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Caesarean v natural birth – pros and cons of each

For many years it has been the case that whenever possible a women should be offered a choice of how to deliver her child – natural vaginal delivery or a caesarean section. However a recent investigation by Victoria Derbyshire from the BBC has shown that in 75% of hospitals women are being denied the right to choose a caesarean.

There are risks and benefits to each option and what is right for one person may not be right for another. That said, what should always be paramount in any decision is the safety of the baby and the mother. Giving birth however will always carry a risk whichever way it is done. What is important is how these potential risks are managed during the delivery.

Caesarean sections can be either elective or planned, for example where the baby is in breach position or is very large; or they can be emergency, for example the result of complications during labour resulting in a need to delivery the baby urgently to avoid potential damage.

Facts about delivery

• More than ¼ births in the UK are by caesarean. Of these around half are planned or elective caesarean, and half are emergency.
• Recovering from a caesarean can take longer and there is a risk of infection and bleeding. More scar tissue occurs with each caesarean which can cause complications in future pregnancies.
• A caesarean carries a risk of temporary breathing difficulties for the baby and a small risk of the baby being accidentally cut when the incision is made into the mother’s abdomen and womb.
• A vaginal birth on the other hand usually means a shorter hospital stay and a much quicker recovery, and avoids the risk of any surgery. However it can sometimes lead to a tear of the perineum which can not only be painful and cause complications for the mother, but it can sometimes require surgery to be repaired.

Where the mother has had a previous caesarean section

A recent study and BBC article has found that planned caesarean sections can be safer for a mother who has had a previous caesarean section. The findings have come from a study of more than 74,000 births in Scotland.

• Attempting a vaginal birth was linked with a small but increased chance of complications for both mother and baby.
• A vaginal birth can put a strain on the previous caesarean scar.
• A vaginal delivery is not advisable in any situation where a woman has undergone three or more previous caesarean sections.
• 28.4% of those who had undergone previous caesarean section and attempted a vaginal birth subsequently ended up having an emergency caesarean section
• Attempting a vaginal birth was associated with increase risk for both mum (1.8% for those attempting vaginal birth and 0.8% where planned caesarean section) and baby (8% with attempted vaginal birth and 6.4% with planned caesarean) suffering serious birth and post birth related problems

Benefits to baby from a natural delivery

A further BBC article has looked at the differences in gut bacteria in babies born vaginally compared with those born by caesarean.

The full study can be found here.

It is claimed that this study may help to explain why babies who are born by caesarean section are more likely to have some health problems later in life (for example Type 1 diabetes, allergies and asthma).
Babies born by vaginal delivery were found to have most of their early bacteria from their mother. Conversely, babies born by caesarean section were found to have high levels of hospital bugs such as Klebsiella and Pseudomonas. Whilst the method of birth is believes to have the biggest impact on babies’ microbiomes, there are other factors which can impact on this such as antibiotics, and whether or not a baby is breastfed. Regardless, any differences between vaginally delivered and caesarean babies were shown to fade over time and by the time the babies turned one any differences had largely evened out.Although these recent studies are not only interesting but also of significant important both to doctors and to pregnant ladies, it has been warned that the findings should not deter anyone from having a caesarean section. In many cases this can be a life saving procedure either for mum or baby or both.

The overriding factor in any delivery should always be the safety of mum and baby.


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