Desired caesarean section (Caesarean section) or spontaneous delivery, which is better?

At some point during pregnancy there comes a time when every woman thinks about giving birth. Many women then consider how they would like to see the birth and perhaps whether a caesarean section would be “better” after all.

Caesarean section (Caesarean section) is the most common operation for women in the world and the rate continues to increase.

The rate of caesarean sections in Switzerland is around 32%, which is of course not only so-called desired caesarean sections, but also spontaneous births that end in a caesarean section. In other countries, such as Brazil, the rate is much higher, where 55% of children are born by caesarean section, in private clinics there even more than 80%.

The health insurance company pays the costs for spontaneous delivery or caesarean section (mandatory service).

There is surprisingly little study data that really shows whether spontaneous delivery or caesarean section is safer for mother and / or child.

Of course, there are medical indications where the doctor recommends a caesarean section, e.g. in the case of child positions that are impossible to give birth (e.g. if the baby is lying across, possibly in breeches), in multiple pregnancies (according to precise criteria), in 2 or more previous caesarean sections and in the event of disorders the placenta.

Then it may also be necessary in emergency situations, if a spontaneous birth would take too long (bad heartbeat, preeclampsia / pregnancy poisoning, uterine rupture, premature placental detachment, etc.) to end the birth by caesarean section. A caesarean section may also be necessary if the birth arrest occurs during the spontaneous delivery.

There are of course other reasons for a cesarean section, for example fear of a spontaneous delivery or a traumatic spontaneous delivery and many more.

For the child Caesarean section and spontaneous delivery are both safe.

About 1% of children who are born at 38 + 0SSW and requested cesarean section can develop a respiratory distress syndrome with a subsequent stay in the neonatology department (Greene.2009, Ehrental.2011). A respiratory distress syndrome is also possible with a spontaneous delivery and is usually not predictable.

The risk of cutting injuries to the baby during a caesarean section is around 2%.

Not clearly confirmed by studies, but an improved child’s immune system through contact with the maternal vaginal flora (microbiome) is possible.

For the mother The length of stay in the hospital is usually shorter in the case of spontaneous delivery. It has no general operational risks.

The risks of a caesarean section correspond to the general risks of an operation, ie bleeding can occur, the risk of infection (risk of wound healing disorders) is slightly higher. The risk of thrombosis is also increased by surgery. With every operation there is also the risk that other organs can be injured.

With every caesarean section, the risk of placenta disorders increases. Placentation disorder means that the placenta can be in the wrong place during a further pregnancy (placenta previa, in front of the inner cervix) or can grow too deep into the uterus (placenta accreta / increta / percreta). The risk of the scar on the uterus rupturing (uterine rupture) is also slightly higher if you become pregnant again.

The pelvic floor is more stressed with a spontaneous delivery than with a caesarean section. Therefore, after caesarean section, urinary incontinence and pelvic floor subsidence are somewhat rarer.

In the case of a spontaneous delivery, around 2 out of 3 women suffer an injury. These are mostly small tears in the vagina or on the perineum (tissue between the vulva and anus) that heal without any problems. Serious injuries are rare.

Many women are very afraid of the pain of a spontaneous delivery. Nowadays the pain can be alleviated very well. In most hospitals, a step-by-step scheme is followed and an individual decision is made as to which method can be recommended in which situation. Even after the caesarean section, pain can occur in the first few days, which is treated with medication.

The bleeding after birth (weekly flow) is roughly the same for both types of birth and can last up to 6 weeks.

The birth mode also has no influence on breastfeeding.

In summary, it is difficult to answer which mode of birth is really “better”. It is important that every woman knows the advantages / disadvantages and risks and can decide for herself. This leads to a good birth experience and even a better bond with the baby.

You are welcome to discuss the birth mode with us in our office hours, and the midwives and hospitals also offer many different courses.