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Types of Birth

A vaginal birth is usually the safest and best option for both you and your baby. However sometimes medical concerns arise that mean a different way of giving birth is needed.

While this may not be what you had planned, you can improve your experience by learning about your birth options in advance so you understand what is going to happen. Talk to your doctor or midwife for more information.

Types of vaginal birth

Spontaneous vaginal birth

A spontaneous vaginal birth relies on your body’s ability to labour and deliver your baby. Your contractions will increase as your cervix opens, and then you push your baby out through your vaginal canal.

Compared to all other types of delivery, vaginal delivery has:
  • less risk of injury and infection
  • shorter hospital stay
  • faster and less painful recovery
  • no complications from surgery
  • less risk of breathing difficulties for your baby.

While vaginal delivery is a normal process, some risks include:

  • vaginal tearing during birth
  • tearing between your vagina and anus (perineum) which may require stitches
  • temporary problems with bladder or bowel control
  • short-term pain during sex.
There are many comfort measures and medication-based pain management options you can chose for vaginal birth:
  • movement
  • massage
  • bath/shower
  • TENS machine
  • nitrous oxide (laughing gas)
  • sterile water injections
  • morphine
  • fentanyl
  • epidural
 

Assisted vaginal birth

There are 2 types of assisted vaginal birth: vaccum-assisted and forceps-assisted.

Vacuum-assisted vaginal birth

A vacuum extractor is a soft cup placed on your baby's head that helps guide your baby out as you push. A vacuum can be used during the pushing stage of labour (second stage) when your baby is low in your pelvis. Your care provider may suggest this when your delivery is not progressing during pushing or when your baby needs to be delivered quickly due to health concerns. This procedure is safe and can help you avoid having a caesarean section.

 

Compared to a caesarean section, a vacuum-assisted birth offers:

  • less risk of injury and infection
  • shorter hospital stay
  • faster, less painful recovery
  • less blood loss
  • no complications from surgery
  • less risk of breathing difficulties for baby.
For baby, compared to a spontaneous vaginal birth, a vacuum-assisted birth has increased risk of:
  • short-term marking or bruising to baby’s head
  • jaundice (yellowing of skiskin and eyes) due to breakdown of red blood cells from bruising
  • more complicated injuries are very uncommon.

For you, compared to a spontaneous vaginal birth, a vacuum-assisted birth has increased risk of:


  • vaginal tearing or small cut (episiotomy) that may require stitches
  • injury to the muscle around the rectum (bowel)
  • temporary problems with bladder or bowel control
  • short-term pain during sex.
 
If you have a vacuum-assisted birth, you may receive pain medication such as:
  • nitrous oxide
  • fentanyl
  • epidural
  • combined spinal-epidural.
 

Forceps assisted vaginal birth

Forceps are slim, tong-like instruments placed inside your vagina on either side of your baby's head to gently pull your baby out as you push. Forceps can be used during the pushing stage of labour (second stage) if your delivery is not progressing or when your baby needs to be delivered quickly due to health concerns.

Forceps-assisted births are performed by an obstetrician who is specially trained to use them. Forceps are safe in the hands of an experienced care provider and can help you avoid having a caesarean section. Your primary maternity care provider will stay with you during a forceps-assisted birth.
Compared to a caesarean section, a forceps-assisted birth offers:
  • less risk of injury and infection
  • shorter hospital stay
  • faster, less painful recovery
  • less blood loss
  • no complications from surgery
  • less risk of breathing difficulties in baby.
Risks of a forceps-assisted vaginal birth

For baby, compared to a spontaneous vaginal birth a forceps-assisted birth has increased risk of:
  • short-term marking or bruising to baby’s cheeks
  • more complicated injuries are uncommon.
For you, compared to a spontaneous vaginal birth a forceps-assisted birth has increased risk of: 
  • vaginal tearing or small cut (episiotomy) which may require stitches
  • injury to the muscle around the rectum (bowel)
  • temporary problems with bladder or bowel control
  • short-term pain during sex.
 
If you have a forceps-assisted birth, you may receive pain medication such as an:
  • epidural
  • combined spinal-epidural
  • pudendal block.
 

Caesarean birth (c-section)

Caesarean birth

A caesarean section (c-section) is a surgical procedure where the baby is delivered through a cut made in a your lower abdomen. Once the baby is delivered, your uterus will be closed with stitches that dissolve and your skin closed with stitches or staples.

