by Christa Melnyk Hines
Following the birth of my son, I was disappointed that I had to undergo a cesarian section (C-section). Nonetheless, the feeling was fleeting as I held my newborn close, realizing the consequences could have been devastating if the surgery hadn’t been performed.
Like many new moms, one of the first lessons I learned was that parenthood rarely goes according to plan. Since you don’t know exactly how your child’s birth will play out, manage some of the uncertainty now by learning the differences between cesarean and vaginal deliveries.
“Our ultimate goal is to have a healthy baby. However you get there, whether that be vaginal or C-section, we want moms and babies to be happy and healthy,” says ob-gyn Dr. Kristen Wootton.
What is a C-section?
A cesarean section is major surgery requiring an incision through the abdomen and uterus. You will receive an epidural and barring an emergency situation, you will be awake during the procedure. Depending on your specific situation, your physician will make a low-transverse incision, which is a horizontal cut across the lower end of the uterus generally preferred for better healing and less bleeding, or a vertical cut incision. Although you’ll feel touch and tugging sensations, you shouldn’t feel pain.
Why a C-section?
According to the Centers for Disease Control and Prevention, the rate of C-sections rose more than 33 percent between 2000 and 2007, declining slightly for the first time in 2010.
“Previous uterine surgery, the baby is too large, baby is in a breech position (rear-end first), the mom may have pelvic shape that would make vaginal delivery difficult, a baby in distress and not tolerating labor – these are just some of the reasons for C-sections,” according to Dr. Jeff Gunnells of Henderson & Walton Women’s Center in Birmingham.
Ob-gyn Dr. Bill Hudson of Women’s Health Specialists in Birmingham says some women even request a C-section versus a vaginal birth, and sometimes a c-section is warranted because of some brain surgeries or neurologic conditions, some cardiac conditions that could put the mother at risk, cephalopelvic disproportion of the baby (where the head is larger than and sometimes the mother’s pelvic opening), or certain fetal malformations or conditions.
Other reasons women may require a C-section include the baby’s position in the uterus, the size of the baby, premature delivery, fetal heart rate changes indicating a lack of oxygen during labor, or if there’s a medical complication with the mother, such as preeclampsia or gestational diabetes, says Dr. Ana Martinez.
What about VBAC?
VBAC stands for vaginal birth after C-section, says Dr. Cindy Lassiter of Henderson and Walton Women’s Center in Birmingham.
“VBAC comes in and out of fashion and certainly comes with its own set of risks. Candidates for VBAC must be carefully selected,” Lassiter adds.
“In the right situation, VBAC is a viable alternative, but it depends on why you had your first C-section,” Martinez says. For example, if your previous C-section was due to your baby being in a breech position, you might be an excellent candidate for VBAC. Your physician will also consider your risk for uterine rupture, your insurance requirements, and the availability of an on-site physician during labor and delivery. “An attempt at VBAC is not recommended if there has been a previous cesarean section,” Hudson says.
“Your doctor has to be available to get the baby out quickly,” Martinez says. “If their office isn’t on campus and a doctor can’t be there the whole time, (VBAC) can be more risky.”
Some hospitals have OB hospitalists available 24-7 to assist patients. Hospitalists are on-site physicians who specialize in the care of hospitalized patients. Consult with your doctor to learn what type of coverage your hospital offers.
Tears and lacerations can occur during vaginal deliveries. Although rare, uterine rupture is a life threatening risk factor particularly for women who opt for a VBAC. A uterine rupture is a tear in the wall of the uterus, usually at the site of a past C-section incision. The incidence rate is about one percent for women who have had low-transverse incisions, rising to five percent for women with vertical incisions. C-section risks include blood loss and complications with anesthesia, as well as scarring and adhesions.
The typical hospital stay for a vaginal delivery is 24 to 48 hours, while a C-section is between three and four days.
A woman who delivers vaginally has no restrictions on lifting and can typically return to her normal routine within a few weeks. With a C-section, expect the recovery to take a little longer as your mobility is more restricted.
“The first two weeks are the roughest,” Martinez says. But, after that, most women are doing well and are off pain medication.
Other than your baby, you won’t be able to lift anything over 10 pounds and due to the pain medicines, you cannot drive for the first two weeks post-surgery. However, breastfeeding is safe and encouraged. Lean on your spouse, a family member or a close friend for assistance, especially if you have other children.
“This is a time in your life when you need a little help and it’s okay to let go of some of our innate control things as moms,” Wootton says. “Let dads be active participants. Let them bring you changing stuff so you don’t have to get up. People are always great to want to bring you food. Use those resources. An incision adds a little bit of a challenge to the mix, but it’s definitely doable when you have good support.”
And remember, even if your child’s birth didn’t go exactly as planned, chances are the elation of holding your much anticipated newborn will overcome any lingering feelings of disappointment.
“You can have the best birth plan...but there are just some things that are out of your control,” says Jen Conrad, a mom of three. “Give yourself some grace and tell yourself you still did something amazing by bringing your sweet baby into this world, no matter how he or she arrives.”
Freelance journalist Christa Melnyk Hines and her husband are parents of two children delivered by C-section. Hines is the author of Confidently Connected: A Mom’s Guide to a Satisfying Social Life. Publisher/editor Carol Muse Evans also contributed to this story.
Birth Plan Considerations
- Write down and discuss your preferences with your physician and significant other.
- Be flexible. Your baby’s birth may not go specifically according to plan.
- Avoid non-medical related pre-term delivery, especially before 39 weeks, which can put your baby’s health at risk.
- Determine who you can ask for support post-delivery to avoid managing alone.