Cesarean Section vs. Vaginal Birth

Childbirth can occur either vaginally or through abdominal surgery called cesarean section (c-section). In the U.S., c-sections account for nearly 32% of all childbirths. 

Since 1985, an ideal c-section rate has been shown to be between 10-15%. That’s because as rates approach 10% maternal and perinatal outcomes tend to improve. But when the rate is greater than 10%, there is no evidence to suggest surgical births provide better outcomes.

There are benefits and risks to both vaginal birth and cesarean section. Vaginal birth is statistically less risky than a c-section. In certain situations, though, such as placenta previa, placenta accreta, and fetal distress, a c-section can be life-saving. Here are some things to keep in mind as you consider which is right for you.

Benefits of Vaginal Birth

Vaginal birth is associated with fewer maternal transfusions, ruptured uteri, unplanned hysterectomies, and ICU admissions. This is true for both vaginal birth with no prior cesarean, as well as vaginal birth after cesarean (VBAC), although the latter is riskier than the former.

Some health benefits of vaginal birth include:

• Prepares a baby’s lungs to breathe
• Exposure to healthy bacteria that boosts a newborn’s immune system
• Shorter hospital stay
• Faster recovery
• Higher rate of successful breastfeeding
• Avoid risks associated with major surgery
• Less potential for complications with future pregnancies and births

If you have had a prior cesarean, you may still be a candidate for a vaginal birth with future pregnancies. While repeat cesarean used to be the standard recommendation, more recent research has shown that vaginal birth after cesarean (VBAC) is associated with a decrease in maternal morbidity and a decrease in complications in future pregnancies.

Benefits of VBAC include:

• Avoidance of longer surgical recovery
• Lower risk of infection
• Reduced risk of postpartum hemorrhage
• Reduced risk of placenta previa and other placenta disorders
• Avoidance of bladder or bowel injury
• Avoidance of hysterectomy

In addition, waiting for labor to occur spontaneously holds benefits, as well. Even if you go on to have a c-section, waiting for labor to begin on its own allows for the presence of critical birth hormones that help to ensure that your baby is ready to be born. In addition, spontaneous labor reduces the likelihood that you will need additional medical interventions.

The Risks of Vaginal Birth

Even though vaginal birth is statistically safer, it is not risk-free. In certain situations, such as fetal distress, placenta previa, and shoulder dystocia, a cesarean is the safer method to give birth. 

Some risks associated with vaginal birth include:

• Perineal tears or lacerations
• Pelvic floor injury
• Urinary incontinence
• Pelvic organ prolapse

Although VBACs are considered safe for some candidates, they are not appropriate for everyone. Some uterine scars are more likely to rupture than others. People who have had vertical incisions are at higher risk of uterine rupture and may not be good candidates for VBAC.

If your doctor determines that you are a good candidate for VBAC, you will still be monitored closely during labor in case the need for a cesarean arises. Uterine rupture is the main risk factor associated with VBAC.

The Risks of C-Section

Cesarean section is a life-saving surgical procedure. When there is a medical emergency or complication, cesareans can be the safest option for giving birth. Still, c-sections are major abdominal surgery, and they do pose an overall greater risk than vaginal birth. 

The World Health Organization (WHO) suggests that c-sections only be performed only when medically necessary. Risks associated with c-sections increase with repeat cesareans.

C-section risks include:

• Blood loss
• Infection
• Blot clots
• Injury to bowel or bladder
• Adverse reaction to anesthesia
• Maternal transfusion
• Ruptured uterus
• Unplanned hysterectomy
• ICU admission
• Children born by cesarean have an increased risk of asthma and obesity
• Increased risk of placenta previa, placenta accreta, and placental abruption in future pregnancies

The Pros and Cons of a Scheduled Cesarean

Emergency cesareans are never scheduled. They are performed as a result of a medical emergency that arises during labor. However, some medical indications for cesarean aren’t emergencies; they are complications that are known ahead of time. In these cases, you may be presented with the option to schedule your c-section or wait for labor to begin. 

The American College of Obstetricians and Gynecologists (ACOG) discourages non-medically indicated elective cesareans. However, absent other indications, if a c-section is performed on maternal request, ACOG recommends they not be scheduled before 39 weeks.

The benefits of a planned cesarean include:

• Convenience
• Avoiding life-threatening complications from certain pregnancy conditions, where labor may pose a risk
• Ensuring a fetus is ready to be born 

The risks of a planned cesarean include:

• Increased risk of Type 1 diabetes
• Possibility of prematurity if the estimated due date is inaccurate
• Cesarean delivery without labor increases the risk of Transient Tachypnea of the Newborn (TTN), a form of respiratory distress

A Word From Verywell

There is no single “right” way to birth a baby. While statistically, vaginal birth produces better outcomes, it is not the best option every time. A c-section can be a necessary, life-saving surgery, but it holds risks and is not recommended without medical indication. 

Talk to your doctor about any concerns you have about vaginal birth, c-section, or VBAC. Your specific circumstance, feelings, and your doctor’s recommendations will help determine which option is best for you.