A caesarean birth may be the best option if there are medical concerns for you or your baby. If you have a caesarean birth, you can usually choose to have a vaginal birth in your next pregnancy.

  • reduced risk of urinary and fecal incontinence
  • avoidance of labour pain
  • reduced risk of complications that come with vaginal labour and birth.

Risks of a caesarean section


For baby:
  • short-term breathing difficulties
  • short-term breastfeeding difficulties.
For you:
  • longer recovery
  • increased bleeding
  • injury to bladder or bowels
  • wound infection
  • increased pain
  • more serious complications or injuries are rare.

Pain relief options for a caesarean section


You will receive a spinal anaesthetic to numb your lower body only. If you already have an epidural in place, more medication will be given to you to make your lower body completely numb. You will remain awake while your baby is born. There are rare circumstances that may require you to have a general anesthetic that will put you to sleep for the c-section.

 More information on caesareans

Vaginal birth after caesarean

Vaginal birth after caesarean (VBAC)

If you had a baby by c-section in the past and are pregnant again, you may be thinking about trying to have a vaginal birth. This is called a Vaginal Birth After Caesarean (VBAC). In most cases, VBAC is safe for you and your baby. Studies show that 70% to 75% of those who have had a c-section are able to have a successful vaginal birth with their next pregnancy, if their pregnancy is eligible for VBAC.

If successful, the benefits of VBAC include:
  • Faster recovery time: your hospital stay may be shorter and you and your baby can go home sooner. You may have less pain and be able to resume normal activities faster than if you had a c-section.
  • You may have less risk of infection, bleeding and other surgery complications.
  • Lower risk of breathing complications for your baby.

  •  Your next pregnancy may have fewer risks and your labour may be faster.
Risks of VBAC
Having a c-section leaves a scar on the wall of your uterus. The scar area is weaker than the rest of your uterus. 

The biggest risk with having a VBAC is that the scar from your previous c-section could open up during labour and delivery. This is called a “uterine rupture”.  The risk of this happening is very small (about 0.5-1%) but can be a very serious, potentially life-threatening complication for both you and your baby.
 
You may be a good candidate for a VBAC if:
it has been at least 18 months since your c-section
if you are pregnant with one baby only
your baby is not larger than usual
your c-section was done with a low side-to-side cut
there were no complications during or after your c-section
there are no complications with this pregnancy that would need a c-section; and
you have not had previous uterine surgery or a previous uterine rupture.

If you have had more than one c-section birth, VBAC may still be an option but the risks are slightly higher. Review your medical history and other circumstances with your care provider to determine if VBAC is the best option for you and your baby. 

If your care provider wants more information to help you decide, they can refer you to one of the pregnancy specialists (obstetricians) at BC Women’s Hospital.
 

Things you can do to help improve your chances of having a successful vaginal birth after a c-section:

  • Plan to deliver your baby at a hospital that can safely provide VBAC. Your care provider can refer you to BC Women’s or another hospital if your local hospital does not offer this option.
  • Let your labour begin naturally. It is best to avoid any medical treatments to start your labour (induction) or to speed your labour up (augmentation) to reduce your risk of complications. 
  • Be open to all birth options. If there are any concerns about your health or the health of your baby, your care provider may recommend a c-section. This includes any signs that the scar on your uterus has opened up.

 

If you decide to have a VBAC, during your labour you are recommended to:

  • Have a monitor on your belly to check your baby’s heartbeat during your labour
  • Have an epidural
  • Have a small IV placed in your hand to allow for a faster change to a C-section delivery in case of an emergency. This should not stop you from walking or going into a bath tub
  • Have your care provider check your cervix at regular intervals to ensure your labour is progressing.
You can change your mind at any time during your labour and ask for a c-section.
 
VBAC is not an option for everyone. A c-section birth may be the best option if there are medical or other concerns about you or your baby.

If you decide VBAC is not the right choice for you and you would rather have a planned c-section, talk with your care provider about how to proceed. If you are seeing a midwife or family doctor for your pregnancy care, you will need to see an obstetrician (pregnancy specialist) to discuss and schedule the surgery. If c-sections are not available at your local hospital, your care provider can refer you to a hospital where they do the procedure. 

Learn more about the benefits and risks of c-section in the tab on caesarean birth.
 
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