Types of birth

You can experience a vaginal birth at home, at hospital or in a birth centre. Your midwife will discuss your birthing options with you.

For some, a vaginal birth is not possible in their pregnancy, and they will require interventions such as a caesarean section or assisted birth.

You may have heard caesarean sections referred to as ‘C-sections’.

Caesareans are births by abdominal surgery, when a cut between 10 and 20cm long is made into your womb via your lower abdomen (usually on the bikini line).

Doctors specialising in birth and pregnancy, known as obstetricians, will carry out caesareans in an operating theatre. You’re usually awake the whole time, but with your lower body numbed by spinal or epidural anaesthetic. You won’t feel any pain but may occasionally feel some tugging or pulling.

A screen will be placed in front of your abdomen so you cannot see what is going on. The doctors and nurses will be speaking to you throughout the caesarean procedure to let you know what is happening.

Following delivery your child will be passed straight to you for skin-to-skin contact if you wish. The entire operation includes the birth, removing the placenta and restitching.

Why do caesareans take place?

A caesarean section is an operation that is usually only carried out if it needs to be. This could be planned, due to the health of you or your baby, or take place in an emergency, when your baby needs to be born quickly and safely.

Caesareans might be recommended by your obstetrician or midwife if you:

• have pregnancy related high blood pressure (known as pre-eclampsia)
• have certain infections such as a first infection with genital herpes
• have HIV
• have a low lying placenta
• have excessive vaginal bleeding or the labour is not progressing

Caesareans might also be carried out if your baby is facing feet first (known as the breech position) or if they are not getting enough oxygen or nutrients.

Some people may request to have a caesarean for non-medical reasons; in this case your doctor or midwife will talk through the benefits and risks of a caesarean with you compared to having a vaginal birth.

Although caesareans are safe procedures, there are risks of complications, including:

• blood clots
• wound infection, or an infection of the womb lining
• excessive bleeding
• damage to nearby areas, such as the bladder
• temporary breathing difficulties in your baby
• accidentally cutting your baby when the womb is opened

It’s important to be aware of these, especially if you’re considering a C-section for non-medical purposes.

Recovery

Recovery from a caesarean procedure often takes longer than it does for a vaginal delivery.

You may experience some discomfort around your abdomen for a while and will be advised to take things easy at first when you arrive at home, for example you might be advised not to drive until after your 6 week check with a GP. Make sure you review your car insurance policy to ensure they are aware of your recent delivery.

The wound from the procedure will form a scar which will fade over time.

Many people who have had a caesarean section can go on to have vaginal deliveries in future pregnancies, this depends on whether a caesarean section is still the safest option. Talk with your obstetrician or midwife about this.

Sometimes it’s necessary for instruments to be used to assist the safe vaginal birth of your baby, around 1 in 8 births require them. You might need an assisted birth if:

• you have been advised not to try to push out your baby because of an underlying health condition (such as having very high blood pressure)
• there are concerns about your baby’s heart rate
• your baby is in an awkward position, such as facing upwards or to one side
• your baby is getting tired and there are concerns that they may be in distress
• you’re having a vaginal delivery of a premature baby – forceps can help protect your baby’s head

The instruments used will either be a vacuum cup (also known as ventouse) or forceps, and they are only used when it is deemed necessary for you and your baby. An episiotomy (a cut to the perineum to make the vaginal opening bigger) might be needed during an assisted birth, which will be repaired with dissolvable stitches afterwards.

During a vacuum (ventouse) delivery

A vacuum cup known as a ventouse will be fitted to your baby’s head. During a contraction and push, your midwife or obstetrician will gently pull this to assist the delivery.

A ventouse isn’t suitable if you are less than 34 weeks pregnant because your baby’s head is softer and more likely to be bruised by the suction cup.

During a forceps delivery

These smooth metal instruments will carefully fit around your baby’s head to help to gently pull your baby out as you push.

Some forceps are specifically designed to correctly reposition your baby for birth if they are facing upwards or to one side.

Before treatment

You will require anaesthetic to numb the area if you have not already had an epidural.

An obstetrician or midwife will speak to you about why they think you need an assisted birth. Your consent will be needed before any assisted birth treatment can commence.