THERE are two methods of delivering a baby, either via the birth canal, known as a vaginal delivery, or caesarean section involving a cut in the abdomen, sometimes abbreviated to c-section or just section.

Currently in the UK three quarters of deliveries are vaginal, the remaining twenty five percent a combination of planned sections, where the decision has been made prior to the event, or as urgent/emergency procedures, in response to complications during labour necessitating such action.

Caesarean section is a surgical procedure, carried out by an obstetrician, a specialist in women’s health. The operation is performed in an operating theatre, usually with the assistance of another obstetrician or trainee, an anaesthetist and their assistant, as well as the required ancillary theatre staff. A paediatrician may be present if it is anticipated that baby will need resuscitation after delivery.

Section involves a horizontal cut to the abdomen, usually 10-20cm in length, just below the “bikini line”, allowing access to the uterus (womb), which is opened to deliver the baby and placenta. After this, once any bleeding has been addressed, the womb and abdomen are closed back up and if baby is well, her or she can be given to mum for skin-to-skin contact and to breast feed if desired.

The majority of sections are performed under regional anaesthesia, either spinal or epidural or a combination, mum being awake throughout, and where their partner can be present (if this applies). In certain situations, general anaesthesia is required.

Reasons for having a section can be divided into medical and “non-medical”. Many are uncomfortable with this differentiation. I will try to explain why below.

Medical reasons are due maternal (mother) and/or foetal (baby) issues. Uncontrolled infection including HIV, Hepatitis C and genital herpes make the natural birth canal less suitable due to potential transmission to baby. A low-lying placenta (placenta previa) may partially or completely obstruct the entrance to the womb. If baby is in the breech presentation, that being bottom or feet down, a procedure called external cephalic version may be offered to try to change this to head down. However, it may be unsuccessful, or declined. Delivering twins or triplets may require caesarean section, though many multiple births are delivered vaginally.

Emergency sections are performed in response to complications during attempted vaginal delivery, either mother becoming unwell with issues including raised blood pressure, excessive vaginal bleeding or fatigue, or if baby is struggling, referred to as foetal distress.

“Non-medical” reasons for c-section are often due to anxieties over the actualities of vaginal delivery. The term tokophobia means a significant fear of childbirth. This may be due to concerns over damage to the genitals, baby, or even death. Previous negative experience of vaginal delivery will affect a woman’s view, although tokophobia occurs in first time mothers. It may be a reaction to previous psychological, physical or sexual abuse.

Statistics show that for uncomplicated pregnancies, vaginal delivery is safer than caesarean section. A mother having a vaginal delivery is more likely to have the same in subsequent pregnancies. For those undergoing caesarean section, future pregnancies usually conclude in the same manner. Caesarean section is not a bar to vaginal delivery in future pregnancy. This is termed VBAC (Vaginal Birth After Caesarean).

Some consultants do not advocate “non-medical” caesarean sections, but it is a mother’s right to decide her method of delivery, and be referred to a specialist who will facilitate c-section if desired.

Of utmost importance is that when you decide, you have explored your options and have made a fully informed decision. Neither vaginal delivery nor c-section is without potential complications. Those associated with vaginal delivery include perceived lack of control over the situation, damage to the genital tract and weakness of the pelvic floor afterward. Those of section are the same risks as for any operation. A non-exhaustive list comprises damage to abdominal organs, risks of anaesthesia, developing a clot in the leg or lung and perhaps most importantly greater time until you can lift and carry than with vaginal delivery due to the abdominal wall needing to heal. If performed before 39 weeks, babies delivered by c-section are more likely to have temporary breathing problems. Infection and bleeding are complications of both methods of delivery.

Yet the majority of vaginal births are largely uncomplicated, and the same can be said for caesarean section. Obstetricians and indeed all doctors are trained to adopt a holistic approach to patient care, and you should never be afraid to ask any question, or express any fear.