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?

Why did i have a VB? Because i was young (late 20s), healthy, fit, and and no concerns were raised at scans and midwife appointments. If they had suggested a section on medical grounds i would have followed that advice.

It turns out i give birth quickly, but easily. Super easily. (i realise this is not the case for everyone). 3 days after giving birth i went for a walk to the shops to buy stamps for birth announcement cards and carried home 2 heavy shopping bags full of stuff for our fridge and biscuits for visitors.

So with dc2, i was happy to go ahead again. Once again no medical concerns that might suggested c section. The only thing was they warned me to get to hospital at first sign of contractions as second births can be faster. So i spent the morning of ds birth just waiting around in the hospital with mild contactions every 15-20 minutes, then at just after lunch my contractions became proper ones, midwife filled the birthing pool as i was 5cm. I got in and 20 minutes later i was holding a newborn.

But i would never judge anyone based on which way they chose to give birth, and im aware not all babies drop out as easily and quickly as mine did.

Exactly.

Women should be informed and then make their own preference, be it a home birth or an elective c-section and it should be supported.

That's it.

Are enough women not arguing over whether to formula feed or breast feed, or whether being a SAHM is better or worse than being a working parent? Let’s have women justify their vaginal or c section births now…

First child
Emergency section why... because we both nearly died. Second child 31 vbac after a prolonged fight for it (it was 33 years ago) forceps and stitches.
Third child 27 vaginally delivered Urethral and clitoral tear (yep the repair was as painful as it sounds). It was due to the very inexperienced midwife, a bank holiday and too quick delivery for second midwife to attend.
It all seems a very long time ago and I ended up alive with 3 live babies so the best outcome for all.

https://publications.aap.org/pediatrics/article-abstract/123/6/e1064/71607/Incidence-of-Early-Neonatal-Mortality-and?redirectedFrom=fulltext.

@IlsSortLaPlupartAuNuitMostly ... yes.. not easy to have one rate but it is generally agreed that 34% is too high.

I believe that the data on here is UK based... https://www.rcog.org.uk/for-the-public/browse-our-patient-information/considering-a-caesarean-birth/#:~:text=Once%20you%20have%20had%20a,when%20your%20baby%20is%20born.

Based on this - if we all had cesareans, approximately 120 more mothers and 120 more babies would die as a result and 420 more women would have their uteruses removed as a result of post operative haemorrhage. Crude calculations - but the risks are higher.

I researched all my birth options and chose an elective C section. The consultant I spoke to who signed off my decision said that if his wife were giving birth, he’d want her to have an elective c section. He said medicine is still very bad at spotting and treating the long-term injuries from birth - even straightforward births - and that women may leave the ward with just a few stitches but he’s seeing women return to hospital 10, 20 years down the line with issues resulting from vaginal births that were never identified at the time.

I didn’t want to tear and I didn’t want to deal with a traumatic birth. In my anecdotal experience and within my close and extended friendship group, uncomplicated first births are very unusual. Nearly everyone has required intervention, or are genuinely traumatised from their birth experiences.

I do see your point op. I had an awful vaginal birth with ds1, utterly dreadful. It took me a long time to recover. it was a huge shock too because I was naive enough to think that all vaginal births ended happily with very few complications. No one understood either because I'd avoided a c section so should have been able to do normal things. It didn't help that the midwifery team always peddled how amazing vaginal births were. I still remember one of them saying in the antenatal classes that, "as you all have low risk pregnancies you'll probably be home by lunchtime the same day".

I had an entirely different experience with ds2. I distinctly remember waking up 2 weeks later feeling fantastic.

Whilst I agree that elective c sections should be available to those who want them, more effort needs to go into making vaginal births and recovery better experiences so women don't feel so traumatised that they opt for c sections next time

The data is naturally skewed on c section trauma as so many are the result of complex and dangerous pregnancies where planned or a situation that is already an emergency wher an emergency section.

It would be interesting to see data on planned elective c section births with no pre operation complications vs the same on vaginal deliveries with no pre birth complications.

@SantaSusan - just in case you do come back to this thread I just wanted to let you know that my reasons for wanting c-sections were exactly the same as yours. Multiple miscarriages led to a total mistrust that my body could do what it was meant to do and after a very stressful pregnancy, I was utterly terrified of things going wrong. In my head a C-section seemed to offer a bit more certainty of outcome.

The consultant I spoke to who signed off my decision said that if his wife were giving birth, he’d want her to have an elective c section.

My best mate is a GP and had 3 electives. She told me the stats for GPs and consultants choosing electives might be because they've seen so many traumatic births.

I wonder what the stats for midwives are? They will have seen the whole range.

The risks to mothers and subsequent babies of indiscriminate CS are very real, and of course an ELCS will almost inevitably be preterm even if only slightly which carries risks.

But the unnuanced pursuit of low CS rates killed and catastrophically injured hundreds of babies in Telford. It's a message that needs to be addressed with a lot of care.

Elective c-sections weren't available with DD1, they were only available with DD2 if an earlier birth had been a c-section for whatever reason & by the time DS came along & elective c-section was an option I didn't see the point given I'd already had 2 straightforward vaginal births with quick recovery so the odds were a vaginal birth was the better choice for me - it was, he was born at 7am & I was home by lunchtime.

Also I need to be put to sleep to get a tooth out so I'm not sure I'd cope with major abdominal surgery while I was awake 🙈😂 so even if it had been available with DD1 I probably would have still gone with vaginal birth.

I don't think there's.any good or perfect option. Everyone's experience is different.

I had a completely "natural" vaginal birth with no complications. It was fast and painful. I found the whole experience traumatic. I did not cope with the,pain at all. I had no feelings at al after birth for my baby. I was the third person to hold him as a result. All I felt was relief it was over.

I also tore and needed a spinal after the birth to be stitched up. So I had a lot of vaginal stitches and also horrendous piles so was in a lot of pain afterwards and struggled to get up to take care of baby.

The stitches also slipped so it got infected afterwards and I couldn't walk for a period and sitting was extremely painful.

I have also been left with stress incontinence and a "gap" where the stitch slipped. The scar is often itchy or uncomfortable. I still have piles 25 years later and now have skin tags where I've had them so many times making it difficult for me to keep clean down there which is horrible.

So almost all the things mentioned by people criticising Caesarian's can happen in vaginal births too. Plus a few more issues. Some women are left completely incontinent out of both ends for life.

By contrast, someone I know two people who've had an ELCS who had a similar experience to PPs. They went it, said it was all very calm ordered. Baby out with no issues and both was out and about within a week (something I couldn't manage), one of whom was trooping around central London!. I was still recovering weeks later.

Personally I think the risk of vaginal births is massively played down and the risk of ELCS over egged by the stats being mixed in with emergency sections. There are risks to both but vaginal birth isn't some perfect low risk "natural" option that some seem to think.

Does this information conflate planned caesareans with emergency though?

Emergency caesareans are a potential side effect of choosing vaginal birth. Women may opt for a planned Caesarean to avoid the risks of an emergency one, so information and ‘fact’ sheets that combine both are so wrong.

Are you more or less likely to be offered an elective c section if you’re older? (I.e 35+)?

Tried both. My godness. C section much better. Way way better. I am in so much agony and pain during natural childbirth. I dont even enjoyed my son afterwards because soo tired. But with c sction i enjoyed the process and everything.

I have three friend who are midwives and they’ve all chosen home births.

My biggest fear going into childbirth was being physically touched by HCP due to past trauma. I also felt panic at the idea of being trapped in a room I couldn’t leave, and being watched, and the idea of not being able to move my legs still makes me feel panicky now.

I needed to give birth without being touched by anyone, in a way I could control, or my guard would have been up at best, or I’d have had a full blown breakdown at worst. C-section would not be my choice because of the immobility, recovery, and intimate touching. It would be very much a last resort and I’d probably need a general anaesthetic. I was able to give birth to my babies in the way that felt best to me, without feeling trapped and without anyone touching me! So I was lucky. But that’s my rationale fwiw

Some academic data to consider (nothing to do with reasons women choose one or the opther, but can help the thread):

From the point of view of the mother, cesarean sections have a significantly higher risk of postpartum haemorrhage (including the need for blood transfusion and total hysterectomy), wound infection, uterine infection, DVT, PE (pulmonary embolysm), anaemia, hospital readmission and death than vaginal birth. They also have a chance of delayed lactation for up to a day, especially elective cesareans where the mother has not laboured.

Vaginal birth, on the other hand, has significantly higher rates of perineal trauma (obviously) and urinary incontinence compared to elective cesarean section (this may not apply to emergency cesarean sections, which have their own subset of risks).

For the subsequent pregnancy after a cesarean section, independently of mode of birth, the woman is at a significantly higher risk of postpartum hemorrhage, placenta accreta or percreta, placental abruption, need for total hysterectomy, uterine rupture during pregnancy, ectopic pregnancy, miscarriage and placental perfusion issues (due to abnormal growth of the placenta). These are known as "SAMM" (severe acute maternal morbidity risks) and are well known risks after a first cesarean section.

For the baby, a cesarean section slightly reduces the risk of perinatal death compared to vaginal birth. However, babies born by cesarean section are at higher risk of needing resuscitation at birth, suffering from RDS (respiratory distress syndrome), TTN (transient tachypnoea of the newborn), problems establishing breastfeeding (often due to mucous that has not been exuded during a vaginal birth, as babies born by CS don't get "squeezed" the same way), and a number of short and long-term problems derived from their abnormal gut flora as a result of not being seeded by the mother's vaginal flora at birth (for instance, higher chance of eczema, allergies, asthma, gut, ear and respiratory infections).

A baby born subsequently after the mother has had a previous cesaresan section, regardless of mode of birth, has a slightly higher risk of miscarriage and stillbirth all related to problems with implantation/placental development caused by the previous uterine scar.

All these risks are described considering the cesarean section was a lower segment incision. A classical (vertical) incisision has much higher risks, but is rarely used anymore.

I had a vaginal birth and then 2 elective c-sections. My vaginal birth was truly traumatic mentally and physically (bad years , pain, long recovery) and I feel as thought the risks were never explained to me. I had to fight hard for the elective c sections but they were both so much easier to recover from. It was surgery but I was up and about the next day and pretty well recovered in about 2 weeks. but everyone’s been experience is different . I do wish I had been given a more balanced picture about the risks of vaginal birth

I really wanted to experience a calm and natural birth, for my baby to choose when to arrive, for me to be the first person who held my baby, and for it to be empowering like so many women say it is.

Two traumatic EMCS later and I'm glad my babies came out safely but I'm sad I didn't get the natural birth experience or to hold my babies straight away. They did at least get to choose when to be born, and I experienced labour right up to the pushing stage both times.

This is interesting as a junior Dr having my first having seen so many birth complications, I had to practically deprograme myself to believe that vaginal birth could be unproblematic. This was in the noughties in South London where there was a very strong movement to re-empower midwives, encourage home birth and "get the section rate down" - it widely acknowledged to be too high even then.

I also need to shout out to my wonderful yoga teacher who taught us how to breathe through the contractions. I am so glad I did, 2 perfectly straightforward VBs, I am something of an anomaly amongst my medic mates.

I had an emergency section under GA with a pretty great recovery just under a year ago. Beyond my mental and emotional trauma from the delivery and her prematurity, I recovered a lot faster than many of the VBs I knew at the time, so am talking from that side of the fence.

There are scientific benefits to a vaginal birth. The baby collects an entire gut bacteria profile from the vaginal canal. The squeezing of the birth canal gives the baby a map of its body and almost instantly wakes it up a little. The length of delivery helps to 'prepare' the baby for the outside world.
Many more I'm sure, those are just the few I've come across.

@Violahastings ... I believe researchers are able to account for these facts. It is challenging to condense the many pieces of research to one 'fact sheet' or post for this thread.... but the paper I quoted earlier stated: Compared with infants delivered via PVD (planned vaginal delivery) infants delivered via ECD (elective cesarean delivery) had significantly higher rates of mortality (adjusted risk ratio [aRR]: 2.1), risk of special care admission (aRR: 1.4), and respiratory morbidity (aRR: 1.8) but not of depression at birth (aRR: 1.1). Compared with emergency CD, newborns delivered via ECD (elected cesarean delivery) had less depression at birth (aRR: 0.6) and admission to special care (aRR: 0.8), but mortality (aRR: 0.8) and respiratory morbidity (aRR: 1.0) rates were similar.

The chances of having an assisted birth (1 in 2) or an emergency cesarean (1 in 3) are very high. It is difficult to weigh up these risks... it is very clear from the data and from this thread.

'Women are designed to have vaginal birth'

Except all the women who die in childbirth because they have no access to a CS.

Given my grandmother had a CS in 1952 which was unusual for the time, then my mum had me by CS, I have to say I never exactly shared this faith that women are designed to have vaginal birth.

Can't think why.

As the guidance says, there are risks and benefits to both, and for that reason it doesn't identify either as more risky than the other. Because the evidence doesn't support that. NICE disagree with your claim that attempting vaginal birth is safer per se than ELCS, and they know better than you.