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what to expect: c-sections vs. vaginal births

February 13, 2014
by Christa Melnyk Hines , The Intelligencer / Wheeling News-Register

Following the birth of my son, I was disappointed that I had to undergo a C-section. Nonetheless, the feeling was fleeting as I held my newborn close realizing the consequences could have been devastating if the surgery hadn't been performed.

Like many new moms, one of the first lessons I learned was that parenthood rarely goes according to plan. Because you don't know exactly how your child's birth will play out, manage some of the uncertainty now by learning the differences between Cesarean and vaginal deliveries.

"Our ultimate goal is to have a healthy baby. However you get there whether that be vaginal or C-section, we want moms to be happy and healthy and babies to be happy and healthy," said Kristen Wootton, D.O., an obstetrician and gynecologist.

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What is a C-section?

A Cesarean section is a major surgery requiring an incision through the abdomen and uterus. You will receive an epidural and, barring an emergency situation, you will be awake during the procedure. Depending on your specific situation, your physician will make a low-transverse incision, which is a horizontal cut across the lower end of the uterus generally preferred for better healing and less bleeding, or a vertical cut incision.

Although you'll feel touch and tugging sensations, you shouldn't feel pain.

Fact Box

birth plan consideration

Write down and discuss your preferences with your physician and significant other.

Be flexible. Your baby's birth may not go specifically according to plan.

Avoid non-medical-related pre-term delivery, especially before 39 weeks, which can put your baby's health at risk.

Determine whom you can ask for support post-delivery to avoid managing alone.

Why a C-section?

According to the Centers for Disease Control and Prevention, the rate of C-sections rose more than 33 percent between 2000 and 2007, declining slightly for the first time in 2010.

Dr. Ana Martinez, an OB-GYN, attributes the rise to a number of factors, including women electing to have a C-section, an increase in births of multiples (possibly due to higher rates of fertility treatments) and repeat C-sections for women who don't qualify or choose not to try a vaginal birth after C-section (known as a VBAC).

Other reasons women may require a C-section include the baby's position in the uterus, the size of the baby, premature delivery, fetal heart rate changes indicating a lack of oxygen during labor, or if there's a medical complication with the mother like preeclampsia or gestational diabetes.

What About VBAC?

"In the right situation, VBAC is a viable alternative, but it depends on why you had your first C-section," Martinez said. For example, if your previous C-section was because your baby was in a breech position, you might be an excellent candidate for VBAC. Your physician will also consider your risk for uterine rupture, your insurance requirements and the availability of an on-site physician during labor and delivery.

"Your doctor has to be available to get the baby out quickly," Martinez said. "If their office isn't on campus and a doctor can't be there the whole time, (VBAC) can be more risky."

Some hospitals have OB hospitalists available 24-7 to assist patients. Hospitalists are on-site physicians who specialize in the care of hospitalized patients. Consult with your doctor to learn what type of coverage your hospital offers.

Risks

Tears and lacerations can occur during vaginal deliveries. Although rare, uterine rupture is a life-threatening risk factor particularly for women who opt for a VBAC. A uterine rupture is a tear in the wall of the uterus, usually at the site of a past C-section incision. The incidence rate is about 1 percent for women who have had low-transverse incisions, rising to 5 percent for women with vertical incisions.

C-section risks include blood loss and complications with anesthesia, as well as scarring and adhesions.

Hospital Stay

The typical hospital stay for a vaginal delivery is 24 to 48 hours, while a C-section may be between three and four days.

Recovery

A woman who delivers vaginally has no restrictions on lifting and can typically return to her normal routine within a few weeks. With a C-section, expect the recovery to take a little longer as your mobility is more restricted.

"The first two weeks are the roughest," Martinez said. But, after that, most women are doing well and are off pain medication.

Following the birth of my son, I was disappointed that I had to undergo a C-section. Nonetheless, the feeling was fleeting as I held my newborn close realizing the consequences could have been devastating if the surgery hadn't been performed.

Like many new moms, one of the first lessons I learned was that parenthood rarely goes according to plan. Because you don't know exactly how your child's birth will play out, manage some of the uncertainty now by learning the differences between Cesarean and vaginal deliveries.

