Why Unplanned C-Section? Natural Birth vs Cesarean Birth Healing-time, Risks etc

“When you change the way you view birth, the way you birth will change.” ~ Marie Mongan

In the first part, I gave a detailed account of my personal experience with both kinds of birthing processes but in this part, I will list down an extensive list of comparisons between the two so you can make an informed decision when your time comes. Though there is a lot of literature on natural birth and cesarean section it is imperative for us to keep them side by side and compare them on critical parameters to prepare ourselves in order to make a choice or otherwise also. 

Natural Birth vs Cesarean Birth Parameters

The following are some parameters that every new mom or expecting mom must aware of. Read below... 

Surgical Procedure

1. Generally, a minor surgery involving a few stitches at the perineum.
2. Natural birth attempts to minimize medical intervention such as the use of anesthetic medicines and surgical interventions like episiotomies, forceps, and ventouse deliveries & c-sections
3. Natural birth vary highly with many mothers considering various interventions appropriate as far as they aid in childbirth through the vagina and avoid the c-section
4. In rare cases of complete perineum tear, complicated surgery is needed
5. Major Surgery: involving cutting through the layers of abdomen and uterus involving six layers of stitches for an average female body

Healing-time After Pregnancy

The following are a few factors that every new mom must remember if recovering from childbirth. Read below...

1. The stitches are only external and can quickly heal in seven to ten days with proper care and precautions.
2. The external stitches heal mostly in seven to ten days with proper care and hygiene but internal stitches take at least six weeks to heal.

Chances of Infection After Pregnancy

In both modes of birthing, chances of infection are high, but the mother can be infection-free by taking advised care and maintaining appropriate pregnancy hygiene.

Degree of Pain

Here are a few points to remember about the degree of pain after pregnancy... 

1. Natural Labor Pains, vary from person to person depending on their health, age, fitness, and attitude towards childbirth and associated pain.
2. Endorphins (natural opiates) are known to be released during natural childbirth. These are found in the placenta and umbilical cord and are likely to help in easing out pain during delivery.
3. A planned cesarean section offers virtually pain-free delivery.
4. Whereas an unplanned cesarean section or an emergency cesarean section, most of the time involves a fair trial for natural birth involving labor pain.

Time for Delivery

1. Natural birth can take 10 hrs. To 20 hours from the onset of labor and birth of the baby.
2. A planned cesarean birth generally takes around an hour or two.

Getting Back in Shape After Pregnancy

1. Faster – mothers resume routine activities and exercises sooner.
2. Comparatively Slower - as mothers are advised more caution and time off while resuming back to routine activities and exercises.

Effect on Sexual Life

In both cesarean and natural birthing, normally it is advised to wait for at least four to six weeks before having sexual intercourse. During this period body gets time to close the cervix, get over with post-partum bleeding and healing of the tears and incisions. [Know - When Can We Resume Sex After Baby?]

Is Birthing Types Has Any Impact on Future Births?

1. Though mothers are advised to maintain a gap between children a natural delivery doesn’t pose any threat to subsequent births
2. Moreover, most of the times subsequent births become easier with shortened labor and lesser pain
3. Natural birth doesn’t put a limit on the number of children
4. At least a gap of two years is advised so as to restore the strength of the uterus adequately from the effect of the surgical incision
5. Subsequent pregnancies are more likely to face complications such as problems with the placenta, abnormal bleeding, ectopic pregnancy (fetus in the fallopian tube) and uterine rupture (life-threatening, but highly unlikely)
6. Not more than three children are advised

Risks to the Mother & Baby

Risk through normal delivery is considered to be highly safe nevertheless, it can also pose certain risks as given below:

1. Complete perennial tear due to improper pushing and faulty episiotomy
2. High risk of developing – if the torn perineum is not repaired properly
3. Retained placenta – in some cases some part of the placenta is not expelled leading to hemorrhage and infection
4. Risk of developing vaginal Hematoma – it is a painful condition involving swelling and accumulation of blood under the stitches or in the outer part of the vagina 
5. Mother more likely to developing urinary stress incontinence

Possible Risks to the Mother

C-section entails several risks for baby & mother (both) to be weighed before making a choice. Read below...

1. Chances of infection in the uterus or nearby pelvic organs such as the bladder and kidneys
2. Increase blood loss, which is twice as much as a vaginal birth
3. Decrease bowel function for several days causing distention, bloating and discomfort
4. Respiratory complications due to reactions to general anesthesia lead to pneumonia
5. Unexpected reactions to anesthesia (such as B.P drops suddenly) and other medicines used in surgery
6. Longer hospital stay
7. Risk of additional surgeries like hysterectomy (uterus removal) and bladder repair
8. Risk of forming adhesions (band of scar tissue) leading to pelvic or abdominal pain, bowel obstruction and even infertility in some cases
9. The risk to fertility and future babies
10. The risk for all future births to be surgical
11. Increased risk of placental and bleeding problems in future pregnancies
12. Higher chances of formation of blood clots in the veins of legs or pelvic organs, which can lead to life-threatening pulmonary embolism (blood clot traveling to lungs)
13. Risk of developing hernia in case of a classical vertical incision generally done in emergency C-sections
14. Chances of developing urinary stress incontinence

Possible Risks to Baby

Below are some risks the newborn baby includes...

