Why vaginal birth?

[SantaSusan]

Inspired by another thread. I'm really interested to understand the reasons for most women opting for a vaginal birth.

Disclaimer: I really, really want this thread to be a nice discussion to share views. I'd hate for this to descend into a judgy or unkind thread! Obviously, however anyone chooses to give birth is their choice alone. And as long as your precious little bundle arrives safely at the end, then who cares how they got there!?

I ended up with an elective. I never in my wildest dreams thought I'd have anything but a vaginal birth. However, for reasons I won't go into, it was decided during my pregnancy that a c section would probably be the best option for me. Everyone I spoke to absolutely loved their c section experience, and 99% of the comments online were so positive, so I wasn't worried about it at all once it was decided upon.

I had absolutely no pain during my c section or during recovery. I breastfed right away. I was up and about pretty much immediately. This seems to be the experience of most women who've had elcs. I would have an elective section again and again. If I'm lucky enough to have another baby, it'll be another section.

As such, I often wonder why more women don't choose to have their babies this way. It's so common in other countries. I think there's a lot of misinformation around c sections. The risks are also lumped in with those of emergency c sections, so electives are often painted to be riskler than they actually are.

You often hear people saying it's major abdominal surgery' in quite a judgemental way, which of course it is. But as far as surgical procedures go, it's generally very straightforward and in most cases, is easy to recover from.

I also repeatedly hear that vaginal is best as it's the most natural. But just because something is the 'natural' way to do something, doesn't necessarily mean it's the best. There's lots of things we do now with technology and with medicine that isn't the 'natural' way, and nobody bats an eyelid.

I can't quite put my finger on why I was so opposed to c sections previously. It's like it was subconsciously ingrained in me for no reason other than popular rhetoric. Which is why I'd be interested to hear why others decided a vaginal birth was best for them? Or why others knew they wanted an elcs? Has your subsequent birthing experience changed your minds at all?

Dead people are cheap.

Living but brain damaged babies due to oxygen deprivation at birth are the most expensive lawsuits of all, and that's why the total costs to the NHS of ELCS and attempted VB are more or less the same: one catastrophic act of negligence will cost the same as several thousand C sections.

Anecdotally I know of a fair few women who have been quite unwell post c section. I briefly nursed on a surgical ward and one poor woman had a c section that caused an infection in her bowel. She then had to have surgery to remove part of the bowel and was on IV nutrition for a week while her bowel healed. For women requiring any type of bowel surgery, previous c sections were potentially problematic because they already had scar tissue and were in a lot
more pain post op.

C section babies generally need more help to breathe, they don’t get the same exposure to vaginal microbes (potentially linked to autoimmune disease) and there is a higher risk of placenta accreta in future pregnancies.

As a medical person I would go for the safest option. About the continence issues DGM had 4 vaginal deliveries largest baby was 10Lbs she was continent till the day she died aged 96.

Yep..risk the natural route. A natural vaginal birth IS a risk. A planned elective CS does remove much of this risk.

You are seeing an inherent benefit and a lesser risk on the basis of it being natural: this isn’t rational. We all do lots of things all the time that aren't natural..vaccination for example. I’d much prefer the modern technology of vaccination as a means of acquiring immunity rather than acquiring immunity via contracting the virus itself. Yes the latter is the natural way..but I’m not risking it.

For me it was that I had no wish to have major surgery. I heal really badly and had lots of issues after laparoscopic surgeries. (even now 20 years plus when a new doctor sees my scar they comment on how bad it is)

My friend had a c-section for her first and then 3 vaginal births she much preferred the vaginal births.

Other friend had 3 c-sections with no regrets. Happy they went as they did.

What I always find problematic with posts like this how women are meant to justify our experiences. For me I want every woman to have a positive experience of childbirth. For me that was to give birth naturally. The best experience of my life was the birth of my 2nd child at home on our bedroom floor. If for a friend that is to have a elective Csection I am for that.

I loathe the " justify your decision" We should be working together to make positive experiences for women.

@SophieinParis
I'm sorry but I don't really think you can compare wanting a vaginal birth to anti-vax. 2 very, very different things!

