Birthing Options

Dr. Naseera Allie, Gynaecologist & Obstetrician
MBChB (UCT), FCOG (SA), MMed (O&G), currently practices at Melomed Gatesville

Prior to the 1960s, most women in South Africa had little choice about their pregnancy and labour. Most deliveries were conducted in homes and those with complications were referred to a hospital. This practice has changed to hospital or clinical deliveries as it is safer for the mother and the baby. The process of birth is a beautiful and natural occurrence, and there are options for the birthing process. As such, mothers are often faced with a dilemma of normal birth vs caesarean section. A woman can discuss her options with her doctor or medical provider. It is important to understand the pros and cons before making a decision.

Normal Delivery

Birth is a different experience for every woman. Normal (vaginal) delivery offers a woman a more natural process.

The advantages include:
• faster recovery time
• reduced risk of infections
• shorter hospital stay

The disadvantages of normal birth include:
• trauma to mother (this includes perineal tears and incontinence)
• hypoxia to baby while in labour and delivery (baby does not have enough oxygen when the mother has a contraction or during the delivery) – resulting in hypoxic brain damage
• trauma to baby at delivery
• cannot schedule delivery
• more stress and anxiety while in labour
• complications of prolonged labour e.g. infections

Caesarean Section
A caesarean section occurs when the baby is delivered via an abdominal incision. This is a surgical procedure and is performed in theatre after the mother has received an anaesthetic. If a caesarean is booked before the woman goes into labour then it is termed as an ‘Elective Caesarean Section’ or a ‘Planned Caesarean’. If the caesarean is done after the labour has started it is referred to as an ‘Emergency Caesarean Section’, even though it may not actually be a true emergency, rather it was unplanned.

The main advantages of caesarean section:
• avoidance of the complications of labour and delivery – birth injury to mother and baby
• scheduled delivery
• less likely to suffer from incontinence.

The disadvantages include a higher rate of maternal morbidity and mortality.
This includes:
• higher rate of infections in the mother (wound and kidney)
• anaesthetic complications
• surgical complications: bleeding, adhesion formation (may affect future abdominal surgery)
• possibility of delivery before the baby is ready
• increased pain compared to normal delivery
• longer hospital stay.

Knowing the above, it is important to discuss your options with your caregiver as there are certain indications for caesarean section where a normal birth would be dangerous to the mother or baby.

A caesarean section should be performed when the continuation of the pregnancy or labour will be harmful for the mother or baby, and normal birth is not considered safe for one or both of mother or baby.

This includes:
• bleeding before labour or during labour
• high blood pressure and other medical conditions in the mother
• suspected foetal distress (tired baby)
• abnormal presentation – breech, cord, brow
• multiple pregnancy
• big baby
• failure to progress in labour
• failed induction of labour
• failed forceps or vacuum delivery.

It is important for a mother to be involved in the decision to perform a caesarean section or a normal birth, as well as to be debriefed afterwards.

What is the right choice?
The birthing process is a personal experience that varies among individuals. You need to choose the best option that suits you.