Cesarean versus vaginal delivery – Which is best?

Until about 50 years ago the cesarean delivery rate was about 5%, but since the 1960s, it has steadily increased to about 1 in 3 now, though for the last 10 years that rate has remained steady.  About 1/3 of cesarean sections are done in women who previously had a cesarean, while 2/3 are done mainly for fetal distress, inability to deliver vaginally (“failure to progress”), and breech. There are often good reasons and indications to do a cesarean. In fact, studies have shown that in countries where cesarean delivery rates are too low (usually below 10%), there is an increase in maternal and neonatal mortality.

Risks for mom from cesarean

Going through labor and having a vaginal delivery can be a long process that can be physically taxing for the mother. A cesarean is a major surgery, and though the vast majority of cesareans can be done safely, there are certain risks to the mother such as blood loss, infection, anesthesia risks, and a longer recovery period. Some women and doctors assume that because the first baby was born via C-section that all of their children will have to be born this way to prevent the uterine scar from opening during labor. In addition, the next pregnancies have increased risks including “placenta accreta,” a serious condition where the placenta attaches or grows into the uterus, and threatens the mother’s life.

Risks for a baby born by cesarean

During labor and a vaginal birth, baby’s lungs get readied so there is a better chance to breathe oxygen after birth. Babies born via C-section often have respiratory issues with extra fluid in their lungs at birth because they don’t have the chance to undergo this process. During vaginal births, babies are also exposed to certain good bacteria (“microbiome”) which may boost the baby’s immune system.

A healthy baby and mother are the goal

In the end, the decision surrounding a vaginal birth or a C-section should focus on keeping mom and baby healthy. Sometimes there is a medical reason that a delivery doesn’t end up as a vaginal birth to keep either the mother or the baby safe. But to decide on a C-section for a non-medical reason may not be in the best interest of mom or her baby.

A Home Delivery in the Hospital: The Best of All Worlds; The Real Reason Why Kate Middleton Left The Hospital Just 7 Hours After Giving Birth

kate middelton baby, duchess kate middelton gives birth, midwives, NHS, UK midwivesTwo days ago, everyone’s favorite duchess, Kate Middleton gave birth to her third child. Seven hours later, to the amazement of moms everywhere, she emerged from the hospital, perfectly coiffed and ready to go home with her new son in tow, Prince Louis Arthur Charles. She spent a total of 12 hours in the hospital, 5 hours before and 7 hours after delivery.  She essentially had a home delivery in the safety of the hospital.

This wasn’t the first time Duchess Kate made a quick exit after delivering: When her first child, Prince George was born, she stayed overnight but went home the next day, and when Princess Charlotte was born, she left after 10 hours.

Was her quick departure simply because of all the media hoopla surrounding the royal couple? Yes, and no.

Of course with Kate Middleton’s prestige, the atmosphere created in a hospital by inquiring minds post delivery would be nothing short of a circus. It’s also a given that she would likely find a quieter environment at home in Kensington Palace with a bevy of medical professionals ready, willing and able to help her 24/7.

But it’s more than that.

On average, a new mom in the U.K. spends on average just 36 hours in the hospital after giving birth vaginally as opposed to the typical 48 hour hospital stay in the U.S. The U.K. actually has the shortest hospital stays in the world for new moms, and with good reason. The system in the U.K. allows for new moms to be cared for by midwives, stressing that “many safety issues could be missed if a midwife does not see the woman at home.”

If new moms go home too early (often due to lack of staff and beds)before doctors have the chance to thoroughly access the mom and baby complications can occur:

“Midwives need to check to make sure women feel up to going home. However, provided the woman is medically fine, has the support she needs at home and the right postnatal care plan in place, and a good community midwife service, then going home even five or six hours after birth may be absolutely fine.”

In Kate’s case, her labor was relatively short, she had a vaginal delivery, and she had no epidural or complications, which makes recovery time faster and easier.

In the U.S., going home so soon might be considered negligent, however, there is no routine follow-up postpartum other than the typical postpartum checkup, which is one short doctor visit that takes place six weeks later.

Having access to a supportive and experienced team of midwives enables new moms to adjust physically and emotionally to the stress that her body and mind have gone through, and continue to go through in the postpartum period. In addition, having support at home helps mothers cope with early discharges.

Yet another reason for going home early is cost. “American hospitals charged moms with employer-provided insurance about $32,000 on average for vaginal births and $51,000 for Cesarean deliveries.” Though partially covered by insurance, not every woman has health insurance or even a decent insurance that will pay the bulk of the bill. And there is no provision in the American health system to do home visits for mothers.

