Choosing Between C-Section and Natural Birth: Key Considerations for Expecting Moms

Cesarean section or vaginal delivery?

Hello Dr.
Tsao, I have a troubling question I would like to ask you.
I live in Europe and am currently 36 weeks and 5 days pregnant.
I went for a prenatal check-up on June 15, and the baby currently weighs 3400g with a head circumference of 35 cm.
For my first child, I had a vaginal delivery, but the baby was born with a large head circumference (37 cm) and weighed 3540g, which resulted in a tear to my anus.
Three months postpartum, I followed up with a colorectal specialist who advised that for my second child, I should definitely have a cesarean section.
However, my obstetrician believes I can attempt a vaginal delivery and has left the decision up to me, but also cautioned that my baby is on the larger side.
I am very hesitant; I want to have a vaginal delivery but am afraid of tearing again.
Could you please provide some advice? Additionally, does an episiotomy reduce the risk of anal fissures? I also asked my doctor about preventing adhesions after a cesarean section.
The hospital here recommends getting out of bed on the same day as the surgery to prevent adhesions, so they do not provide adhesion prevention patches.
If I have a cesarean section and get up early, can that really prevent adhesions, or are there other methods? Thank you.

Mrs. Peng, 30~39 year old female. Ask Date: 2016/06/20

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, since you have given birth once, the birth canal has already been stretched, and the likelihood of tearing to the anus may not necessarily occur.
You should consider a vaginal delivery.
Of course, the sooner you can start moving after the surgery, the better.
Wishing you good health.

Reply Date: 2016/06/20

More Info

Choosing between a C-section and natural birth is a significant decision for expecting mothers, especially when previous birth experiences and medical advice come into play. In your case, having experienced a natural birth that resulted in a perineal tear due to your baby's head circumference, it is understandable that you have concerns about the potential for similar complications in your second delivery.

Key Considerations for Your Decision
1. Previous Birth Experience: Your first birth resulted in a significant tear, which can understandably raise concerns about the risks of natural birth in subsequent pregnancies. The recommendation from your rectal specialist to consider a C-section is based on the potential for similar complications, especially if your second baby is also on the larger side.
2. Baby's Size: You mentioned that your current baby is already weighing around 3400g at 36 weeks, which is considered on the larger side. Larger babies can increase the risk of complications during delivery, including tearing and the need for interventions. However, it’s essential to consider that not all large babies lead to complications, and some women successfully deliver larger babies naturally.

3. Medical Opinions: You have received mixed advice from your healthcare providers. While your obstetrician believes you can attempt a natural birth, they also caution you about the baby's size. It's crucial to have an open dialogue with your doctor about your fears and preferences. Discussing your previous experience and the potential risks associated with a natural birth versus a C-section can help you make a more informed decision.

4. Perineal Protection: Regarding your question about episiotomy (the surgical cut made during childbirth to prevent tearing), it can indeed reduce the risk of severe tearing, but it is not a guarantee. Many practitioners now prefer to allow natural tearing to occur, as it often heals better than a surgical cut. Discuss this option with your healthcare provider to understand their approach and what might be best for you.

5. C-Section Recovery and Adhesion Prevention: You mentioned that your hospital encourages early mobilization after a C-section to prevent adhesions. Early ambulation can indeed help reduce the risk of adhesions, as it promotes circulation and healing. However, it’s also essential to follow other postoperative care guidelines, such as avoiding heavy lifting and following your doctor's advice on activity levels during recovery.

Making Your Decision
Ultimately, the choice between a C-section and a natural birth should be based on a comprehensive understanding of your medical history, the current pregnancy's specifics, and your personal preferences. Here are some steps you can take:
- Consult with Your Healthcare Providers: Schedule a detailed discussion with both your obstetrician and the rectal specialist. Ask them to explain their reasoning behind their recommendations and what they believe is the safest option for you and your baby.

- Consider a Second Opinion: If you are still uncertain, seeking a second opinion from another obstetrician may provide additional insights and help you feel more confident in your decision.

- Evaluate Your Comfort Level: Reflect on your fears and preferences. If the thought of a natural birth causes significant anxiety due to your previous experience, it may be worth considering a C-section for peace of mind.

- Prepare for Both Scenarios: Regardless of your decision, prepare yourself mentally and physically for both possibilities. Understanding what to expect during recovery from a C-section versus a natural birth can help you feel more in control.

In conclusion, both C-sections and natural births have their advantages and risks. Your decision should prioritize your health, comfort, and the well-being of your baby. Open communication with your healthcare team will be key in navigating this important choice.

Similar Q&A

Can You Choose Natural Birth After C-Section Due to Fetal Distress?

If the first delivery was via cesarean section due to fetal distress, can the second delivery be a vaginal birth?

Dr. Wei Fumao reply Obstetrics and Gynecology
It is advisable to attempt natural delivery, but it should be done in a hospital with adequate facilities for emergencies.

Natural Birth vs. Cesarean: Making the Right Choice for Your Delivery

Hello, I am currently 34 weeks pregnant! During my prenatal check-up on Saturday (March 4), the fetal position was normal! For my first child, I had a cesarean section in 2000 due to abnormal fetal positioning. After receiving anesthesia, I began to shake involuntarily, and the s...

Dr. Huang Jianxun reply Obstetrics and Gynecology
Hello: There are risks associated with vaginal delivery after a cesarean section. Please respect the opinions of your attending physician. Sincerely, Dr. Huang Chien-Hsun, Obstetrics and Gynecology.

Choosing the Right Time for Scheduled C-Section: A Guide for Parents

Dear Doctor, Hello. My wife's due date is in late March. She has a double uterus and double cervix. The baby is currently in a breech position with some malpresentation, and there is also a slight deficiency in amniotic fluid. The doctor has recommended a cesarean section. ...

Dr. Zhuang Zhijian reply Obstetrics and Gynecology
Based on your description, a cesarean section would be more ideal. Generally, the procedure is performed after the fetus reaches full term (at least 37 weeks). If a scheduled time is arranged and all preparations are in place, it is considered safer. In contrast, performing an em...

Cesarean vs. Natural Birth: Pros, Cons, and Key Considerations

Hello Doctor: 1. What are the advantages and disadvantages of cesarean section versus natural childbirth in terms of pain intensity and duration (for the average person), and what are the respective precautions? 2. Are there any side effects associated with epidural anesthesia?...

Dr. Xu Junrui reply Obstetrics and Gynecology
1. Advantages of vaginal delivery: smaller incisions, faster postpartum recovery, lower risk of postpartum hemorrhage, no need for anesthesia, and shorter hospital stay. Disadvantages: longer labor duration (intense contractions) and higher likelihood of pelvic floor prolapse in ...