Vaginal Birth or Caesarean Section: How the Decision Is Made

The mode of birth is decided with the health of mother and baby as the first priority. Where there is no medical contraindication, vaginal birth is the most appropriate route for most pregnancies; caesarean section is a life-saving operation in defined circumstances. The decision is reached together, in the light of the pregnancy, the presentation of the baby and the mother's history.

Advantages of vaginal birth

• Hospital stay of one to two days and recovery within one to two weeks.
• Lower rates of infection, haemorrhage and venous thrombosis.
• Earlier skin-to-skin contact and easier establishment of breastfeeding.
• Better clearance of fetal lung fluid and favourable microbiome development.
• No increase in the risk of abnormal placentation in future pregnancies.

Indications for caesarean section

• Placenta praevia or placental abruption.
• Transverse lie, certain breech presentations, cord prolapse.
• Fetal distress on cardiotocography.
• Obstructed labour or cephalopelvic disproportion.
• Previous classical (vertical) uterine incision or multiple previous caesareans.
• Active genital herpes or untreated HIV infection.
• Severe pre-eclampsia, some multiple pregnancies and severe growth restriction.

Risks of caesarean section

Caesarean section is major abdominal surgery. It carries risks of haemorrhage, infection, bladder or bowel injury, venous thrombosis and anaesthetic complications. Recovery takes two to four weeks, and heavy lifting should be avoided for four to six weeks. Repeated caesareans increase intra-abdominal adhesions and the risk of serious placental abnormalities such as placenta accreta. The mode of the first birth is therefore particularly important for women planning several children.

Vaginal birth after caesarean (VBAC)

Women with a single lower-segment (transverse) incision, a cephalic presentation and no additional risk factors may plan a vaginal birth, with success rates of 60–80%. Because the risk of uterine rupture is approximately 1 in 200, birth should take place under continuous monitoring in a unit with immediate access to emergency caesarean section. A previous vaginal birth improves the likelihood of success.

Pain relief and the birth plan

Epidural analgesia is the most effective and safest means of relieving labour pain and does not increase the caesarean rate. Water immersion, freedom of movement, breathing techniques and massage also help. Discussing a written birth plan with your clinician at 32–34 weeks — covering analgesia, birth partner, skin-to-skin contact and early feeding — clarifies expectations. The plan should remain flexible so that it can accommodate events in labour.

Common pitfalls

• Choosing caesarean because of fear of childbirth without seeking counselling.
• Neglecting early mobilisation after caesarean, which raises thrombosis risk.
• Planning an elective caesarean before 39 weeks without a medical indication.
• Arriving at the day of birth without ever discussing a birth plan.

When to seek advice

• When contractions become regular and increasingly frequent.
• Immediately if your waters break, even without contractions.
• With bleeding, severe headache, visual disturbance or sudden swelling.
• If you notice reduced fetal movements.

Birth planning in Adana

Op. Dr. Sadık Kükrer, MD provides antenatal care, birth planning, assessment for vaginal birth after caesarean and high-risk pregnancy management in Adana, Türkiye.