In stark contrast, Kate gave birth at the Lindo Wing at the NHS St. Mary’s Hospital and was given access to “state-of-the-art equipment, WiFi, modern decor, daily newspapers, meals prepared by on-site chefs and afternoon tea.” She essentially brought her home to the hospital, had a home delivery in the hospital with all emergency support if necessary, and then she was discharged seven hours later, and the cost of her calm, thorough, and peaceful delivery experience may just shock you. Duchess Kate’s hospital bill for firstborn George was just $15,000 even with the royal treatment and is presumed to be similar with this new baby as she opted for private care again, now for the third time. And it’s not only Kate’s royal status that afforded her this perk; the National Health Service “provides free maternity care to U.K. residents who give birth in their hospital system, but all new moms also have the option of pursuing private care.”

It makes you wonder why we can’t employ a similar system in the U.S., doesn’t it?

What are our chances of conceiving?

In order to get pregnant, the following has to happen:

  1. You must have regular sex during the fertile window as well as through the menstrual cycle, not too much or too little
  2. He has to have enough good quality and mobile sperm
  3. Her fallopian tubes must work and function well
  4. She must ovulate
  5. Her eggs must be of good quality (the younger you are the better your eggs)
  6. The endometrial lining must be receptive for the embryo to implant

Anything that goes wrong with any of the above, and your chances of getting pregnant diminish.

You are more likely to get pregnant faster if:

  • You have regular menstrual cycles and ovulate regularly
  • Your eggs are OK
  • He has enough good quality and mobile sperm
  • Your fallopian tubes are open
  • You have intercourse regularly and at the right time
Probability of pregnancy with a single act of intercourse
The probability of pregnancy with a single act of intercourse

You should have intercourse every 1-2 days during the “fertile window” and also regularly through the menstrual cycle.

You and your partner have the highest chance of conceiving in the first 3 months of trying. For young fertile couples, the chance of conception is between 20% and 37% during the first 3 months, and it increases to 80% by one year and 90% after two years of trying. Women over the age of 35 and men over the age of 50 have lower fertility rates.

Your chances of getting pregnant improve significantly when you address each of the 6 items above. Being at your best health and optimal weight, adopting a healthier lifestyle, and taking prenatal vitamins improves fertility,  your chances getting pregnant, and decreases many medical risks. If a woman has a medical or genetic condition or risk of one, she should seek advice from a medical professional before getting pregnant.

How can we naturally improve our fertility and get pregnant faster?

Many couples trying to conceive want to know want they can do to improve their chances getting pregnant and having a healthy baby…

Diet and Lifestyle: Be at your optimal weight, take a supplement, no smoking or alcohol

Try to attain your optimal weight (BMI of 19.5-24.9) because being too thin or overweight decreases fertility, especially ovulation. There is little evidence that certain diets (low fat, vegetarian, vitamin-rich, antioxidants) improve fertility. Taking a supplement that includes 600-800 mcg folic acid improves fertility and decreases the risk of miscarriage and having a baby with malformations. Both smoking and alcohol (especially alcohol in higher levels) have been associated with an increase in infertility. Moderate caffeine consumption (1-2 cups of coffee a day) has no negative effect on fertility or pregnancy. Sauna bathing is safe for women, but men should prevent overheating of testicles. Environmental exposure to pesticides and other environmental exposures may have reproductive consequences.

Frequency, Timing, and Position of Intercourse: Have sex once every 1-2 days and each day during your fertile window

The highest pregnancy rates are achieved by frequent but not too frequent intercourse. More than 5 days between ejaculation or more than once a day will decrease his sperm count. Once every 1-2 days is optimal, but even less frequent intercourse (two to three times per week) achieves nearly equivalent results.

Probability of pregnancy with a single act of intercourse. M
The probability of pregnancy with a single act of
intercourse.

To improve your chances of getting pregnant, you must have sex during the right time in your menstrual cycle. The fertile window is the time in a cycle when you must have intercourse for conception and pregnancy to occur. The fertile window last 6 days and ends on the day of ovulation. It lasts for 5 days before ovulation and on the day of ovulation. Most doctors recommend the “missionary position” though there are no specific studies showing any differences in fertility in various positions. While it’s more fun for a woman to have an orgasm, there is no proof that it helps improve fertility.