"Our ultimate goal is to have a healthy baby. However you get there whether that be vaginal or C-section, we want moms to be happy and healthy and babies to be happy and healthy," said Kristen Wootton, D.O., an obstetrician and gynecologist.

What is a C-section?

A Cesarean section is a major surgery requiring an incision through the abdomen and uterus. You will receive an epidural and, barring an emergency situation, you will be awake during the procedure. Depending on your specific situation, your physician will make a low-transverse incision, which is a horizontal cut across the lower end of the uterus generally preferred for better healing and less bleeding, or a vertical cut incision.

Although you'll feel touch and tugging sensations, you shouldn't feel pain.

Why a C-section?

According to the Centers for Disease Control and Prevention, the rate of C-sections rose more than 33 percent between 2000 and 2007, declining slightly for the first time in 2010.

Dr. Ana Martinez, an OB-GYN, attributes the rise to a number of factors, including women electing to have a C-section, an increase in births of multiples (possibly due to higher rates of fertility treatments) and repeat C-sections for women who don't qualify or choose not to try a vaginal birth after C-section (known as a VBAC).

Other reasons women may require a C-section include the baby's position in the uterus, the size of the baby, premature delivery, fetal heart rate changes indicating a lack of oxygen during labor, or if there's a medical complication with the mother like preeclampsia or gestational diabetes.

What About VBAC?

"In the right situation, VBAC is a viable alternative, but it depends on why you had your first C-section," Martinez said. For example, if your previous C-section was because your baby was in a breech position, you might be an excellent candidate for VBAC. Your physician will also consider your risk for uterine rupture, your insurance requirements and the availability of an on-site physician during labor and delivery.

"Your doctor has to be available to get the baby out quickly," Martinez said. "If their office isn't on campus and a doctor can't be there the whole time, (VBAC) can be more risky."

Some hospitals have OB hospitalists available 24-7 to assist patients. Hospitalists are on-site physicians who specialize in the care of hospitalized patients. Consult with your doctor to learn what type of coverage your hospital offers.

Risks

Tears and lacerations can occur during vaginal deliveries. Although rare, uterine rupture is a life-threatening risk factor particularly for women who opt for a VBAC. A uterine rupture is a tear in the wall of the uterus, usually at the site of a past C-section incision. The incidence rate is about 1 percent for women who have had low-transverse incisions, rising to 5 percent for women with vertical incisions.

C-section risks include blood loss and complications with anesthesia, as well as scarring and adhesions.

Hospital Stay

The typical hospital stay for a vaginal delivery is 24 to 48 hours, while a C-section may be between three and four days.

Recovery

A woman who delivers vaginally has no restrictions on lifting and can typically return to her normal routine within a few weeks. With a C-section, expect the recovery to take a little longer as your mobility is more restricted.

"The first two weeks are the roughest," Martinez said. But, after that, most women are doing well and are off pain medication.

Other than your baby, you won't be able to lift anything more than 10 pounds, and the pain medicine prohibits you from driving for the first two weeks post surgery. However, breastfeeding is safe and encouraged. Lean on your spouse, a family member or a close friend for assistance, especially if you have other children.

"This is a time in your life when you need a little help and it's OK to let go of some of our innate control things as moms," Wootton said. "Let dads be active participants. Let them bring you changing stuff so you don't have to get up. People are always great to want to bring you food. Use those resources. An incision adds a little bit of a challenge to the mix, but it's definitely doable when you have good support."

And remember, even if your child's birth didn't go exactly as planned, chances are the elation of holding your much-anticipated newborn will overcome any lingering feelings of disappointment.

"You can have the best birth plan ... but there are just some things that are out of your control," said Jen Conrad, a mom of three. "Give yourself some grace and tell yourself you still did something amazing by bringing your sweet baby into this world - no matter how he or she arrives."

Freelance journalist Christa Melnyk Hines and her husband are the parents of two children both delivered by C-section. Hines is the author of "Confidently Connected: A Mom's Guide to a Satisfying Social Life."

 
 
 

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