The moment of birth is very special and much anticipated, after all, it’s finally time to meet the baby. Some mothers prefer to be actively involved in the process through a natural birth, while others opt for a cesarean, usually out of fear of pain and for its practicality. Both alternatives have their advantages and disadvantages and, despite the right to choose, the decision should be made together with the doctor. That’s because there are a number of factors that can make one option safer than the other for the mother and baby, as we will see below. The main goal is to ensure a smooth delivery and, when there are no contraindications, the choice is up to the woman. When deciding, the doctor should guide and mention some pros and cons, as well as warn about possible changes of plans at the time of birth. Check below some basic characteristics of natural birth and cesarean section. Take the opportunity to reflect and list questions to discuss with your obstetrician.

  1. Natural birth: what it is, pros and cons
  2. Cesarean section: what it is, pros and cons
  3. Is it really possible to choose?

Natural birth: what it is, pros and cons

Natural birth is when childbirth occurs through the mother’s vagina. It is the “normal” outcome of a pregnancy, without a surgical procedure, but with possible medical interventions such as anesthesia, nerve block, or amniotomy, for example.

Amniotomy is a practice aimed at purposely and artificially rupturing the amniotic sac, in order to speed up labor.

It is divided into 3 phases and begins with labor:

  • Phase 1 – the first is dilation, characterized by uterine contractions that dilate the cervix and facilitate the descent of the fetus. Initially, contractions are infrequent and irregular, evolving in intensity and becoming shorter in interval.
  • Phase 2 – next comes the expulsion stage, when the cervix reaches 10 cm dilation and begins to allow the baby to pass through the birth canal. Strong, regular contractions help the baby through the process.
  • Phase 3 – The third phase is placental delivery characterized by the expulsion of the placenta after birth, the organ that connected the baby to the mother.

The cervix needs to be sufficiently dilated for the baby to pass through.
The pain felt at the time of birth is subjective, as each woman reacts differently to stimuli. Furthermore, the use of anesthesia or painkillers helps in the process. Some women, however, opt for humanized birth, which is the same as natural birth but without medical interference or medications, respecting the mother’s and baby’s own timing. Among the benefits of natural birth is the quick recovery after the procedure, since there is no surgery. The risk of infection is also lower and breast milk comes in sooner, due to the release of oxytocin during birth. Another point is the absence of lasting scars at the end of the process. For the baby, natural birth strengthens the immune system due to the passage through the birth canal and contact with the mother’s microorganisms. In addition, it reduces the risk of future lung problems, as the passage through the vagina compresses the chest and helps expel fluid from the lungs.

With natural birth, the baby’s arrival to the world is also less stressful, as their body receives a kind of massage along the birth canal, creating a sensation of touch and making them less startled by the hands of the person receiving them.

The pain of labor is cited by many women as the main reason for opting for cesarean section. And in fact, it can be quite painful. However, the woman’s body is prepared and capable of this process and there are various medications available to help reduce the pain. Generally, discharge is given 24 hours after birth. The puerperium, the mother’s full recovery period, takes about 40 days. Sexual intercourse should be avoided for 30 to 40 days and physical exercise only about 15 days postpartum. More moderate activities like walking and yoga are usually cleared earlier.

Cesarean section: what it is, pros and cons

Cesarean section, or C-section, is a surgical procedure in which the baby is delivered through the mother’s abdomen. For this, the woman receives anesthesia and the doctor makes a cut about 2 or 3 cm above the pubic bone. The incision measures about 10 cm and the tissue layers are opened until the uterus is reached. Once located, the baby is gently pulled out and the umbilical cord is cut. The placenta is then removed and the incision is stitched closed.

The whole process takes about 30 minutes to 1 hour and no pain is felt, only in the postoperative period.
The postoperative period varies from woman to woman, but is longer compared to natural birth. Discharge is given after 2 days of hospitalization, which can be extended to 5 days or more depending on circumstances at birth. In general, after 10 to 15 days the woman feels well enough to return to activities, but intense physical exercise only after 45 days post-surgery. Sexual intercourse should also be avoided during this period and full recovery can take up to 6 months.

Unlike natural birth, breastfeeding is more difficult after choosing a cesarean and the scar from the incision, though small, remains, which can be unpleasant for some women. Furthermore, infection risks are higher with this type of delivery.

Among the advantages of this option is the fact that it can be scheduled, meaning the date and time of the baby’s birth can be chosen by the family from the 39th week of pregnancy. Labor is also short and the woman feels no pain during the process, only some contractions at the beginning.

Is it really possible to choose?

According to guidelines from the WHO, World Health Organization, the rate of C-sections should not exceed 15% of births in a country. In Brazil, however, this rate is very high and concerning, since the life risks are greater compared to natural birth. The convenience and practicality of cesarean section are factors that drive up this rate in the country. However, natural birth should be prioritized by doctors in all circumstances, except in situations of risk.

Recently, a very interesting study was published on the Trocando Fraldas website with updated information on C-section rates in Brazil, region by region.

During a normal and uncomplicated pregnancy, when there are no contraindications, the woman can choose the birth option that suits her best. The doctor will provide all the information, advantages, and disadvantages of each type during their discussion to help with the decision. However, there are situations in which the decision is medical, as the mother’s or baby’s life might be at risk. The choice for natural birth should be reconsidered when:

  • problems occur with the placenta such as detachment or adhesion to the uterine wall;
  • the baby is positioned in a way that makes extraction difficult;
  • the mother has active genital herpes, AIDS or other conditions like hypertension, heart problems or uncontrolled diabetes, for example;
  • the baby is very large and heavy, with a body mass index above 25kg/m2;
  • the mother has had previous C-sections, two or more, or has had surgery on the uterus.

In addition, it’s important to highlight that even if a natural birth is chosen, changes of plans can happen during the process, which may require a C-section to ensure the pregnancy’s viability and to avoid risking the lives of mother and baby. Thus, during labor, for example, if there is no progress in contractions or dilation large enough, it may be necessary to perform a cesarean section, even if natural birth was the original choice.