Why normal delivery for childbirth needs to be the norm again

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Pregnancy and childbirth should be a positive experience for every woman. Yet, a huge number of expecting mothers today willfully opt for Cesarean Section because they do not want to bear the pain of childbirth. Such women do not realize the tremendous health and psychological benefits that accrue to the mother with normal delivery, the way nature intended.

When a child is born, the woman is also reborn in the form of a mother. Giving birth naturally is an experience that generates a sense of achievement and empowerment in her. It also has long-term implications for a woman’s health and wellbeing.

Sheryl Feldman, the celebrated author of “A Midwife’s Story,” put it succinctly when she said: “There is a power that comes to women when they give birth. They don’t ask for it; it simply invades them, accumulates like clouds on the horizon and passes through, carrying the child with it.”

To be sure, childbirth is fraught with risk due to labor complications that may arise. In fact, these account for 30% of all maternal deaths, 50% of all stillbirths and 25% of all neonatal deaths worldwide. However, these complications are largely preventable with timely intervention and quality medical care at and around the time of birth.

Cesarean Section is the surgical delivery of a baby through a cut made in the mother’s abdomen and uterus. It was introduced to reduce the risk to mother and baby in complex cases of childbirth, not as a general alternative to normal delivery. Yet, the number of women worldwide opting for Cesarean Section is increasing every year. The Cesarean rate in India has risen to 21.5% now and is as high as 32% in urban settings, according to NFHS 5 survey 2019-21. In other words, one in three deliveries happening in Indian cities today is through Cesarean Section.

There are two main reasons for this. The first is medical interference with normal physiological process of labor and childbirth, even in the absence of any medical indication that may necessitate a Cesarean Section. The second is a misconception among women that it is an easy gateway to escape labor pains, and a painless, safer, and better alternative to vaginal delivery. In my experience, more than half of all pregnant women today are voluntarily choosing Cesarean Section as the preferred mode of delivery.

WHO conducted a critical appraisal of the indications of Cesarean Section. It found that in one-third (34%) of all such cases, the medical team chose this procedure due to labor arrest or non-progress of labor. Here, obstetricians need to understand that every individual is different. Evidence has proved that the rate of cervical dilatation could be different for different women. Patience in the medical team, and the woman herself, can still lead to a normal vaginal delivery, provided there is no maternal or fetal compromise otherwise.

To encourage natural births and avoid Cesarean Section, medical teams can take several measures such as preventing unnecessary induction of labour, allowing ambulation for woman in labour, providing continuous labour support, avoiding unnecessary interventions like augmentation of labour or Artificial Rupture of the Membranes (ARM), and encouraging spontaneous pushing in non-supine position.

The woman’s perspective about labour pain is the most common problem faced by doctors today that adversely affects her abilities, leading to fear and anxiety. There is a definite need to allay her anxiety, and counsel and prepare her for vaginal delivery during the antenatal period itself. Shared decision-making, keeping the labouring woman at the forefront, and providing her effective pain relief strategies and supportive care will help alter her misconceptions.

Vaginal delivery has many advantages, such as faster recovery and shorter hospital stays, less chances of secondary infection, and fewer complications in future pregnancies. On the other hand, a study by PLOS Medicine found that women who deliver by Cesarean Section have a higher chance of having fertility issues, still-births, and miscarriages. They may in future also experience placental complications or an ectopic pregnancy at the scar site. Cesarean Section can also cause intestinal blockage or bladder injury.

Vaginal delivery offers benefits to the babies too. When the child is born naturally, the muscles involved help squeeze out the fluids from the child’s lungs, leading to lower risk of respiratory ailments. Hormonal exchange also takes place during this time, which improves the child’s immune system.

Cesarean Section is recommended only when the life of the mother or fetus is at risk. It should not be an option to opt for as a painless mode of delivery. A collaborative effort between the expecting mother, her family support system and the healthcare provider is required for successful vaginal delivery. This will change the fear-tension-pain cycle to safety-and-peace cycle, and go a long way in promoting vaginal birth.

