Having a baby is one of the most wonderful moments that life can bring. But it can be quite stressful. There are lots of decisions to be made in the weeks leading up to the birth of your baby; What will you name the baby? Which hospital will you choose to deliver your baby at? And indeed… would you prefer to have a vaginal “natural” delivery, or choose to have a cesarean section? Now… some of us won’t get a choice. Your mode of delivery will depend on various factors, including the nature of your pregnancy, the position of your baby, yours and your baby’s medical and physical health, the considerations of the obstetrician and the obstetrician’s experience. The most important consideration when choosing a mode of delivery is the well-being of both the mother and baby. A healthy, happy baby and mother is what both you and your health care team should be working together to try to achieve.

 

Sometimes, when the choice is taken away from you, it can be difficult to process and comes to terms with. Perhaps the choice of mode of delivery was not what you imagined, perhaps it doesn’t align with your values or your expectations of yourself, or perhaps it has impacted other aspects of your delivery, such as being able to labour actively or without drugs. I want to take a slight tangent on the topic and reassure my readers that it is O.K to grieve the loss of your birth plan or to feel disappointed. Of course your family and friends know that you are grateful that you have been blessed with a healthy baby, you don’t have to feel guilty about that! But it is also O.K to express some self-compassion, kindness toward yourself and a sense of loss if your birth plan did not go the way you had hoped.

 

Your obstetrician will be the guiding light to understanding weather you should have a vaginal delivery or a cesarean section delivery. They are the experts in their field and delivering a baby is a very complicated and multifaceted event. You should always consult your obstetrician when deciding on what mode of delivery is best for you and your baby.  One thing that can often get overlooked in discussions, and often misunderstood is how the physical recovery will go after a vaginal delivery versus a cesarean section delivery. People often have lots of fear towards one or the other because of things they may have heard or seen. In today’s blog, I want to discuss some of the common myths about cesarean sections and their recoveries… and bust them!

 

Myth # 1:If you have a cesarean delivery you won’t be able to care for your baby in the first 6 weeks.

 

This myth carries truth in the fact that as a precaution following your caesarian delivery, you are recommended to lift no heavier than the weight of your baby. This is to protect the integrity of your wound and allow your stomach and uterus to heal. Generally speaking, if you avoid over activating your abdominal muscles and you move slowly and safely, there is no reason that you can’t lift your baby, place them to sleep, carry your baby and play with them on the floor. By moving carefully, you should be able to care for you baby in all the ‘regular’ ways and it is quite safe. For example, when moving from lying to sitting, roll to your side and push up through your hands. When getting up off the floor, move to 4 point kneeling, and use your legs to push up to standing. .

Myth # 2: If you have a cesarian delivery, you will have to have another cesarean for subsequent pregnancies

 

Vaginal births after cesarean (VBACs) are not always complication free. Depending on the reason for your first cesarian, it is often recommended that you have another cesarean to protect the integrity of the uterus and to ensure a safer delivery for both you and your baby. Saying that, for those women who attempt a VBAC, research has shown that 60-80% of these women are successful in delivering their baby vaginally. Generally speaking, the chances of a successful VBAC are higher if you have only had a low, small incision in the uterus during your last cesarean, you and your baby are healthy and well, your pregnancy is complication free, the reason for your last cesarean is not an issue this time around or you have had a previous vaginal delivery in the past. If your baby is overdue, you have a large baby or have had 2+ previous cesareans, your obstetrician is likely to recommend another. Remember, the rationale to have or not have a VBAC is based completely on individual circumstances and can be a complex decision to make.

