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Submitted by PatientsEngage on 29 July 2017

Dr Shruti Mohanka, OBGYN and Fertility expert at Global Hospital in Mumbai, clears our doubts about various pregnancy delivery methods available to women and the benefits and risks of each

In the past decade, there have been a growing incidence of C-section deliveries in India, especially in the urban areas. In a socially complex culture such as India, the spouse, relatives, and the doctor’s opinion are held more highly than the patient’s. This results in lack of authority or consent of expectant mothers with limited or no education on varied delivery options. There is usually no accountability and unwarranted Caesareans due to religious beliefs of delivery dates, private care, painless and vaginal-free deliveries.  

The long term ramifications of these decisions on the health of the mother is often not understood. Such practices can be decreased with vigilant prenatal care to avoid any fetal distress, good diabetic control, awareness about benefits of vaginal delivery, risks of C-sections, input from counsellors, midwives and consultants etc. We need a quorum of doctors, nurses, midwives and healthcare managers to address the issues of unnecessary C section as a public health concern.

Dr. Mohanka answers questions raised by PatientsEngage:

What are the different types of childbirth methods?

There are 4 types of delivery methods:

  1. Normal vaginal delivery- can be spontaneous or induced.
  2. Vaginal assisted delivery can be Vacuum or Forceps
  3. Caesarean section
  4. Vaginal birth after Caesarean (VBAC)

Can you briefly describe each?

  1. Normal vaginal delivery is the onset of labour at 37 weeks of completed term with vortex presentation. It is without any undue prolongation with minimal or no aids or complications to the mother or the baby. It can be spontaneous where pain starts on its own or induced either medically or surgically.
  2. Vaginal assisted delivery can be ventouse/vacuum or with forceps.
    Ventouse is an instrument designed to assist delivery by creating a vacuum between it and the fetal scalp. It is indicated as an alternative to forceps use. It is commonly used when there is delay in the descent of the fetal head.
    Forceps are a pair of obstetric instruments that are designed to extract the fetal head and complete the process of delivery.
  3. Caesarean section is an operative procedure done after fetus is 28 weeks old.
  4. Vaginal birth after Caesarean (VBAC) means having a baby delivered vaginally when you have had a C-section in the past.

What are the benefits and risks associated with method?

DELIVERY METHOD BENEFIT RISK
Normal vaginal delivery The recovery of mother is quite fast. There are fewer chances of respiratory complications to the fetus. No risk of anaesthesia and related complications. The baby is immediately with the mother post the delivery. Contraction pain and vaginal discomfort experienced. Prolonged or obstructed labour may end up with vaginal or cervical lacerations, urinary incontinence, genitourinary prolapse or post-partum haemorrhage. If there is cord prolapse with fetal distress, an emergency C-section may be required.
Ventouse/vacuum assisted delivery Can be used for incompletely dilated cervix or when the head is un-rotated or mal-rotated. It requires less force, less technical skills and is more comfortable to the mother. Fetal complications are less. In ineffective where moderate traction is required. It cannot be applied when fetus is in face presentation. It can cause cephalohematoma, superficial scalp abrasion and sloughing of the scalp.
Forceps assisted delivery Used when there is inadequate maternal explusive effort or the mother is exhausted or has cardiac disease. Appropriate in case of fetal distress with non-reassuring fetal heart rate. Used to cut down on prolonged 2nd stage of labor. Higher risk of foetal morbidity and perpueral sepsis. Associated with vaginal laceration, cervical tears, post-partum haemorrhage, anesthesia complications and extension of episiotomy.
Caesarean section Done mainly for safety of the mother and child. Longer hospital stay and recovery period! Haemorrhage if the incision is extended. Shock, infection, intestinal obstruction, thromboembolic disorder, wound complications etc. Raises future risks of placenta previa and placenta accrete.
Vaginal birth after Caesarean (VBAC) Avoidance of surgical procedure and its complications. Small chance of uterine rupture at the site of previous C-section. An unsuccessful VBAC required urgent C-section after onset of labor carries more risk.

Why have C-sections become more populat in recent years?

There have been many reasons for the sudden surge in Caesarean deliveries in recent times. These include:

  • The increasing age of the expectant mother especially first time mothers.
  • Increase in chances of complications due to age of mother.
  • Early detection of risk factors and complications due to medical advancement.
  • Increase in fertility-assisted pregnancies and avoidance of any chances with normal deliveries for such pregnancies.
  • Avoiding complications of forceps and vacuum assisted deliveries.

We strongly urge you to understand the benefits and risks of various delivery methods, especially long terms risk to the mother's health, before you choose one of them