Natural birth or caesarean?

Especially on the occasion of the first pregnancy, having some doubts about which type of birth to prefer is completely natural and legitimate. Having never had any direct experience, the stories of friends, mothers, aunts, neighbors or colleagues and the anecdotes intercepted in the waiting rooms between an ultrasound and a check-up can orient preferences or give rise to fears (almost always unjustified) towards the different modalities of childbirth.

In this regard, it should be immediately specified that, if there are no problems related to the mother or the child, it is better to let nature take its course and reserve the caesarean section only for cases in which it is really indicated and useful to ensure the success of the birth and reduce the risk of possible complications. In all other cases, it should be remembered that the female organism is perfectly capable of giving birth to a newborn in a completely physiological and natural way: indeed, it can be said that it was designed precisely for this.

More and more women, however, even in Italy, find themselves facing this moment in an operating room, transforming the birth of the child from a natural event “assisted” to a real medical act. A decision that should not be condemned, but that should be taken only exceptionally, in the event that specific contraindications to vaginal delivery occur during pregnancy or during labor. But this is not always the case.

The advantages of natural childbirth for mother…

It is difficult to find a pregnant woman in the world without any fear at the thought of having to give birth. From the uncertainty of the duration and suffering of labor, to the actual dynamics of the expulsion of the child, the aspects that can generate concern and perplexity are really many.

Despite these unknowns, in most cases, the future mother is reassured by the fact that it has always been like this for all women and that, after the pain and fatigue of spontaneous birth, only the joy of the birth of her child will remain.

But there are also those who are frightened to the point of wanting to be subjected to caesarean section, without knowing in detail the two types of childbirth and their respective advantages and disadvantages.

If it is left to nature, the pain is undeniable, but it will not be an end in itself, and once the child is born the sense of gratification and fulfillment will be so high as to generate new energy in the new mother. Moreover, the awareness of having faced and completed such an intense and demanding experience will instill in the woman a renewed self-esteem that can, at least in part, protect from the postpartum depression with which many women have to deal in the weeks or months following the birth of the child.

The benefits of vaginal delivery for the mother are not only psychological, but also physical. Despite the pain experienced and, in some cases, the need for stitches to promote the healing of a spontaneous laceration or episiotomy (cut made by the midwife at the level of the tissues of the perineum to facilitate the exit of the baby), the recovery is still very rapid, while after a birth by caesarean section a longer convalescence may be required , since it is in effect a surgical intervention, which requires spinal or general anesthesia.

The rapid recovery after vaginal delivery will allow the new mother to get up, walk and take care of the baby independently already a few hours after birth; In addition, it will favor the beginning of breastfeeding and the construction of the bond between mother and baby thanks to immediate physical contact (“bonding”).

… and for the child

The benefits of a vaginal birth are countless for the baby as well. The hormones produced by the mother during labor (oxytocin, endorphins, adrenaline, etc.) will, in fact, allow the newborn to arrive more prepared at the time when he will begin his extra-uterine life.

In addition, the passage into the birth canal during the expulsive phase helps the baby to begin to breathe independently, cleaning the lungs of amniotic fluid residues and dilating the bronchioles, **and allows him to come into contact with the bacteria that will colonize his intestine (microbiota) and favor the development of his immune system.

In practice, despite still lacking its own immune system capable of defending it from diseases, a baby born with vaginal delivery will be a little “stronger” and ready to face the outside world, from the first days of life.

The Myths About Caesarean Delivery

There are cases in which the expectant mother assumes that she must undergo a caesarean. These are, for example, twin pregnancies, or women who have already given birth to a baby by caesarean section. Or even in the case in which the contractions of labor begin before the natural end of gestation (corresponding to the 40th week after fertilization) and, in particular, before 37 weeks of pregnancy have elapsed (preterm birth). In all three of these cases, however, it is not always necessary to give up natural childbirth.

For example, when there are two babies in the womb, if at the end of pregnancy they are both in a cephalic position and there are no specific maternal or fetal problems, it is advisable that the twin birth takes place vaginally, while if one of the two fetuses is breech, or in any case positioned in a non-ideal way, it will be necessary to discuss with your gynecologist what to do.