“Let your obstetrician be your guiding light. Of course, tell them how you feel and your preferences, but at the end of the day, modern medicine has come a long way to delivering healthy, happy babies and mothers, and that should be the most important consideration of all”

 

Myth # 3. The recovery time takes much longer after a cesarean versus a normal vaginal delivery

 

The first 6 weeks after a cesarean are hard. Your belly will be sore, you won’t be able to move in the same way that you used to and you will generally be a bit fragile and slow. However… you will have avoided the risk of sustaining obstetric injuries with a vaginal delivery, a major predictor for the development of urinary incontinence, prolapse and bladder and bowel dysfunction. So, in answer to the question about which mode of delivery will enable you to recover best? It completely depends on what outcomes we look at, what muscle groups we consider and what level of intervention and injury you sustained during your delivery. For example, you could coast through a cesarean section, get stitched up perfectly and be back to your normal self in 4-6 weeks. Alternatively, you might have had a traumatic vaginal delivery, have perineal stitches, difficulty sitting and poor bladder and bowel control for months following… or you could have a perfect vaginal delivery, a small baby and be back to feeling well within a couple weeks. The possible combinations and sequence of events are almost endless, and everyone’s experience is their own, with limited relevance to your situation or possible outcomes.

 

Myth #4. My baby will be at risk of long term health problems if they are delivered via cesarean section.

 

This seems to be one that keeps popping up time and time again. As a physiotherapist, it is not in my area of expertise and is best discussed with a paediatrician or child and maternal health nurse. As I understand it, yes, a vaginal delivery that goes well generally has better long term health outcomes than a cesarean delivery of the same child. This seems to cover everything from asthma to learning difficulties that will all be fixed by the magical vagina bacteria. Of course I am sure that some amazing and legitimate research has gone into proving these facts, and as I said, I am not an expert- but one thing that I know for sure is that it is not black and white. Not every woman and pregnancy are the same and there are a myriad of issues for an obstetrician to consider before recommending a mode of delivery. It is a balancing act.

“The benefits of delivering a baby vaginally (with all it’s baby health benefits) is lost if it has destroyed the mother in the process or if the risk for the baby outweighs the benefits.”

 

Myth # 5. I won’t be at risk of incontinence or prolapse if I have a cesarean delivery

 

It has now been reported that 46% of women who have a baby will experience pelvic organ prolapse, and 1 in 3 women will experience urinary incontinence, or bladder weakness. While we understand the causes of these problems to be multi factorial, we know that obstetric trauma (e.g. injury from the use of obstetric instruments, tearing, nerve damage during vaginal deliveries) is considered to be one of the biggest and most important risk factors when predicting pelvic floor dysfunction. Obviously this is avoided when you have a cesarean section. However… This is not the ONLY predicting factor as to whether you will have troubles. Just being pregnant is a risk factor for pelvic floor damage. Combined with constipation, impact sports, heavy lifting, smoking, menopause and obesity, just being pregnant can create damage enough for you to experience prolapse or urinary incontinence… and we thought we had found a magic bullet!

 

Myth #6. I won’t bond with my baby if they are delivered via cesarean.

 

Post natal depression is something that I hold close to my heart, because of vast ways it can creep up on you. It can affect everyone, from the most traumatic childbirth to the best, to the person that seems to have everything together or the person who can’t stop crying. It affects all walks of life. Not bonding with your baby is sometimes a symptom of post natal depression, and is NOT, I repeat IS NOT, a sign of being a bad mother. We are all doing the best we can and we are all learning in our own ways. Cesarian’s do not cause post natal depression, but how we feel inside ourselves about our birth plan can. Sometimes, people can also suffer from a form of post traumatic stress disorder, especially if they feel that their life or their baby’s life was in danger.  Once again I am not an expert in this field, but if you or anyone you care about is suffering from post natal depression, post traumatic stress or feel they cannot bond with their baby, I urge you to seek help from your GP, a psychologist or counsellor or via support services such as BeyondBlue, that can be accessed by clicking here.

 

So… should you have a vaginal delivery or a cesarean delivery? As you can see, there is no right answer. Listen to your heart and listen to your health care team. Be mindfully present during your pregnancy and during your childbirth regardless of which way it happens. Embrace change and own your decisions, because you are doing what is right for you and your baby in that moment. Moment by moment by moment.

 

Coming up…

Pelvic floor muscle strengthening during pregnancy has been shown to reduce the risk of obstetric injuries and the use of instruments during childbirth. We are looking forward to harnessing the power of the pelvic floor in round 3 of Pregnancy Pilates at Yoga Space Gippsland! Get in touch to secure your place. Until then…

 

Be kind to yourself,

Julia Berger
Physiotherapist