Natural childbirth or caesarean section?

Alicja Halbersztadt: We are terrified by the thought of labour pain, fatigue and exhaustion. We wonder if we will be able to get to the appropriate delivery room with qualified and empathetic staff and if we will be able to cooperate properly. Of course, we are most concerned about the child’s life and health. After all, it is the most important thing!

Some of us, fearing the pain, exhaustion and complications that may accompany childbirth and the forces of nature, are considering the possibility of surgical termination through Caesarean section. It is therefore important to be aware of the benefits and risks of each of the ways of pregnancy termination.

The caesarean section procedure is classified as a so-called „major surgical procedure” with the opening of the abdominal cavity and the opening of the uterine cavity, therefore, similarly to other operations in this area, it is associated with the possibility of a number of complications. The mortality rate of women after caesarean section is two- and in developing countries even almost four times higher than the death rate of women after vaginal delivery.

There are a number of risk factors and complications that are more common in women after an operative termination of pregnancy, such as, for example, pelvic infections, haemorrhagic complications. It is estimated that blood loss during caesarean section is almost twice as much as that after vaginal delivery. Surgery may damage other organs, especially the bladder and intestines. Surgical intervention often causes temporary impairment of the functioning of the gastrointestinal tract, causing pain, flatulence, constipation and discomfort in many patients for several days after delivery. One should also pay attention to the possibility of complications related to anaesthesia and the use of a number of drugs during and after the procedure, to which the woman’s body may react in an unexpected way (for example, in a sudden increase in blood pressure).

Later, the process of scarring of the tissues damaged during the procedure may cause adhesions that change the anatomical conditions in the pelvis, often causing pain, disturbances in the digestive tract or the bladder, and the possibility of complications in the next pregnancy (placenta previa, premature detachment of the correctly seated placenta).

It has also been observed that the caesarean section, which is a much greater burden for the woman in labour than natural delivery, delays the moment of establishing a mutual maternal-neonatal bond, also delays the moment of starting lactation, often causing psychological complications in young mothers.

There are a number of reports in the literature about the importance of the stress of childbirth, which the new-born experiences as he or she overcomes the subsequent stages of the birth canal during childbirth. Such positive neuroendocrine stimulation plays a key role in the processes of adaptation of the new-born to living conditions outside the uterine cavity.

One of the evidence of worse adaptation of new-borns born through caesarean section compared to the group of children born vaginally is more frequent breathing disorders and lower Apgar score, which may also be caused by the influence on the foetus of both anaesthesia and the procedure itself. There is also a higher percentage of premature babies born, especially in the case of elective, planned, performed without labour due to incorrect assessment of the gestational age and determination of the wrong date of delivery.

There are also a number of reports of worse psychomotor development and a higher incidence of certain diseases in children born through caesarean section compared to children born naturally.

However, it should be remembered that there are a number of medical indications, maternal and foetal diseases, obstetric and perinatal clinical situations that prevent the proper course of natural delivery. When the life and health of the mother and child are at risk, the risk exceeds the risks associated with caesarean section surgery. Therefore, each patient in whom a caesarean section is necessary must be carefully informed by the obstetrician about possible complications of both surgery and anaesthesia, in order to be able to consciously decide about her and her child’s life and health.