There is no evidence that specific sexual positions, orgasm, or prolonged rest after intercourse increase the chance of conception. Some lubricants (Astroglide®, KY® Jelly, KY® TouchTM, saliva and olive oil) used during intercourse may decrease sperm motility (movement) or survival. These should be avoided if possible. Others (PreSeed®, mineral oil, or canola oil) have no such effect and can be used as needed.

Ovulation: When Does It Happen and Ovulation Monitoring

Because the fertile window is set by the day of ovulation, it is important to know when a woman is ovulating. There are several methods of determining ovulation. Cervical mucus and vaginal secretions start to increase 5 to 6 days prior to ovulation and peak 2 to 3 days before ovulation. These changes can be monitored to identify the fertile window in many women. Urinary ovulation predictor kits can also be used to detect the rise in luteinizing hormone (LH) that happens just before ovulation. LH is the primary trigger that results in the eggs being released from the ovary (Why Am I Not Ovulating?).

Probability of conception according to vaginal secretions on day of intercourse
The probability of conception according to vaginal secretions on the day of intercourse

Cervical mucus (CM or vaginal secretions) provides a good index of when ovulation may be expected. CM changes from the time of the menstrual period (bleeding) from dry to moist to slippery and clear, similar to egg-white cervical mucus (EWCM) around ovulation. The estimated probability of conception, in relation to the characteristics of cervical/vaginal secretions, is shown in the right figure. The probability is highest when mucus is slippery and clear, although such mucus is by no means a prerequisite for pregnancy to occur.

Delivering with a midwife in the hospital: the best of both worlds

When I think back to when my first child was born, one very vivid scene unfolds in my mind. It begins with me pleading for someone to go out and get the doctor who had vanished about an hour prior because this baby was coming now! My husband frantically ran into the hall and called the nurse who in turn called the doctor who yelled down the hall that no, it was not time yet. I was at the point of screaming and through tears said to my husband who had come back in the room, “Oh my god, this baby is coming now.”

Yes, I was young. Yes, it was my first baby. Yes, I had no experience with labor or childbirth and the doctor on call definitely had. So when he said the baby was not coming, I took his word for it…until I felt my daughter’s head crowning and pleaded with someone to believe what I was saying. A sympathetic nurse finally came in, took one look and sprinted for the door to find the doctor, who now ran in and scowled, “Don’t push. At least let me get my gloves on.”

My first daughter was born seconds later and luckily for him, I was so inundated with joy and happiness that I didn’t let him have it (although if I could go back to that day now, well, some things are better left unsaid!).

Naturally, with my next pregnancy, I wanted to avoid anything remotely close to this experience but did want to give up access to medically safe birth. I wanted to deliver in a hospital again, but this time with a more caring and calm professional. I did a thorough search and ended up choosing a team of certified nurse midwives whose practice was overseen by an OB/GYN.

From the first prenatal visit, I felt acknowledged and heard. I was given ample time for my questions at each 20-30 minute visit, and I had access to the team at all hours. I also always felt supported. Their stance was that as long as my wishes were medically safe, they would back me up. So if I wanted to stand up during labor or walk around, or sit or alternate, I could do it, as long as there were no complications necessitating otherwise.

While my midwife was supportive of my decisions and I delivered naturally with no intervention or meds, if I had needed them, they were readily available to me.”

My midwife was so incredibly calm. She had seen it all before and offered motherly support and also made me feel like everything I was doing was fabulous. This was invaluable … there is nothing more than a mother-to-be needs during a harrowing labor than encouragement.

My labor and delivery with my second daughter, and then my son after that, were glorious, in a beautiful wing of a hospital in a private birthing room. I didn’t need any medication whatsoever, no episiotomy, and delivered easily. I would not trade those experiences for anything.

However, while my midwife was supportive of my decisions and I delivered naturally with no intervention or meds, if I had needed them, they were readily available to me. If I wanted an epidural, it was there. I was asked but declined, and was repeatedly told I could change my mind. There was no judgment. If I had planned on a purely natural childbirth but wanted every drug available once the hard labor kicked in, my midwife would have happily given it to me.

Most importantly, if my labor had stalled, or if there was a cord prolapse, or the baby’s heartbeat declined, I would have been given a cesarean section in a matter of minutes because I delivered in a fully equipped hospital, had registered for a birthing room months before, and already had a team of professionals tending to me since early labor.

I wanted the best of both worlds. I wanted the expertise and surgical ability of a doctor along with the experience and support of a certified nurse midwife. I also wanted to deliver in a hospital with an operating room and an entire team of specialists just in case the baby or I needed it.

In today’s world, there is no reason to be extreme; we have great medical advances available to us, we should utilize them all.