Caesarean section vs normal delivery

While some women prefer to have a Caesarean delivery, the majority of my patients desire a vaginal delivery. Although I can relate to having a preference, I encourage my patients to keep an open mind because a vaginal delivery is not always best for the health of the mother and infant.

There are a few conditions that are widely agreed as necessitating a scheduled Caesarean section. These include a baby in the breech or transverse presentation, placenta praevia, placental abruption, and if a woman has an active outbreak of genital herpes.

Removal of fibroids

Women who have had prior myomectomy for the removal of fibroids are often counselled on the need for a Caesarean delivery, especially if the surgery involved entry into the cavity of the uterus. Women who have uterine fibroids may need this route of delivery if the fibroids appear to obstruct the vaginal delivery of the baby.

Women with certain conditions, including types of heart and lung disease, may also require a Caesarean delivery. In addition to these indications, many of which are known prior to labour, a woman may be advised of the need for surgery during labour if, for example, her labour pattern is slow, suggesting a baby that is too large for the birth canal or if the labour monitoring suggests that the baby could be in jeopardy if labour is allowed to continue. Women who have had Caesarean sections in the past are often advised to have a repeat Caesarean section, although in some cases a vaginal delivery may be possible.

Debatable

Some reasons for Caesarean section may be more controversial or debatable than others, but having a clear understanding of your doctor's reasons for choosing a certain route may relieve some of the anxiety. I will address one such issue.

As previously mentioned, a vaginal delivery is possible after a Caesarean section. However, many doctors, including myself, choose not to offer this as an option. The major risk with vaginal delivery after previous Caesarean section is the rupture of the uterus. Although this risk is fairly low, the complication can be fatal to both mother and child. As such, it is safer to offer vaginal delivery after previous Caesarean section in a facility where an emergency Caesarean section can be performed.

Time is of the essence in performing such a surgery, and a baby may have to be delivered within 20 minutes of a diagnosis of the rupture to ensure its safety. Unfortunately, this speed of delivery is all but impossible in a private-hospital setting, and usually requires a hospital where doctors to perform the surgery are available on a 24-hour basis.

Nevertheless, a Caesarean section is not without risks, and the risks increase with the number of surgeries. Therefore, women should have a detailed discussion with their doctors about choice of delivery.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.