I didn’t want a c section (until I was in labour anyway!) in part due to concerns re: recovery; loss of sensation (happens to a significant % of women apparently); effect of pain relief on the baby; and concerns re: the varying epigenetics. When I was in labour that all went out of the window I might add!

Because I wanted to be at home with my family, not in hospital. Because my DH was able to cook me a lovely breakfast and I could sleep in my own bed. I watched the final Grand Prix of the season with my baby in my arms and cooked us all supper. Why would I have wanted surgery when I had that?

@SantaSusan but it is a giant wound. It's a cut through several layers of your abdomen, big enough for doctors to put their hands into to pull a baby out. If I sonehow fell on a large blade and had a cut that big it would be considered a major wound.

You may have been very lucky but it's still true that post c section you are advised not to drive or do heavy lifting for six weeks. Women I know who had c sections had terrible trouble establishing breast feeding because they couldn't support the weight of the baby properly and definitely took a lot longer to recover than those who had natural births. I had a 20 month old when dd2 was born, I was able to pick dd1 up the same day as giving birth. Post c section you would definitely need extra support with an older toddler.

I've had one vaginal birth and one elective c section, and I can tell you right now that I was left with more issues from the vaginal birth by a mile!

4 years later I can still feel the scar tissue and an unpleasant throb down there if I do a lot of walking. Still have a small amount of discomfort during intimacy.

Zero issues with the ELCS, up and about immediately, less pain relief needed than after my vaginal birth, no ongoing issues at all, driving again within 3 weeks, small neat scar that's barely visible.

The issue I have with a vaginal birth is that no one can predict how it is going to go. No one sits down and lists all the risks associated with it. You're only given risks for c sections which naturally makes them seem the less attractive option.

You just exchange one set of risks for another:

For baby

Chance of birth injury of all kinds to infant is much lower in LCS but chance of of feeding and breathing problems is higher.

Mother:

Chance of vaginal tears and later continence issues is lower with LCS but chance of infection is higher, also risk of later adhesions.

LCS has longer recovery ( on average) but VB means usually an element of unpredictabilty and some hours/days with the pain of contractions.

Really you pays your our money and you takes your choice.

I had some pressure put on me to have a C section in the states with my first - and opted for induced vaginal birth (which is no cake walk!) - zero judgement on whatever people chose to do but my reasons for choosing a vaginal birth were

• I had read about the immune potential of exposure to the maternal microbiome during a vaginal delivery
• I had read some interesting studies about the neuro protective benefits of the hormonal environment of a vaginal birth (theories included oxytocin circulating in high quantities, the mechanical pressure on the skull)
• am quite physically active + the idea of an extended surgical recovery was a strong deterrent.
• The idea of Birth as a part of meeting my baby felt empowering rather than scary to me - and I knew I had a solid back up plan with a midwife + Dr I trusted if I needed it.

In an ideal world of infinite knowledge + resources I suppose everyone would have the info they needed + be able to make the choices they wanted…

I planned an ELCS with my second... she was breech. She had other ideas, tuned herself around and waters broke 2 days before the op was scheduled. You don't always get the chance.

Nobody can choose to have a VB, you can only choose to attempt it. For a sizeable minority of us, depending on age and health, what you'll actually get is an EMCS, and hence the NHS has to pay for a midwife to keep half an eye on you for twelve hours and then a full surgical team to do the EMCS. That's one reason why ELCSs aren't significantly more expensive for the NHS than attempting VB.

I attempted two VBs. The first one ended with an EMCS and the second with forceps. I wasn't old or obese, just bloody awful at giving birth. Clearly back of the line when they handed out the magical powerful bodies other women seemed to be gifted with.

I found giving birth vaginally a very active process. Did much of it standing or sitting up. A challenge met well. Wouldn't have dreamt of entrusting myself to random surgeons instead.

The worst pain I've ever been in was not from giving birth but from a botched lumbar puncture, a procedure similar to epidural. You couldn't pay me to have a surgical procedure that is avoidable.

