With every new baby comes a birth story, unique to the mother and the medical needs of her and her baby. In a world where openness is becoming more and more valued and women are sharing their experiences, it's worth exploring the differences between the two most common birthing options: vaginal births and c-sections. To better understand both, BRIDES spoke with Dr. Geeta Sharma, OB/GYN at New York-Presbyterian and Weill Cornell Medicine.
A vaginal birth is much more than what some might think is simply "pushing out a a baby." It comes after "successful trial of labor" which Sharma describes, "involves an early stage of labor (the latent phase) that can last days as contractions develop and take time to become organized, coordinated and regular and then after 4-6cm [dilation], one enters the active phase where the progression of cervical dilation should be more predictable. At 10 cm [dilated] the parturient (pregnant woman in labor) enters the active stage and is 'fully dilated' or 'complete' and pushes with contractions to assist in bringing the baby through and out the birth canal."
Sharma explains that while the woman is actively pushing and at the time of the actual delivery, positions that help the baby come down and keep the fetal heart rate reassuring will be suggested. Perineal massage to reduce tearing and to protect the perineum during the delivery may also be performed as an episiotomy (a cut in the perineal body that lies between the vagina and the rectum).
Other recommended components of vaginal births include delayed cord clamping, Sharma says, "provided the baby is doing well and does not need immediate attention, which is rare," and the placing of the newborn baby on the mother to begin the skin to skin bonding process. Then, the significant other is encouraged to cut the cord, whenever possible.
The placenta (which also has to "come out" or be delivered) is then given time to separate; Sharma says, "This can be facilitated by the patient gently pushing and/or massaging the uterus via the abdomen." Then, "Any tears are sutured and the provider will review the type of tear and how to promote good healing and pain relief. Ice packs (or an ice diaper!) can help tremendously for the first 24-48 hours." Sharma says women can expect a heavy period and cramping as the uterus becomes smaller, which is normal and needed to reduce bleeding. Additionally, the drug Pitocin is given to encourage the uterus to return to a smaller size and to reduce life-threatening hemorrhage.
Just as with a c-section, there is also, of course, a recovery period for vaginal births. During this time, Sharma explains, "The perineum is washed after using the bathroom with a water bottle and then one taps dry with a soft cloth or tissue. Keeping the perineum clean and dry will help with the healing. A spray and gel for pain relief is often given on the postpartum floor to help relieve discomfort. Walking will help reduce swelling in the area and promote healing. The perineum is still rich with blood supply and usually heals well."
See more: Demystifying Pregnancy: Fact vs. Fiction
A Caesarean Section, aka "c-section," differs greatly from a vaginal birth as it is major abdominal surgery, "but one with nice prize at the end!" says Sharma.
It's expected to be a bit nervous or overwhelmed before facing a c-section, whether its scheduled or not. Sharma says, "Often patients request medication to ease their nerves prior to a c-section, but we cannot administer anything close to delivery that will make the patient sleepy as that can pass through the placenta and make the fetus sleepy."
In the operating room, there might be some unfamiliar faces, including a pediatrician for your baby. "As some fetuses born by c-section take time for their lungs to transition, a pediatrician is in the room for the delivery to help with the ABCs (airway, breathing, circulation) to ease the transition for the baby," Sharma says.
The beginning of the operation can move more quickly than the final stages, as opening the layers to the uterus takes usually less time than closing all the layers. The good news? Sharma says that during the rest of the c-section procedure, the mother is allowed to hold the baby, once the little one is doing well, breathing and maintaining an appropriate temperature.
Another option called a “gentle” cesarean, allows the patient and her support person to be more involved with the c-section. "For example," describes Sharma, "the patient’s monitors are placed so that they don’t interfere with her holding the baby against her skin and a clear drape may be used or the drape lowered to allow them to see the delivery of the baby."
After a c-section, as with most surgery, pain control is important, as is walking and movement after resting for at least 12 hours post-op, which is critical for a smooth recovery. Sharma describes, "Since mothers are still at risk for a DVT (deep vein thrombosis) after delivery, walking will help with their circulation and to reduce the risk of complications."
While the delivery mechanism is vastly different, both vaginal births and c-sections are no easy feats and, as such, the mother will need the support of her friends and family. Postpartum blues and/or depression are not uncommon, and while support might help, Sharma recommends, "All moms should be encouraged to speak with her OB or a therapist to help with the often overwhelming emotions that accompany the new challenge of taking care of a newborn and adapting to postpartum, both physically and mentally."
In reality, there is no "safer" option, as each woman and baby's needs can vary greatly. Ultimately, Sharma says, "We want a healthy mom and baby(ies). The mode of delivery is second to that most-important goal. In certain circumstances, a c-section will be safer for that patient and that baby."
In these instances, there may be conditions that make a vaginal birth not possible, or safe:
o When the exit is blocked (placenta previa, fibroids in the lower segment)
o 1 or 2 prior c-sections and no prior vaginal deliveries
o Extensive prior uterine surgery
o Need to avoid emergency c-section (this is always preferable, but for some patients with certain medical conditions and prior abdominal surgeries, a careful plan will help avoid complications for the mother and baby)
o Fetus is in distress and it is not possible to effect a vaginal delivery quickly
o Fetus is not head down
Other times, vaginal births are the safer option, as it is preferable to avoid major abdominal surgery wherever possible. Sharma says, "Thankfully, most labors end with a successful vaginal birth of a healthy baby. We stay on track for a vaginal trial of labor unless the fetus does not seem to tolerate labor and/or there is slow or no progress in labor."
While having a plan is great, being flexible is key. Often times, "baby is the boss," says Sharma, "and keeping these little ones happy is critical for a safe outcome. Discuss your questions with your provider to make sure you are on the same page. Keeping a list of preferences as a reminder to discuss in labor is better than reducing a vibrant engaged patient/couple to a sheet of paper printed out from the Internet with check boxes as instructions."
Just as flexibility is imperative in parenting, it is also equally important in the birthing process, too. Sharma explains, "We change positions, strategies and techniques often to individualize to the patients, mother and baby, and the labor process. Keeping an open mind, relaxing the pelvis, breathing deeply and staying focused on a healthy outcome are very important."
Ultimately, whichever way your baby enters the world is sometimes out of our hands. Though, Sharma advises, "Be an active participant in your birth process and do keep an open mind. We cannot script out the birth but the provider and patient should communicate and keep their minds open."
Also, because postpartum is an exciting yet challenging time filled with change and the unknown, she recommends new moms join a mothers’ support group, yoga class with babies, go for a walk, and have a low threshold to seek out professional help if needed.