Vaginal versus cesarean delivery: Clinical

Vaginal and cesarean delivery are the two ways that a baby can be born. With vaginal delivery, the baby comes into the world through the mother’s vagina, or birth canal, and the process is called labor, whereas with cesarean delivery, also called a c-section, surgery is done to get the baby out.

Now, generally speaking, vaginal delivery is the preferred option.

But in some cases, complications may arise during labor, or a vaginal delivery may be contraindicated in the first place, and a c-section may be done.

And finally, a c-section may be performed on maternal request.

Ok, now, vaginal delivery, or labor, has three stages.

Stage I is when the cervix dilates to 10 centimeters, and it’s divided into a latent phase, covering dilation from 0 to 6 centimeters, and an active phase, when the cervix dilates completely.

Stage II is when the fetus passes through the birthing canal.

If everything goes well, the baby is delivered and labor progresses to stage III, which is the delivery of the placenta.

Complications that may arise during labor come in two flavors.

First, labor may fail to progress as expected, and second, there may be non-reassuring fetal status, sometimes called fetal distress, during delivery; and both are indications for a C-section.

So, in the first category, the indications are active phase arrest and prolonged second stage.

Active phase arrest means there’s there’s no cervical change during the active phase after 4 hours of adequate uterine contractions, or 6 hours without adequate uterine contractions.

Remember that adequate uterine contractions are higher than 200 Montevideo units, or MVU.

A prolonged second stage, on the other hand, is when it takes longer than 3 hours in primiparas and 2 hours in multiparas for the baby to descend through the birth canal.

In this case, an emergency C-section is indicated if the fetal head is not engaged, meaning it hasn’t reached the inlet of the pelvic brim during that time.

Now, the second category refers to non-reassuring fetal status during labor.

Fetal status can be indirectly assessed through the fetal heart rate. This can be done through auscultation or electronic fetal monitoring.