The most important thing: ask questions

The safest option can be different for every woman and every pregnancy, and sometimes the safest plan can change during labour.

We encourage you to talk openly with your obstetrician about:

• What are my individual risks?

• What are the benefits and risks of vaginal birth in my situation?

• What are the benefits and risks of caesarean birth for me and my baby?

• How likely am I to need an induction?

• What happens if labour does not progress?

• When might forceps or vacuum be recommended?

• What happens if my baby shows signs of distress?

• If I have had a previous caesarean, am I a candidate for VBAC?

• What can I expect during recovery?

In an emergency, there is often very little time to discuss every possible scenario. Having these conversations during your pregnancy means you can feel better prepared if an unexpected situation arises.

Our goal is not to make you worried about birth. It is to make sure you feel informed, prepared and supported.

You don’t have to read any further, but the reality is that things can and do go wrong. That’s where we come in - helping you stay protected, supported and safe when you need it most.

There is no single "right" way to give birth.

As you prepare to welcome your baby, you may have already thought about how you would like to give birth. Whether you are planning a vaginal birth or a caesarean birth, our role is towe will support you throughout your pregnancy and birth journey.

Birth does not always follow the plan we start with. Sometimes circumstances change, and even though we may all hope for an uncomplicated vaginal delivery, an assisted vaginal birth or caesarean birth may become the safest option for you or your baby.

We believe that understanding the possibilities before you go into labour can help you feel more prepared and confident in making decisions if circumstances change.

This information provides an overview of some of the more common and important risks associated with vaginal and caesarean birth. It is not intended to replace personalised advice from your obstetrician, and we encourage you to use your appointments to ask questions about what may be relevant to you and your pregnancy.

A little perspective on birth in Australia

Every birth is different, but Australian data gives us a useful picture of how babies are born. For women having their first baby in Australia in 2023 data reported approximately:

• 41.6% had an unassisted vaginal birth
• 21.9% had an assisted vaginal birth using forceps or vacuum
• 36.5% had a caesarean birth
• 42.8% had labour induced

For women who have previously had a caesarean birth, approximately 11% had a vaginal birth after caesarean (VBAC). Among women who actually choose to attempt a VBAC, the chance of successful vaginal birth is generally around 50 – 60%, depending on individual circumstances.

It is also important to understand that forceps and vacuum births are generally used when assistance is needed, for example if the baby needs to be born more quickly or if labour is not progressing as expected. It is not usually something a woman chooses as a preferred method of birth.

Forceps or vacuum birth occurs in around 1 in 5 first births, but is much less common in subsequent births.

If you are planning a vaginal birth

A vaginal birth is often the preferred mode of birth and a safe and positive experience for many women. However, like all births, it has potential risks.

Perineal tears

During a vaginal birth, the tissues between the vagina and anus (the perineum) can stretch and tear. Some tears are minor, while others may require stitches. Only 7% of women having their first baby will have no tears, 18% with the second and 30% with the third.

A third- or fourth-degree tear, which involves the anal sphincter or surrounding tissues, occurs in approximately 2 - 4% of vaginal births.

An episiotomy (a small surgical cut to the perineum) may sometimes be recommended. It is particularly likely to be recommended when an assisted birth with forceps or vacuum is required, as it can reduce the risk of more significant tearing.

Bleeding after birth

Some bleeding is normal after giving birth. Occasionally, heavier bleeding known as a postpartum haemorrhage can occur. This can be serious if not managed promptly. Treatment may include medication, an iron infusion or, in some circumstances, a blood transfusion.

Infection

Infections involving the uterus, bladder or perineal area can occur after birth. These infections are generally less common following vaginal birth than caesarean birth.

Pelvic floor changes

Pregnancy and vaginal birth can place stress on the pelvic floor muscles and surrounding tissues.

