lifetime, due to some associated risks.

Having a baby by C-section can be appealing in another sense that it takes place in a controlled, medical environment. This makes this birthing option generally a safe means of having a baby. There are still risks involved and your doctor will take you through these very carefully.

As a C-section is considered a surgery, recovery time is longer than that of a vaginal delivery. You may spend more time in hospital following the birth than if you’d opted for the alternative, and will also require a period of time recovering at home once you are discharged.

Some possible risks of a C-section you will need to be mindful of include:

• Infection
• Heavy bleeding and the possibility of requiring a blood transfusion
• Blood clots
• Injury to organs in the body

There may also be some risks to the new-born baby during the delivery. One such risk possibility is breathing problems following birth. If this happens, your baby may need to be cared for in the hospital’s neonatal intensive care unit (NICU) for a handful of days (at least).

If you, as a new mother, have plans to bear more children in your reproductive years, you will need to take the decision to deliver by C-section carefully. Having more than one Caesarean procedure also carries some risk to you physically. You can encounter some difficulties with more than one C-section, as those that follow the first tend to carry more risk.

If you already know that you would like to have more children and may consider this birth method again, talk to your doctor about your plans and ensure that you are well aware of all the factors that could affect your plans.

Some possible risks include the placenta not attaching correctly in the uterus. If this happens the risk of bleeding is much greater and could result in a necessary hysterectomy. Scarring in the uterus could also split open, and this can also have an impact on any future pregnancies.

Generally, a vaginal birth following a C-section experience is not always possible for many moms-to-be. It can happen that some women are able to deliver vaginally a second time around (known as a VBAC – vaginal birth after Caesarean delivery). Depending on the nature of the C-section method previously experienced, it may be possible. If you’ve had more than one C-section surgery, chances are slim to none, that you’ll ever be able to deliver vaginally.

Ultimately, when it comes to making a decision, for personal or medical reasons, or both, weigh up the benefits and risks carefully. The best scenario is when the benefits outweigh the risks. What’s most important is that the delivery experience is safe for you and your baby.