Risks of Vaginal Birth

Rates of physiological or 'natural' vaginal birth are very low in Australia (Li et al. 2012). As a result, research which compares caesarean birth with vaginal birth is on the whole comparing caesarean birth with 'medicalised' vaginal birth. This makes it very difficult to provide good information about the risks of 'natural' vaginal birth. A number of routine obstetric practices make 'medicalised' vaginal birth riskier for the mother and baby.

It is hard to compare the risks of vaginal birth with the risks of caesarean, as it is difficult to know how many women give birth 'naturally' in Australia. The most complete data we have for how women went giving birth is for 2010. In 2010, labour started on its own for 27% of women e.g. labour was not induced. Of these women, 25% did not use drugs for pain relief. A very basic way of working out how many births were 'natural' is to say that it was 25% of all the labours which started on their own (Li et al. 2012). This means that just under 7% of births did not involve any medical intervention and were therefore 'natural'. However, studies which compare vaginal birth and caesarean birth are not focusing upon 'natural' birth, they are comparing statistics from all vaginal births, the vast majority of which are 'medicalised'.

The main risks of vaginal birth relate to women's experiences of ‘medicalised' vaginal births which including interventions such as the use of a synthetic oxytocin drip, epidural anaesthesia and, either a forceps or vacuum delivery with episiotomy.

When compared with caesarean birth, vaginal birth increases the risks to the mother of:

• abdominal and perineal pain during the birth (NICE 2012)
• injury to the vagina or perineum (New South Wales Government 2012, Victorian Department of Health 2011)
• severe bleeding in the immediate period following the birth (NICE 2012)
• urinary stress incontinence (Rortveit et al. 2003).

When compared with caesarean birth, vaginal birth increases the risks to the baby of:

• psychological distress (vacuum and forceps assisted births) (Li 2010)

References

• Beckmann, M.M., Stock, O.M. (2013). Antenatal perineal massage for reducing perineal trauma. Editorial Group: Cochrane Pregnancy and Childbirth Group Published Online: 30 APR 2013
• Li, H-T., Ye, R., Achenbach, T., Ren, A., Pei, L., Zheng, X., Lui, J-M. (2010). Caesarean delivery on maternal request and childhood psychopathology: a retrospective cohort study in China. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02762.x
• Li, Z., Zeki, R., Hilder, L., and Sullivan, E.A. (2012). Australian Mothers and Babies 2010. Perinatal Statistics Series Number 27. Australian Institute of Health and Welfare, Canberra, Cat. no. PER 57. Available onilne at http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129542372
• National Institute of Clinical Excellence NICE (2012). Caearean Section. NICE Clinical Guideline 132. Available online at http://www.nice.org.uk/nicemedia/live/13620/57163/57163.pd
• New South Wales Government 2012). Birth complications: Perineal tears by year. Health Statitics in New South Wales report. Available online at http://www.healthstats.nsw.gov.au/indicator/mab_pnspvbth_cat
• Rortveit, G., Daltveit, A.K., Hannestad, Y.S. and Hunskaar, S (2003). Urinary incontinence after vaginal delivery or caesarean section. The Norweigan EPINCONT Study. N Engl J Med 2003; 348:900-907 March 6, 2003DOI: 10.1056/NEJMoa021788
• Victorian Department of Health (2011). Births in Victoria 2007 and 2008. The Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM).