Vaginal delivery versus C-section delivery

The recommended rate for C-sections is 10-15%, in South Africa, 26% of children born, are born via C-section. Why is it so high and why does it matter?

It took me becoming a mother to understand the depth and intricacies of childbirth. Initially, I did not get it – and I imagine a lot of people don’t.

This is why people are so easy to weigh childbirth on a “how did you deliver your baby” scale. When posed with the question: “Did you have a natural birth?”, my response is always “well, I had a vaginal delivery if that’s what you mean?”

To me, that question categorizes a Caesarean section (C-section) birth as non-natural. So, a woman naturally carried a human being for nine months, then, because she chose or was forced to have a C-section, “nature” goes out the window? This makes zero sense to me.

Here are the facts. C-sections have been on the rise globally in recent years. Obstetricians encourage their patients to choose a C-section for several reasons; they want to avoid being medically sued as often natural birth is less predictable and complications can develop, the team is scheduled and available at the predetermined date thus removing the risk of the obstetrician’s preferred team be unavailable and of course this makes the doctor’s life somewhat easier and manageable.

The biggest risk that doctors want to avoid is faecal and urinary incontinence and pelvic floor prolapse that occurs after vaginal delivery. Faecal and urinary incontinence occurs when a patient cannot control their urinary or bowel movements. This means that urine and stool would leak without the woman being aware of it. This is one of the many realities a lot of women have to face after vaginal birth.

The recommended rate for C-sections is 10-15%, in South Africa, 26% of children born, are born via C-section.

According to the World Health Organisation (WHO) and the Lancet, 106 of the 169 countries in the world are over the recommended rate of Cesarean sections is around 10% -15 % of all births. Countries with the highest C-section rates include the Dominican Republic, Brazil, and Turkey. But to bring it back home, about 26% of children are born through a C-section in South Africa, well above the WHO’s recommendation.

I have had numerous conversations with women about childbirth – both woman who have delivered vaginally and via c-section.

One mom said, “My pain threshold is very low, and there is only so much pain I can bear”. So, she elected to deliver via c-section. Maybe she just watched too many birth videos and listened to too many horror stories from other moms, and she was not about to take her body through that.

Most of the moms that I speak to never had a choice. Its either the baby was in the bridge position, the mom was not dilating fast enough which means the labour is not progressing, the cord was around the baby’s neck, or there were other reasons for the medical team to opt for an emergency c-section. There are some other serious issues that can lead to emergency c-sections.

-If the baby is too big to go through the birth canal

-Severe bleeding during labour

-At risk babies with a slow heart rate or other complications

I am told that the after-effects of a C-section are pretty hairy too, but I can only comment on the postpartum phase of vaginal birth. And I was shocked by it. 

Women have to deal with tearing or an episiotomy (which is where the doctor or midwife has to make an incision to the perineum and the posterior vaginal wall to enlarge the opening for the baby to pass through to avoid the rupture of tissues if it appears there is a risk tearing), haemorrhoids and sexual dysfunction, over and above weak pelvic floor muscles that hinder a woman’s ability to be as physically active as they would like. Not to mention, the pooping, swearing, sweating and hours and hours of excruciating pain.

So, yes, a vaginal delivery is not the magical experience it is often made out to be and the healing process is not the easiest.

The truth is that giving birth – vaginally or through the sunroof – is risky. There is no easy way to get it done.

In C-sections, women can experience increased blood loss due to the incision on the abdomen and uterus. The incision prolongs recovery for months after delivery and the incision site can also experience an infection.

A lot of women struggle to breastfeed immediately after giving birth and also bonding with the little one because of the pain associated with C-sections. A very rare occurrence after a C-section is an injury to organs such as the bladder or the bowel.

The Council for Medical Schemes revealed in 2017 that six out of 10 mothers delivered by C-sections in the South African private health sector. It also says that 76% of all deliveries in the private health care system in South Africa are done via C-section

According to the World Health Organisation, “many C-sections are undertaken unnecessarily, which can put the lives and well-being of women and their babies at risk – both in the short and long term”.

The price component also comes into play. Natural births cost far less, and there has been talk of medical aid companies increasing the portion patients must pay when electing to deliver via Caesarean.

I believe moms today have been made to fear vaginal births, but it is what your body was made to do, and there is no better feeling than putting your body through this test and coming out the other side. I believe women should trust their bodies and not be scared of the process. However, if you feel it is not something you want to experience, and are less anxious at the thought of a C-section, then that is ok too.

And the end of the day it is your body and your decision to make. As with any elective surgery, you weigh the risks and make a decision. Moms who choose C-section are also well informed and well researched and it is a choice that should be available to moms who feel this is the best option for their delivery.

All I want to say to any expecting moms out there is – trust your body, seek medical advice from a professional you feel aligns with your birthing desires, do your own research, get a second opinion and then when you have all the facts at your disposal make an informed decision with the support of your inner circle birthing team – partner, doctor, anaesthetist and midwife/doula.

And don’t be afraid of natural birth, most moms who have delivered vaginally will concur that you will be surprised by the depth of your mental, physical and emotional strength, and even more surprised by the miraculous abilities of your body to do it.

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