“When I was in labour with Bren, his head was twisted and I couldn’t get him out. I was already in labour for 25 hours, so I agreed to a C-section,” says Dale Loh, 33, mum to Kay, 6 months, and Bren, 4.

With Kay, however, Loh was offered an elective C-section but wanted to try a vaginal birth. But when Kay’s heart rate kept dropping during contractions, the doctor advised getting a C-section.

“I didn’t beat myself up over what had happened,” says Loh. “With hindsight, the thing that really matters is my baby’s safe arrival.”

Even if you’re planning a vaginal delivery, be sure to make a note in your birth plan that a C-section might be a real possibility. You should also prepare mentally for this surgery.

Here’s what you need to know about C-sections:

1) C-sections may be safer if the situation demands it

According to Dr Tony Tan, a specialist in obstetrics and gynaecology, a C-section is safer than a vaginal birth only in the following cases:

* Placenta praevia (low-lying placenta with a risk of severe bleeding when attempting a vaginal birth).

* Baby is in breech, transverse or oblique positions.

* Multiple pregnancies where the first twin is not cephalic (head-down position).

* Foetal distress and poor progress in labour.

* Certain medical conditions like pre-eclampsia.

* Severe intrauterine growth restrictions.

Babies are colonised with their mother’s bacteria from the lower genital tract during a vaginal birth, unlike babies born by C-section.

2) Your health risks increase after each C-section

Having one C-section means you’re more likely to need another in the future, so this is something to bear in mind if you’re planning a big family. While C-sections are very safe operations, you need to be aware that once you start having multiple C-sections, the risk of complications increases, Dr Tan explains. It also increases the risk of uterine rupture, placenta accreta — when the placenta attaches itself too deeply into the uterine wall — and unexplained stillbirth, he adds.

3) Babies born via C-sections aren’t colonised with the mother’s bacteria

Babies are colonised with their mother’s bacteria from the lower genital tract during a vaginal birth, unlike babies born by C-section. While some have proposed that a gauze from the vagina of the mother be used to rub on the body of the baby post C-section, to allow the same colonisation, most medical authorities are not comfortable doing this, says Dr Tan. This is because some bacteria from the mother’s vagina may actually harm the baby, he adds.

4) The recovery time is longer

The recovery time for C-sections is slightly longer than in vaginal births, says Dr Tan. “On average, most patients are able to function almost normally after three to seven days post-Caesarean, while the same happens at about two to four days for a post-vaginal delivery,” he notes.

With C-sections, it often takes one to two months for most women to get back to their old selves, compared to their post-vaginal delivery counterparts (no complications), which is within one to two weeks. Recovery is also more gruelling if you go through a long labour before deciding to do a C-section versus going in for an elective Caesarean. If you’ve had a C-section, you’ll have more restrictions about what you can do in the days and weeks following childbirth. Common don’ts include climbing stairs, driving or lifting anything heavier than your baby. Check with your doctor as to when you’ll be able to resume normal activities.

5) The pain is more intense

Some women want a C-section to avoid the pain of childbirth or to escape unpleasant side effects like episiotomy stitches. But since a C-section is about abdominal surgery, the pain actually lasts longer. C-section stitches heal in varying degrees, especially as the underlying stitches in the muscle layer takes longer to heal (around 12 weeks).

6) You’ll have a scar

If you’re carrying twins or an excessively large baby, a larger incision is necessary. During your four- to six-week convalescence, expect feelings of numbness, tingling, and itching at the site of your incision. Be sure to watch for signs of infection: If the incision area is red, swollen or weeping pus, or if you have a fever.

“On average, most patients are able to function almost normally after three to seven days post-Caesarean, while the same happens at about two to four days for a post-vaginal delivery.”

Can you give birth vaginally after having a C-section?

Upset you didn’t get the vaginal birth that you had planned? As the name explains, a VBAC is the option to deliver vaginally after a undergoing a C-section. Some three to four out of five mothers who attempt a VBAC are able to deliver vaginally.

Dr Tan clues you in on several important facts if you’re considering a VBAC for future pregnancies:

Suitable candidates for VBACs:
* Have a healthy and uncomplicated pregnancy.

* Fit and healthy with no major medical conditions. Those with heart conditions, blood-pressure problems or diabetes are not suitable candidates.

* The foetal positioning is right and baby is not in a breech position.

* Labour needs to occur naturally. No induction can take place and the labour itself cannot be augmented in anyway.

Health risks
Complications include a failed VBAC, resulting in an emergency C-section and uterine rupture.

* A uterine rupture may result in death or permanent brain damage to the baby. It also causes excessive bleeding and injury to neighbouring organs, like the bladder and intestine, which may require surgical repair, a blood transfusion or a hysterectomy (removal of the womb).

* A failed VBAC also poses other risks of post-delivery complications, such as wound infection and thromboembolism (blood clots within the deep veins).

Advantages of a VBAC
There are many benefits to delivering naturally. With good monitoring throughout your pregnancy, the risk associated with VBACs can be greatly reduced. The advantages of a successful VBAC (compared to an elective C-section) include decreased blood loss, decreased post-delivery complications such as wound infection, pain and a shorter recuperative period.

Photos: iStock

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