There are, however, no real contraindications to a vaginal birth if the woman has already undergone a caesarean section during previous pregnancies, indeed. Performing a caesarean section several times can involve considerable risks for the pregnant woman, which are justified only in the face of a significant probability of maternal or fetal complications in the case of natural birth. If there is no such risk of complications, vaginal delivery is always preferable.

Even preterm birth does not necessarily have to take place in the operating room, but the method used to deliver the baby will be chosen on a case-by-case basis, based on the condition of the mother and fetus.

When is C-section better

Often the birth by caesarean section is seen as a “escape” from the suffering of labor, when in reality it is a real surgery, which involves some risks, such as infections or bleeding. That is why it should only be carried out when there are precise indications.

In particular, the main circumstances which not only justify, but make preferable, the performance of a caesarean section include cases where:

• the fetus is still in breech position at the end of pregnancy (or, in any case, when labor begins)
• “placenta previa” is present, which is when the placenta completely or partially covers the birth canal through which the baby must pass
• The expectant mother suffers from diabetes and, at the same time, the estimated birth weight, based on the length of the fetus measured in the last weeks of pregnancy, exceeds 4.5 kg (so-called “fetal macrosomia” situation)
• the umbilical cord is located poorly positioned and prevents a safe expulsion of the baby through the vagina
• childbirth occurs non-term and in situations of emergency or unconsciousness of the mother (for example, after a car accident)
• There is a high risk of maternal or foetal mortality in the case of vaginal delivery.

In these cases, vaginal delivery is not recommended, while by caesarean section the benefits for mother and baby will outweigh the risks. As anticipated, however, for the mother the recovery in the period following the birth of the child by caesarean section will be a little longer due to the incision of the abdomen and uterus, and also the hospital stay will have a longer duration.

Giving birth (naturally) does not mean suffering

As mentioned, one of the main reasons that lead some women to prefer delivery by caesarean section rather than vaginally, even in the absence of specific obstetric or fetal problems, is the fear of the pain of vaginal delivery. Pain that can be feared only by “hearsay” or because of a traumatic experience lived during a previous birth.

A number of points need to be made in this regard. First of all, every woman and every pregnancy are a case in themselves: therefore, the pain that can be experienced will most likely be different in characteristics and intensity from that declared by friends, acquaintances or other women in your family. Moreover, often, the first vaginal birth is more laborious and painful than subsequent deliveries: consequently, any unpleasant experience lived giving birth to the first child is not said to be repeated during a subsequent vaginal birth.

In addition, pain can be relieved by epidural analgesia, a safe practice for mother and child that allows the woman to live the moment of delivery in a much more serene way.

Typically, epidural analgesia is administered after labor has begun, at a dilation of 4-5 centimeters and with the baby’s head “well compared”, ie pushing against the cervix that is dilating and against the woman’s pelvis.

To establish before delivery if there are no contraindications to epidural analgesia will be the anesthesiologist of the hospital where you chose to give birth who, a few weeks before the expected date of delivery, will carry out all the necessary tests to assess the suitability of the pregnant woman to receive it. In particular, it will be essential to exclude the presence of blood clotting defects.

How to choose consciously

The best advice to face pregnancy and the moment of childbirth in a serene and conscious way is to read up on the moment of childbirth and on the ways in which it can be carried out, without being influenced by the story of unpleasant experiences of friends or acquaintances.

It is very useful, however, to share and compare in a positive way with other pregnant women, with the companions of the pre-birth courses, with the midwife and the trusted gynecologist.

Another tip is to start preparing in time for the emotions that can be experienced after the birth of the baby, leaving the body the time necessary for the episiotomy, any lacerations or the scar of the caesarean section to completely heal and that the hormonal balance has been restored, leading over time to the gradual recovery of fertility. Being aware and serene with respect to the “after” will allow you to live with less stress even pregnancy and the moment of delivery.