1. Premature birth, possible if the due date is calculated wrongly
2. Injury – In forceps and ventouse delivery there is a fair chance of injury to the baby
3. Infection – Prolonged labor and rupture of the uterine membranes can lead to neonatal infections
4. Respiratory problems such as transient tachypnea, which is abnormal, fast breathing during the first few days after birth. Moreover, some research even links asthma to cesarean birth
5. Low APGAR (Appearance, Pulse, Grimace, Activity, Respiration) scores as most of the drugs used for anesthesia cross the placenta and reach the baby. As a consequence, babies born through c- section are drowsy, less responsive for almost 48 hrs
6. Mostly, the breastfeeding gets delayed for 24hrs to 48 hrs, making breastfeeding more difficult for the child and the mother
7. Fetal injury, although rare but can happen accidentally

What Mothers Feel If Giving Birth Naturally

The following are a few emotional changes most of the mothers giving birth by normal delivery feel...

1. Fulfilled and elated for achieving their baby braving the labor pains.
2. More happy with their bodies

However, some mothers feel the birthing experience very painful but feel glad to get over with it many mothers feel & some may happy to get their baby safe and sound but may feel dissatisfied with their post-surgery demeanor.

What Mothers Feel If Giving Birth C-section

Some feel disappointed for not being able to deliver naturally and may feel disconnected from the baby for some time. With the birth of a child, all women delivering naturally or surgically undergoes a lot of emotional changes occurring due to hormones, physiological changes, personal circumstances and challenges.

Various researches suggest that about 15 % of new mothers experience postpartum depression. The symptoms may include are

1. Anxiety, lethargy, sleeping problems & confusion
2. Frequent crying, guilt feelings,
3. Frightening thoughts,
4. Low self-esteem,
5. Eating problems,
6. Decreased sex drive,
7. Mood swings,
8. Feelings of hopelessness,
9. Irritability, forgetfulness,
10. and feelings of being overwhelmed

Mostly, the symptoms subside within six weeks naturally but when they do not subside and the depression becomes more serious professional intervention is needed. Drugs administered minimally.

Why Artificial Induction of Labor?

However, artificial induction of labor includes administering hormonal drugs containing oxytocin and likes are used to accelerate labor and then some antibiotics to prevent infection Anesthesia – Epidural, Spinal, General, post-delivery antibiotics, and pain killers cost almost half of the cesarean delivery expenses.

Contra-indication of Natural Birth

There are several reasons where a scheduled or planned cesarean is suggested prior to labor or at the beginning of labor. These reasons are basically the conditions where the possibility of natural birth is nil or is life-threatening for both the baby and the mother. These include:

1. Placenta Previa
2. Certain fetal positions (Transverse lie and some breeches)
3. Higher-order multiples
4. Active maternal herpes
5. Previous invasive uterine surgery, including a previous classical cesarean incision
6. Certain fetal conditions
7. Diseases that may make vaginal birth difficult like a pulmonary or coronary disease of the mother
8. HIV positive mother with a high viral load at the time of birth

Why Unplanned Cesarean?

Sometimes when the mother is in labor trying for natural birth certain complications arising making further trial for vaginal delivery life-threatening to mother and/or baby and consent is sought for cesarean delivery. Such conditions include:

1. Failed Induction – either cervix fails to dilate in a preset amount of time or mother or baby become ill from the induction of labor
2. Labor Dystocia – Labor stalls completely
3. Fetal Distress – when the baby’s heart rate becomes abnormal or non-assuring
4. Maternal Distress – fever or other problems with the mother
5. Infection of mother or baby
6. Continued bleeding from the placenta or the uterus as in a placental abruption or uterine rupture
7. Prolapsed Cord – when baby’s umbilical cord precedes the exit from the uterus
8. Cephalopelvic disproportion (CPD) often termed, as ‘Big baby’ is where the size of the baby doesn’t match with the size of the baby.

Some of the reasons mentioned above lead to emergency cesarean, where it is necessary to deliver the baby through C-section immediately to avoid loss of life and damage to the mother or the baby.

I have made the above lists as exhaustive as I could (pardon me if you still find it incomplete) and I hope that this research helps all those expecting parents who seek clarity between the two procedures. Keep tuned to the next blog where I will talk about vaginal birth after cesarean(VBAC) and the many misconceptions surrounding it.