Monday, May 1, 2017

Normal Delivery or caesarean ??

You are Pregnant.Are you ?Most likely you are if you are reading my post or are planning it real soon.Or may be you are not.Pregnancy and delivery are facts of life which most of the women go through with great apprehension,enjoyment ,doubts and at times confusion.

It is a quite frequent question - Doctor ,which one is better -normal or Caesarean section ?Well well,may be few years back my answer would have been 'of course vaginal delivery if you can manage it safely'.Still my answer is more or less the same but my attitude to it has changed slightly.I don't know whether it is right or wrong but it is changed for sure.I will share my thoughts and the reason behind it.

Before I write what I feel,let me tell my interpretation of high Caesarean section rate in corporate hospitals.It isn't certainly not for money making.No doctor is paid more for doing Caesarean vs normal delivery.Hospital probably gains marginally from caesarean section but atlas I haven't been told my anyone and I mean no one in either of the the two hospitals I have worked to perform a single un indicated surgery.The most common reason is a scared doctor,scared of things going wrong during the long process of labour and at times not to wait the long hours of labour and get tied leaving rest of the chores and social life and responsibilities and at times a busy OPD.

Now coming back on track,Vaginal delivery is good.Caesarean is good too.Vaginal birth after caesarean section is no less good.But what is bad then ?Bad is when a procedure is done against the wishes of the Lady and if it is unindicated. Now a caesarean on demand of a lady without any Obstetric indication isn't unindicated. The Lady needs to know pros and cons of all the three methods and after that whatever she decides is a correct decision.

Not many of us give a unbiased we including me.Vaginal delivery is the normal process which nature wanted.But has caesarean got certain advantages over it ? Probably yes.With vaginal delivery there is for sure more chances of weakness of the pelvic floor in long run with an increased chances of urinary leakage,pelvic organ prolapse.It is not to be mistaken with me saying ,women who delivered by caesarean won't or can't have these problems.If the baby size is too big and if it is a traumatic delivery it can have long lasting impact on your pelvic wall as well as the baby.Again i am not saying ,it is rule of thumb but it can happen.

Now caesarean - well it has many disadvantages too.Recovery is longer than vaginal delivery for sure but it isn't a long long process but there is increased risk of adhesions,injury to bowel and bladder,infection,ectopic pregnancy,placenta praaevia and increased possibility of caesarean section in future pregnancy.

Vaginal birth after caesarean section can be achieved in 60 to 80 % of women who had previous caesarean section.But if any female decides an elective caesarean after a previous caesarean is also not an insane decision.VBAC has a risk (1%) of previous scar giving way during labour and that risk increases if we need to use any drip -syntocinon or Prostaglandin gel either for induction or augmentation.The lady needs to take an informed decision whether is wishes to take the risk of repeat major surgery or the scar giving way.

Now you know,when I see dispassionately which I wasn't able to do before due to my NHS training which  then recommended -Normal delivery rate of 80%,I don't think either of the mode of delivery is bad.It is all about choices.But what I do disapprove is ,if the woman wants a vaginal delivery and can achieve one safely to convert it into a caesarean.

If any one of you wish me to write any further posts on this issue or any other please do write back .


Vartika said...

That makes sense.. Instead of making a procedure evil.. It should be about choice and safety of mom and the baby.

Doc, can you please write a bit about 'active management of labour' and what it entaila. I will specifically like to understand how much management (intervention) is too much management.

Dr Kaushiki Dwivedee said...

Ok Vartika.I will try to give an over view of how a labour should be monitored and interventions taken.It is a difficult issue as every Lady is different and every pregnancy is different with different requirements -management wise but will surely try to write some basic principles.