Many questions that pregnant women have from the start of pregnancy include the method of delivery, whether to opt for a normal delivery (Normal Labor) or cesarean section (Cesarean Section). The answer varies according to the beliefs and experiences of each doctor.
NORMAL LABOR
In normal head-first delivery, the doctor delivers the head and body of the baby primarily using the mother’s contraction efforts. Nowadays, pain relief medication through spinal injection is also provided, known as Painless Labor.
OPERATIVE VAGINAL DELIVERY
- Using vacuum (Vacuum)
- Using forceps (Forceps)
- Breech delivery (Breech Assisting or Breech Extraction)
CESAREAN SECTION
Cesarean section is the surgical delivery of a baby through the abdomen. Normally, doctors recommend attempting a natural delivery first, following World Health Organization (WHO) guidelines, which promote natural childbirth as it often results in less blood loss, quicker recovery, and a return to normal activities sooner. The chance of delivering vaginally is high at 80 – 90%, and the recommended cesarean rate should not exceed 15%. Nowadays, with an increased desire for convenience, certain birth dates, and painless delivery methods, cesarean delivery rates have risen annually, for instance, 32% in the United States and up to 46% in China, with Thailand at about 34%.
Indications for Cesarean Delivery
Normally, cesarean delivery should only be performed with the following indications, but this also depends on the readiness of the healthcare personnel and the facilities of each hospital, such as:
- Cephalopelvic disproportion (CPD), where the baby’s head is too large to pass through the mother’s pelvis.
- Placental abnormalities, such as placenta previa (low-lying placenta that covers the cervix) or placental abruption (premature separation of the placenta), which can cause bleeding before delivery.
- Complications that necessitate immediate delivery, like umbilical cord prolapse.
- Fetal distress, where the baby’s heart rate is abnormally slow, severe preeclampsia, or uterine rupture.
- Extended labor (Prolong of Labor) or failure of labor induction (Failure Induction).
- Abnormal fetal positions, such as transverse lie, breech presentation, or multiple pregnancies.
- A mother’s history of cesarean delivery (Previous Uterine Scar), which increases the risk of uterine rupture with a vaginal delivery.
- Mother’s infection, such as genital herpes at the time of delivery, which can be transmitted to the baby during vaginal birth.
In hospitals that strictly adhere to guidelines, cesarean delivery is not performed without the indications mentioned above. However, many hospitals allow cesarean delivery based on the pregnant woman’s request. If there’s a choice, the benefits and disadvantages of both normal and cesarean delivery should be considered. Operative vaginal delivery methods, such as using forceps or vacuum, are utilized in cases where the mother’s pushing is ineffective, or there’s prolonged second-stage labor, and vaginal delivery is deemed possible after evaluation.