ABStRAct from: https://poliklinika-harni.hr/images/uploads/2784/obolijevanje-majki-nakon_carskog-reza.pdf
Caesarean Section (CS) is the most common obstetric surgery performed today. With advancement of anaesthesia and technique resulting in improved outcome and safety, its rate has been rising. Nevertheless, it carries risk of complications resulting in morbidity and sometimes mortality. Therefore, CSs done without medial indications, remains questionable.
Maternal mortality and morbidity after caesarean birth is nearly five times than vaginal births, especially the risks of haemorrhage, sepsis, thromboembolism and amniotic fluid embolism. In a subsequent pregnancy, CS increases the risks of placenta previa and adherent placenta which may further result in higher risk of haemorrhage and peripartum hysterectomy. Technical difficulties due to adhesions increase the risk of injury to bladder and bowel.
Though CS can be life saving for a foetus in jeopardy, yet in countries with high caesarean rate increased neonatal mortality and morbidity is seen i.e., iatrogenic pre-term births and respiratory morbidity. Risk of rupture uterus and stillbirths in women with previous CS also increase perinatal mortality. Neonatal adaptations is delayed in caesarean babies i.e., maintenance of body temperature, glycaemia and pulmonary respiration. Development of neonatal immune system is also affected in babies born by CS. Hence, CS should be done only if medically indicated.

Molina G et al., in a study of WHO member states representing 97.6% of all live births in the world, has shown that the optimum caesarean rate should be below 19.1% - the UK is at 34%.

It is undeniably natural but so then are cystoceles, rectoceles and potentially lifelong stress incontinence. I have always been prone to tearing and UTIs and sex has sometimes been problematic - I mentioned elective caesarian to the midwife when I was pregnant with DC1 and tbh you’d have thought I said I wanted to leave the baby in the marsh for the fairies to raise it, it was ‘oh don’t be daft you’re a strong healthy girl.’

I really wish I’d listened to my instincts because I had rapid, violent births and I’ve been left fairly damaged down below. From my experience of post natal care (and from better stories I’ve heard from European friends) this country’s health service is not massively motivated to address child-birth injury.

I eventually saw a consultant privately a year and an half after my final birth, when it became apparent no amount of Kegels was putting things right. He said some women are not designed to give birth naturally and if I’d seen a gynaecologist after baby one I’d have had been recommended to have no subsequent vaginal births. Too little too late!

It wasn’t intended to be snippy at all! I just wanted to be informative and helpful.

That's really interesting and I'm not denying the thrust of the argument because I haven't read it but surely you can't have a single optimum CS rate for every country because the maternal age profile differs so much?

I had an (emergencyish) c-section and I am really sad that I didn't have a vaginal birth (only child, too old now to have another).

My experience was pretty standard, and whilst I had a fairly quick recovery and no major problems, it was still... Not great and I think would have been different with a vaginal birth.

I couldn't get out of bed until the next morning when the epidural wore off. I had to keep buzzing the nurse every time my baby cried so they could get him and pass him to me. It was awful, they often didn't come for ages because they were busy and I had to sit there listening to him cry unable to get to him. In the end I fell asleep with him on top of me which they (rightly) told me off for doing. My milk was then slow to come in (common with c-sections). Nobody told me that this might happen and so we had an awful start with breastfeeding, ending up back in hospital because he wasn't gaining enough weight.

Small infection in the wound at one point.

Years later, part of the scar became painful, and when I moved my stomach to look something "popped" and loads of gunk oozed out. That was fun.

If I could go again I def would choose vaginal over c-section.

Because it's the default.

C sections are far more costly so are not available on demand here.

V births generally require less medical staff resources, shorter (if any) time in hospital, fewer drugs.

Which country are you in?

I don’t think the evidence shows this. I believe that statistically it is very slightly safer for mothers in terms of death rate to have a natural birth (the risk overall being very small) but a c section is much safer for baby. Additionally in terms of other complications (long term incontinence etc) the risks are far less with a c section. In most developed countries c sections are the preferred choice for births. The fact is a natural birth is slightly cheaper for the nhs so we have all been conned in to believing a natural birth is the only way to go.
For the record I had a c section and was up and about after a couple of hours.

Yep..risk the natural route. A natural vaginal birth IS a risk. A planned elective CS does remove much of this risk
Yes of course a c-section removes the risks unique to a vaginal delivery. But c- sections come with their own risks, short- and long term

That was what I was going to post.

Both my babies were born in 4 hours and under, no options no discussion on sections just born in the default way.

The risk of infections, scar tissue endometriosis and not being offered was my experience and why I would elect.