This was the topic of discussion over lunch break today. A colleague is pregnant for the second time. Her first baby was delivered via elective caesarean due to a transverse lie, in other words baby's head did not go down and so her uncle, who happened to be an obstetrician, advised her to have an elective or planned caesarean.
I have been asked this question before.
"Since you have experienced both normal delivery and caesarean section, which, in your opinion, which is better?"
Thankfully, for most women, if not all, that is not a decision to be considered. It's not like when are going shopping for a piece of clothing and can choose which colour of clothing to buy to go with our new handbags (that was cynical, by the way).
Understand That It Is Not A Choice
For the vast majority of women, the best way to deliver a baby is the 'normal' way. And believe it or not, that is the aim for almost all women who deliver in hospital. We doctors do our best, to assist the patient to deliver their baby's normally. And so do our midwife and other health professional colleagues (in Malaysia we have the traditional bidan, though I am not sure of their current role in the community).
Both Are Painful
Having gone through one vaginal delivery, albeit induced, and three planned Caesarean sections, I could honestly say that normal delivery is the best. Of course the pain of the contractions, was to me, something completely out of this world. I am lucky, never had to experience such an intense feeling of pain that you can't really think of anything else but the pain. I remember thinking to myself, during labour that, "Ok, I've had enough of this, please can I just go home?"
I must say that everyone's experience of birth is probably different. Plus every birth of each child is a different experience. So I can just share what I went through and what others have shared with me, plus what I see through my line of work.
My Experience of An Induced, Vaginal Delivery
My first baby was induced, and I have heard that the pain of induced labour is worst than if it started naturally. I was long overdue, 42weeks plus, the OBGYN was hesitant to induce earlier because in the earlier part of pregnancy, the scans showed a small baby. He was small for dates. At least we were told, and being first time parents we believed everything and bought the smallest clothes available for newborn, something XXXS. It turned out baby was huge, 4.42kg. The biggest baby on the ward.
Labour was horrible. I did not get any pain relief except the gas because it all went too quickly for a first-timer. When I told the midwife I felt like pushing, she laughed. My husband was getting ready for Friday prayers. They decided to check and lo and behold, baby was ready to come out. So there was no time for epidural or any fancy analgesia.
My First Elective Caesarean Section
For my second birth, which was a planned C-section as advised by the OBGYN. Since the first baby was big, their siblings tend to follow a similar pattern, and baby could get stuck so it was better to have an operation. All my births were planned. All four of them. I get to choose their birth date. I get to pack my bags and check in to hospital in the morning in an orderly manner. Nothing like what you see on TV or read about how other people get sent home in the freezing cold, awaiting the contractions to get real strong at the bus stop, or having their water brake in public places, giving birth in the taxi or on a wheel chair en route to the delivery ward, nothing dramatic like that. All well planned and orderly, sort of the way I like it.
The moment the OBGYN pulled out my second baby, I remember thinking to myself, "Wow, it's that easy" remembering the pain and agony of pushing, wave after wave of all energy consuming, breath-taking contraction, I had to do none of that and baby is out already. Well, nothing would have prepared me for the post-op pain, lying in bed for 24hours afterwards, extremely painful first attempt at breast-feeding baby since I was still less than 24hours after surgery and they made me try to lie on my side, then getting up for the first time, was the most horrible, postural hypotension plus vertigo plus weakness in the whole body after losing blood during surgery (if I remember correctly my Hb was only 8 at that time, and I've never such a low Hb my entire life). I tried to get up with the help of two nurses but had to immediately sit down, the world was spinning too fast. I had to sit down and breath a few deep breaths before trying again. I made it to the bathroom and had my first shower sitting down in a darkened bathroom as the two really nice nurses helped me undress and waited for me at the door in case I needed help. Once I was up and about, it was ok and I felt like I did not ever want to go back into the bed. I had morphine but suffered from morphine induced itch. I also learnt that my blood pressure which normally is quite low, became lower due to the anaesthesia and worried some of the staff that they had to keep checking it during the night and so my sleep was much disturbed. Husband also just dumped all the bags and when baby pooped, the nurse had to spend much time looking for the cotton and diaper and I couldn't get up to help. This was a public hospital in Ireland.
Delivering in Malaysia via Planned Caesarean Sections
My second and third Caesareans were in Malaysia, all my children were born in different hospitals, by different OBGYN's except the first was delivered by a midwife. After every surgery, all planned, I felt the pain was worse than the previous surgery, and recovery took much longer. It could be due to the post op analgesia, I did not received any morphine after the second section. I did get two pethidine injections after the third section. In Malaysia I find the OBGYN's like to give diclofenac plus some other stronger version of paracetamol, which is just not enough for me. Mobilising is slow due to poor pain control compared to the first section.
Delivering in a Private Hospital versus Public Hospital in Malaysia
Some of the good things about delivering in the private hospital in Malaysia is that at least they take complete care of the baby for the first few days. Most of my baby's had to have a few bottles of formula the first day because it was just to painful for me to even attempt a feed. The second day was mixed and by the third day, pain control is much better, I am able to sit out on a chair for longer periods of time and cant wait to go home. At least I had a good nights sleep and some rest that really helps the healing.
Can I Wear a Bengkung or Binder Right After Delivery If I Had Surgery?
After delivering my fourth baby, the OBGYN actually provided a bengkung or binder to wear immediately after the first day or when starting to mobilise. I found this helped very much to relieve the pain because it supported the wound and kept it in place. But it was troublesome to put on every time getting up and have to reposition it many times through out the day. Still, it helped a lot. I must remind everyone that all my sharing is NOT a substitute for medical advice. Please check with your own doctor/OBGYN.
Conclusion
In summary, vaginal delivery is a thousand times better than Caesarean section, faster recovery, less pain after delivery, easier to breast-feed baby, unfortunately the choice is not ours to make. OBGYN would recommend surgery only if the benefits outweigh the risks. I cant imagine how my second or third or fourth child would have been born without having surgery, and for that, I am thankful.
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