Pregnancy and childbirth should be a positive experience for every woman. Yet, a huge number of expecting mothers today willfully opt for Cesarean Section because they do not want to bear the pain of childbirth. Such women do not realize the tremendous health and psychological benefits that accrue to the mother with normal delivery, the way nature intended.

When a child is born, the woman is also reborn in the form of a mother. Giving birth naturally is an experience that generates a sense of achievement and empowerment in her. It also has long-term implications for a woman’s health and wellbeing.

Sheryl Feldman, the celebrated author of “A Midwife’s Story,” put it succinctly when she said: “There is a power that comes to women when they give birth. They don’t ask for it; it simply invades them, accumulates like clouds on the horizon and passes through, carrying the child with it.”

To be sure, childbirth is fraught with risk due to labor complications that may arise. In fact, these account for 30% of all maternal deaths, 50% of all stillbirths and 25% of all neonatal deaths worldwide. However, these complications are largely preventable with timely intervention and quality medical care at and around the time of birth.

Cesarean Section is the surgical delivery of a baby through a cut made in the mother’s abdomen and uterus. It was introduced to reduce the risk to mother and baby in complex cases of childbirth, not as a general alternative to normal delivery. Yet, the number of women worldwide opting for Cesarean Section is increasing every year. The Cesarean rate in India has risen to 21.5% now and is as high as 32% in urban settings, according to NFHS 5 survey 2019-21. In other words, one in three deliveries happening in Indian cities today is through Cesarean Section.

There are two main reasons for this. The first is medical interference with normal physiological process of labor and childbirth, even in the absence of any medical indication that may necessitate a Cesarean Section. The second is a misconception among women that it is an easy gateway to escape labor pains, and a painless, safer, and better alternative to vaginal delivery. In my experience, more than half of all pregnant women today are voluntarily choosing Cesarean Section as the preferred mode of delivery.

WHO conducted a critical appraisal of the indications of Cesarean Section. It found that in one-third (34%) of all such cases, the medical team chose this procedure due to labor arrest or non-progress of labor. Here, obstetricians need to understand that every individual is different. Evidence has proved that the rate of cervical dilatation could be different for different women. Patience in the medical team, and the woman herself, can still lead to a normal vaginal delivery, provided there is no maternal or fetal compromise otherwise.

To encourage natural births and avoid Cesarean Section, medical teams can take several measures such as preventing unnecessary induction of labour, allowing ambulation for woman in labour, providing continuous labour support, avoiding unnecessary interventions like augmentation of labour or Artificial Rupture of the Membranes (ARM), and encouraging spontaneous pushing in non-supine position.

The woman’s perspective about labour pain is the most common problem faced by doctors today that adversely affects her abilities, leading to fear and anxiety. There is a definite need to allay her anxiety, and counsel and prepare her for vaginal delivery during the antenatal period itself. Shared decision-making, keeping the labouring woman at the forefront, and providing her effective pain relief strategies and supportive care will help alter her misconceptions.

Vaginal delivery has many advantages, such as faster recovery and shorter hospital stays, less chances of secondary infection, and fewer complications in future pregnancies. On the other hand, a study by PLOS Medicine found that women who deliver by Cesarean Section have a higher chance of having fertility issues, still-births, and miscarriages. They may in future also experience placental complications or an ectopic pregnancy at the scar site. Cesarean Section can also cause intestinal blockage or bladder injury.

Vaginal delivery offers benefits to the babies too. When the child is born naturally, the muscles involved help squeeze out the fluids from the child’s lungs, leading to lower risk of respiratory ailments. Hormonal exchange also takes place during this time, which improves the child’s immune system.

Cesarean Section is recommended only when the life of the mother or fetus is at risk. It should not be an option to opt for as a painless mode of delivery. A collaborative effort between the expecting mother, her family support system and the healthcare provider is required for successful vaginal delivery. This will change the fear-tension-pain cycle to safety-and-peace cycle, and go a long way in promoting vaginal birth.

Dr. Pratima Mittal is Head & Senior Consultant, Dept. of Obstetrics & Gynaecology, Amrita Hospital, Faridabad

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