Is an elective Caesarean Birth better?

As a Consultant Obstetrician and Gynaecologist, I have been thinking about how best to advice women who ask about the benefit to them of avoiding a vaginal delivery and having an elective caesarean section instead. Sometimes there are clinical reasons why a Caesarean may be advised. However, sometimes women will request a Caesarean section when there is no obvious reason to indicate this is necessary.  Despite some press statements to the contrary this is still a relatively unusual request.  I suppose my answer will depend on what the woman is concerned about, what her choices are, her experiences, her physical and psychological well-being. 

If it is her risk of death as a result of childbirth that she is worried about, then there is little to choose either way. Both options carry pretty much the same risks to the mother.

If her priority is a predictable date of birth then caesarean section always wins. However, is this predictability really the most important thing to take in to account at such an exciting time?

If it is minimising physical “trauma” then the issue is less clear, as a caesarean section has major abdominal trauma to the mother and for most vaginal births perineal trauma is much smaller with few long-term consequences. Caesarean section normally requires a longer recovery time and perhaps a longer stay in hospital.  It is true that more complex perineal trauma can occasionally occur with vaginal birth with potential long term problems.  These risks can be minimised (but not completely illuminated) by the woman being proactive about her birth.  The most important action is to seek out your midwife and maximise your chance of a normal birth by embracing techniques to optimise the position of your baby and prepare yourself physically and psychologically for birth. Ask your midwife about techniques to ensure you are really prepared for birth. Also, some women have asked for a “hands off” technique in relation to delivery of the baby’s head. Whilst every birth is different, evidence suggests that this has led to a significant rise in complex perineal trauma rates. More recently, this trend is being reversed and with a skilled midwife supporting a slower, more gentle birth of the baby’s head.  Recent results show that this has resulted in a two to three fold reduction in complex trauma, so, with the correct preparation and a skilled midwife, vaginal birth generally results in less physical trauma.

It is true that a vaginal birth, with all the unpredictability and excitement that goes with it, can lead to psychological concerns for some women. Typically, women report that they are worried about feeling out of control, or losing their dignity. Again, this is when the support of a skilled midwife, preferably one who you have got to know and trust during your pregnancy, is invaluable in helping you to feel empowered and in control. Your midwife can assist you to have a dignified, positive birth experience, giving you and your baby the best possible start in life.

Mr Mark Doyle

Consultant Obstetrician and Gynaecologist