Pregnancy and birth

Vaginal birth or caesarean section – a question of conviction

One in three children are born by caesarean section in Switzerland. Source: iStock

According to the latest survey by the Swiss Federal Statistical Office (2015, proportion of deliveries by caesarean section), one in three children are born by caesarean section in Switzerland. As caesarean numbers increase, so does the number of opponents – this is a highly polarizing issue.  

Breech, transverse or oblique baby positions, multiple births, placenta praevia and diabetes or high blood pressure in the mother: whereas a number of decades ago, caesareans were only used when certain risk factors were present, they have now become a popular alternative. When caesarean section is used due to the above risk factors, it is called a primary caesarean section. Secondary caesareans, by contrast, are emergency operations performed in the event of birth complications.

The fact is that childbirth is never entirely predictable – it can always follow a different course than expected. Certain risks already become apparent before the birth, while others only emerge during it.

More than just an easier way of giving birth

Since more and more primary caesareans are being planned where there is no medical necessity (elective caesareans), the procedure has acquired the image of being an “easier” way of giving birth. In fact, the motivation is seldom egoistic. Even if the predictability of this method can be an advantage, it is often the uncertainty and fear of vaginal birth and its consequences which influence the mother-to-be’s decision.

Although a caesarean can help to limit the physical consequences of childbirth for the mother, it is also an operation which comes with all the associated risks. One unpleasant side effect of caesarean sections is postnatal pain. The actual operation is generally painless due to the anaesthetic, but the wound pain can cause the mother a lot of problems in the first few weeks after the birth. Although modern techniques and high standards of hygiene have transformed the caesarean section into a relatively unproblematic routine procedure, the operation itself can still be associated with the following risks:

  • Complications due to the anaesthetic
  • Risk of infection
  • Tissue injuries
  • Problems with wound healing
  • Risk of thrombosis

The risks of caesarean sections to the child are low in comparison to those faced by the mother. Occasionally, the baby is injured. It can suffer small cuts or grazes, but these heal well in the vast majority of cases.

Birth experience is key 

Studies show that vaginal birth has a positive effect on the bond between mother and child. For the mother, the birth experience can be very important as a way of bringing the pregnancy to a close. If there are risks in the pregnancy which could make normal birth more difficult, the gynaecologist or the midwife will discuss with the parents which type of birth and which location for giving birth are most suitable for mother and child.

According to experts, the most frequent complications of vaginal birth include:

  • The mother’s cervix does not open
  • The baby’s head does not enter the mother’s pelvis correctly
  • Contractions are irregular or become weaker 
  • The baby’s heart rate deteriorates

With continuous care during the birth, these problems can usually be identified and treated in plenty of time. Be it a natural birth or a caesarean, at the end of the day, there are two options, and it is up to every woman herself to make the right choice.  

Proportion of caesarean deliveries, as a percentage (2015):
Figures from the Swiss Federal Statistical Office (FSO) (in German and French only)

In an interview with Comparis, midwife Barbara Stocker Kalberer, President of the Swiss Federation of Midwives, talks about why childbirth is “not a walk in the park or a wellness event”.

Ms Stocker Kalberer, many pregnant women choose a planned caesarean section because they are afraid of the pain. Is this method of childbirth really easier?
Barbara Stocker Kalberer: A caesarean section is an operation in the operating theatre with everything that involves. Many women are nervous and full of trepidation about the procedure. The unknown element and the unpredictability of childbirth sometimes cause more fear than the impending pain. When will it start? Where will it start? Will I be able to get hold of my partner? What if we don’t make it to the hospital in time? These questions are on the minds of most women and couples before the birth. Planned caesareans supposedly involve fewer of these uncertainties. Studies have shown that women are able to cope better with planned caesareans and find them easier to tolerate than emergency caesareans.

And how about after the birth?
Women are often surprised by the pain after a caesarean and about the fact that they are restricted in their ability to look after their newborn baby. Also, breastfeeding can be very difficult with an abdominal suture. Other women, by contrast, experience little pain and can recover and get back on their feet relatively quickly. The experience of a planned caesarean varies considerably from person to person.

How can natural birth be made as painless as possible?
Childbirth is not a walk in the park or a wellness event. It is a major physical and mental accomplishment by a woman, comparable with a long mountaineering trip. She enters into this mountaineering trip well equipped, with plenty of provisions and with a midwife as her guide. Mental preparation for what is to come is very important. At the end of the day, however, she has to walk the path herself. Sometimes, she has to cut short the journey because she has run out of strength or because complications occur. Not all women find the pain equally hard to bear. Some women become exhausted very early on, while others walk the path, breathing during the contractions and renewing their energy during the breaks.

And which remedies help during the birth?
There are natural remedies such as essential aromatherapy oils, baths, hypnosis, massage, acupuncture, exercise or homoeopathy which help women to relax during the breaks in the contractions. The breaks in childbirth are key. Most women experience a crisis at some point during the birth and want to give up. At this moment, the support not just of the midwife but also of the partner or another attachment figure is extremely important. Once the crisis has been overcome, the child is usually born very soon after. If natural remedies and obstetric methods are insufficient, medications can be used to ease the woman’s pain. The method of choice for many women is epidural anaesthesia, which blocks the pain, ideally without restricting the woman’s movement, meaning that she is still able to stand up.

When do you advise against natural birth?
There are a number of serious disorders affecting the mother or the child which necessitate a caesarean section. In addition, multiple births of triplets or more always take place by caesarean. With twins, it depends on how the babies are positioned in the uterus. Even with single pregnancies, there are abnormal positions such as the transverse position which make vaginal birth impossible. If the child is estimated as being very heavy – more than 4,500 grams – on the basis of ultrasound scans or palpation of the abdomen, a caesarean is often recommended.

Caesarean section or natural birth: Which is associated with more risks?
Studies show that the rates of mortality and morbidity (i.e. death and injury) are higher for mother and child in caesarean sections than in vaginal births. At present, a lot of research is being done into why children born by caesarean develop asthma, allergies, diabetes and bowel disease more frequently and are more often obese. Hopefully, our understanding of these connections will improve in the near future.

And when is an emergency caesarean necessary?
There are situations during childbirth which are life-threatening to both mother and child. In the child, this usually becomes apparent in the trajectory of the heart sounds. In the mother, heavy bleeding is particularly dangerous. Women giving birth in Switzerland are continuously attended by a midwife. Midwives are trained to recognize warning signs and take action in plenty of time. For this reason, death rates in mother and child are extremely low here in comparison with Third-World countries.