Babies can enter this world in one of two ways: a vaginal birth or surgical delivery by cesarean section. The ultimate goal of both methods is to ensure that the baby and mother are healthy.
In some cases, a C-section may be expected and thus scheduled in advance — for example, in the case of twins or other multiples; a medical condition, such as diabetes or high blood pressure; an infection that could be passed along to the baby during birth, such as HIV or genital herpes; or problems with the placenta.
A C-section may also be necessary if the baby is very large and the mother has a small pelvis, or if the baby is not in a heads-down position and efforts to turn the baby into this position before birth have been unsuccessful.
Sometimes an obstetrician decides to perform an emergency C-section because the health of the mother, the baby, or both is in jeopardy. This may occur because of a problem during pregnancy or after a woman has gone into labor, such as if labor is happening too slowly or if the baby is not getting enough oxygen.
Some C-sections are considered elective, meaning they are requested before labor. Someone may choose to have a C-section to plan when to deliver or if they previously had a complicated vaginal delivery. But if someone is eligible for a vaginal delivery, there are not a lot of advantages to having a C-section, said Dr. Allison Bryant, a maternal-fetal medicine specialist at Massachusetts General Hospital in Boston.
Although C-sections are generally considered safe and, in some situations, lifesaving, they do carry risks. The procedure is a major surgery and involves opening up the abdomen and removing the baby from the uterus. Because first-time C-sections often lead to C-sections in future pregnancies, a vaginal birth is generally the preferred method of delivery for first pregnancies. About 2 in 3 babies in the United States are born via vaginal delivery, according to the National Center for Health Statistics.
Vaginal birth in people who have previously had a C-section, whether elective or because of an emergency, may be contraindicated depending on the location of their C-section incision and risk of uterine rupture in which the uterus bursts open along the old cut, according to the Royal College of Obstetricians and Gynecologists. This type of birth is known as Vaginal Birth After Cesarean (VBAC). However, not all hospitals are not equipped to deal with VBAC complications and some doctors refuse to oversee them, said Dr. Patricia Santiago-Munoz, a high-risk pregnancy specialist in the Department of Obstetrics and Gynecology at University of Texas Southwestern Medical Center in Dallas.
Regardless of how they give birth, "women should be as informed as possible about their childbirth options so they can have a voice in the process, advocate for what they want and make the most informed choice," Bryant said. Here is more information about the pros and cons of the two birthing methods.
Vaginal delivery: Pros
- Vaginal births typically require shorter hospital stays and recovery times compared with C-sections. Although state laws vary, the typical length of a hospital stay following a vaginal delivery is 24 to 48 hours, although it could be shorter than the allowable time period permitted in the state, Bryant told Live Science.
- Vaginal births typically avoid the risks associated with major surgery, such as severe bleeding, scarring, infections, reactions to anesthesia and longer-lasting pain. And because major surgery is not involved, a mother may be able to begin breastfeeding sooner.
- A baby who is delivered vaginally will be able to have more early contact with their mother, who can initiate breastfeeding sooner than she could if she had a C-section, Bryant said.
- During a vaginal delivery, muscles involved in the process are more likely to squeeze out the fluid in a newborn's lungs, Bryant said, which is beneficial because it makes babies less likely to suffer breathing problems at birth.
Vaginal delivery: Cons
- Going through labor and a vaginal delivery is a long process that can be physically grueling. On average, first-time mothers spend between four and eight hours in active labor, which is when their cervix is fully dilated and their body wants them to push, according to maternal- and baby-health organization March of Dimes.
- During a vaginal delivery, there is a risk that the skin and tissues around the vagina could stretch and tear while the fetus moves through the birth canal. Severe stretching and tearing may require stitches. This stretching and tearing also could cause weakness or injury to pelvic muscles that control urine and bowel functions.
- A 2018 review in the journal PLOS Medicine found that women who delivered vaginally were more likely to experience urinary incontinence (and leak urine when they cough, sneeze or laugh) and to have pelvic organ prolapse, which is when one or more organs slip into the pelvis, compared with women who delivered via C-section.
- A vaginal delivery may also cause lingering pain in the perineum, the area between the vagina and anus.
- If a woman has had a long labor or if the baby is large, the baby may get injured during the vaginal birth process itself, resulting in a bruised scalp or a fractured collarbone, according to Stanford Children's Health.
- A woman may choose to have a C-section if she has overwhelming anxiety about a vaginal birth, which may affect her experience of delivery.
- Women who have C-sections are less likely to suffer from urinary incontinence and pelvic organ prolapse compared with women who deliver vaginally.
- A surgical birth can be scheduled in advance, making it more convenient and predictable than a vaginal birth and labor.
- If the baby or mother is in danger, a C-section can be lifesaving.
- C-sections typically require longer hospital stays — two to four days, on average, compared with one to two days for vaginal deliveries. The recovery period is also longer and there may be more pain and discomfort in the abdomen, as the skin and nerves surrounding the surgical scar need time to heal, often at least two months.
- A C-section increases the risk for post-delivery ailments such as pain or infection at the incision site and longer-lasting soreness, according to the U.K.'s National Health Service.
- A C-section involves an increased risk of blood loss, Bryant said, as the bowel or bladder can be injured during the operation or a blood clot may form.
- Women who had a C-section are less likely to begin early breastfeeding compared with women who had a vaginal birth, according to a 2012 review published in The American Journal of Clinical Nutrition.
- Women are three times more likely to die during a cesarean delivery than during a vaginal birth, due mostly to blood clots, infections and complications from anesthesia, according to a 2006 study published in the journal Obstetrics & Gynecology. Moreover, a 2017 review based in Brazil found that women were more likely to die during a C-section or develop an infection than during a vaginal delivery, although they were less likely to bleed out.
- Once a woman has had a C-section, she is more likely to have a C-section for future deliveries, Bryant said. There may also be a greater risk of future pregnancy complications, such as placental abnormalities and uterine rupture, which is when the uterus tears along the scar line from a previous C-section. The risk for placental problems continues to increase with every C-section a woman undergoes, according to the Mayo Clinic.
- Babies born by C-section may be more likely to have breathing problems at birth and even during childhood, such as asthma, according to a 2019 study published in the journal Allergy, Asthma & Clinical Immunology.
- A 2018 review published in the journal PLOS Medicine found that there was a higher risk of stillbirth when women had C-sections. The authors acknowledge, however, there may have been confounding factors which were not taken into account in their study, such as whether these c-sections were emergencies and when in the labour process they occurred.
- During a C-section, there is a small risk that a baby can get nicked by the scalpel during the surgery and get injured, Bryant said. For reasons that remain unclear, some studies, including a 2020 investigation of more than 33,000 women, have also suggested a link between babies delivered by C-section and a greater risk of becoming obese and developing type 2 diabetes as children and as adults.
Editor's Note: If you'd like more information on this topic, we recommend the following book:
- This is what happens during a C-section, as described by the Mayo Clinic.
- Here is how a woman's vagina changes after a vaginal birth, described by NHS.
- It is possible to have a vaginal birth after having a C-section (known as a VBAC). Here is some information about VBACs from National Childbirth Trust 1st 1,000 Days, a U.K.-based charity.
This article was updated on May 20, 2021 by Live Science contributor Sarah Wild.