A Question of choice

Too posh to push, or does mother nature know best? C-sections shouldn't be taken lightly

It's a question that crosses the minds of almost all mothers-to-be - natural birth or caesarean section? And it's a question with no definite answer. All mothers-to-be have the authority to make their own choice between natural birth and planned caesarean, unless, of course, some complication arises that makes a C-section a necessity. But for those for whom the choice remains within their power, Yaowaluk Rapeepattana, obstetrician and gynaecologist at Samitivej Hospital Women's Centre, shares some ideas as to why she thinks a natural birth should be the answer.

Why would you recommend natural birth over planned caesarean?

Because nature is better. There is a lot of published data that shows if a woman can succeed with a natural birth then we should not do a caesarean unnecessarily. Caesareans pose more complications for the mother than natural births.

What about women who say they prefer a caesarean?

Of course we accept that some women request caesarean sections. We respect their choice. It is my personal opinion that everyone has the right to choose what, where or with whom they want to give birth - as long as they have the correct information. But let's go back to the history of the caesarean section. Caesareans first happened when we needed to save the baby's life - when a natural birth wasn't possible because of an abnormal position or if the baby was in danger, such as when the umbilical cord was wrapped around its neck, or an abnormal placenta location or a low lying placenta. In those cases, a caesarean section would save the baby's life, or even the mother's life.

It seems that planned caesareans have become more popular. It's a cultural thing, but you believe in respecting a woman's rights. But now you want to promote natural birth. Is that correct?

Yes. We want to do the best for families because caesarean sections have more complications for mothers than natural births - for example, infection and bleeding.

Yes, but what about soreness or pain? Is one method more painful than the other?

We cannot compare the pain. I always tell my patients, you cannot just expect a caesarean section to be less painful than a natural birth. Of course, if you doubt it and decide to have a caesarean section, then you skip labour pain. You will have no labour pain, it's true. But after the caesarean section you will have a painful abdomen. Nobody can skip some pain. We have to accept that there is a lot of pain in this world. We have to go with that pain. But it won't last long. Every pain can be healed.

Does it make any difference to the baby if it's a natural birth or a caesarean section?

There are now thousands of studies with well accepted data that show that a caesarean can decrease neo-natal mortality among babies. Neo-natal mortality is mostly caused by hypoxia [oxygen deficiency] among newborns. It is still about five per 1,000 newborn deliveries for natural birth. For caesarean sections it is less than 0.1%.

Is there any impact on breast-feeding if the mother has a caesarean or natural birth?

No, because if we give the baby to the mother right away and start breast-feeding, it will be the same because breast-feeding, or lactation, depends on how early you feed the baby and how frequently.

Is it possible to have a natural birth if you've had a caesarean section previously?

Of course. I cannot guarantee 100%, but if you try natural birth after a caesarean section the success rate is about 80%.

Do you have any comments on the advantages or disadvantages of water birth and natural birth?

Natural birth is almost the same as water birth, except with the latter you need to sit in a pool and the baby comes out in the water. The mother needs to sit. She cannot lie on her back or stand up either.

What about sex after natural birth? Does natural birth cause dilation of the vagina or vulva?

Yes. We have to accept that the baby needs some space to come out. After natural birth - or vaginal birth - you need to do special exercises to keep your muscles strong and healthy as they used to be.

During natural birth, are some women scared that they don't have the strength to finish the delivery - that it's too hard physically?

No, not really, if you prepare yourself well such as with exercise, which is very important before delivery. And get plenty of rest and have healthy food and support. You need to believe in yourself, that you can do it.

You recommend exercise, diet and plenty of sleep - is that exercise for nine months or for how long?

From after the first trimester until delivery and after delivery as well. But we don't push the patient. We just want the best for the delivery. It is one of the most important experiences in our lives. We want our patients to be safe - safety comes first. And happy too. We want the parents to be happy, the baby to be happy, everyone to be happy.

What about the differences in the recovery time for planned caesarean section versus natural birth? How long does it take for a mum to get back to normal?

It depends on how long the delivery was. If it's not the first delivery, it can be very quick. Especially if after the first baby, the perineum does not tear. There will be no wound, no scar. So they'll feel very little pain.

A lot of young women giving birth for the first time would like the hospital to advise them what to do.

Yes. I always tell them that labour pain is nothing to be afraid of. You can be happy, because during labour your brain will produce hormones like oxytocin which will make you feel happy and help you bond with your newborn baby. There's nothing to fear. You can enjoy the ride. Labour pain is like a cramp in your tummy. It will come and go, come and go. At last it may come every few minutes before you give birth. But you know that if the pain comes, it will go and then come again. The pain will dilate your cervix and then your lovely baby will come out soon. It means you're going to see your baby. In our lifetime many events or situations happen like this. Sometimes after it rains you see a beautiful cloud or sky. You need to imagine something strong and beautiful like your newborn baby.

In your experience, the most successful natural births happen to what kind of mothers? Are they mostly spiritually strong people, happy people first and foremost?

The first thing is attitude. There is greater success among mothers who have a strong desire to succeed with natural birth. I don't blame anyone who asks for an epidural block or painkiller, because sometimes it depends on the baby's position or the size of the baby. If the baby is too big or the position is not right, it can be more painful than a smaller baby, or a baby in the right position. I never blame my patients, because there are many factors.

With a planned caesarean you know that you will have your baby in at, say, 8 o'clock on a Saturday morning. But with a natural birth, it can be any time within a few days, within a week. Does that uncertainty cause some women to choose a planned caesarean?

As long as the baby is strong and the mother is strong, then there is no limit on the time. Some research shows that too long a labour may have some effect on the baby. But we can monitor that. Nowadays we have instruments to measure if the baby is at risk or not.