For some women, this can contribute to longer-term problems such as:

•  urinary incontinence
• bowel or faecal incontinence
• pelvic organ prolapse
• pelvic floor weakness

These problems do not happen to everyone, but the risk of pelvic floor injury is generally higher following vaginal birth than caesarean birth.

Assisted vaginal birth

Sometimes your baby needs help being born using forceps or a vacuum cup.

This may be recommended if your baby needs to be born more quickly, if you are becoming exhausted, or if pushing is not progressing as expected.

Your obstetrician will discuss the reasons for assisted birth with you and explain the options available at the time.

Emergency caesarean birth

Occasionally, a vaginal birth may not progress as expected, or there may be concerns about your baby's wellbeing.

In these circumstances, an emergency caesarean birth may be recommended.

Risks to your baby

Most babies goes through birth without any issues, but complications can occasionally occur.

For example, babies can experience temporary signs of distress during labour, which is one of the more common reasons an assisted vaginal birth or emergency caesarean may be recommended.

Rarely, birth can result in injuries such as:

• bruising or other birth trauma
• a fractured collarbone
• brachial plexus injury affecting the nerves to the arm
• hypoxic-ischaemic injury (HIE)

Your obstetric team will monitor you and your baby during labour and recommend intervention when necessary to reduce these risks.

Shoulder dystocia

Shoulder dystocia occurs when a baby's shoulders become temporarily stuck after the head has been born.

It occurs in approximately 0.5 - 0.7% of births. Although uncommon, it can require urgent management and can carry risks for both mother and baby.

Your obstetric team is trained to recognise and manage this situation if it occurs.

If you are planning a caesarean birth

A caesarean birth is a very common procedure. It is often chosen by women (maternal choice) or needed for medical reasons.  It can be planned in advance or performed urgently when needed. While caesarean birth can be the safest option in many circumstances, it is still major abdominal surgery and carries its own risks.

Bleeding

Bleeding can occur during or after a caesarean birth. Occasionally, additional treatment such as medication, an iron infusion or blood transfusion may be required.

Infection

The risk of infection is higher following caesarean birth than vaginal birth.

Infections can involve the surgical wound, uterus or bladder. Antibiotics are routinely used around the time of surgery to reduce this risk.

Blood clots

Pregnant women are at higher risk of developing blood clots. Surgery and reduced mobility can increase the risk of blood clots in the legs or lungs.

This risk remains very low, but preventative measures such as compression devices, early mobilisation and, where appropriate, blood-thinning medication are used to reduce the risk.

Injury to surrounding organs

Because the uterus is located close to the bladder, bowel and ureters, there is a small risk of injury to surrounding organs during surgery.

This is uncommon but is  more likely to happen during an emergency caesarean, particularly when labour is advanced, or if you have had previous abdominal or pelvic surgery.

Anaesthetic risks

Most caesarean births are performed using a spinal or epidural anaesthetic, meaning you are awake for the birth of your baby.

General anaesthetic is used less commonly and may be required in certain emergency situations or if the spinal or epidural does not work.

As with any anaesthetic, there are potential risks, which your anaesthetist will discuss with you.

Breathing difficulties for your baby

Babies born by caesarean, particularly before labour has started, have a slightly increased chance of developing temporary breathing difficulties.

One example is transient tachypnoea of the newborn (TTN), where the baby takes longer to clear fluid from their lungs after birth.

When a caesarean is planned, timing the birth appropriately (usually at or after 39 weeks when clinically suitable) helps reduce this risk.

Future pregnancies

Having a caesarean birth can affect some future pregnancies.

There is a small risk of uterine rupture in a future pregnancy or labour after a previous caesarean. There is also an increased risk of conditions involving the placenta, including placenta praevia (low lying placenta) and placenta accreta spectrum (placenta adherent to uterus).

These risks generally increase with the number of previous caesarean births.

If you are considering a vaginal birth after caesarean (VBAC), your obstetrician can talk you through the potential benefits and risks based on your individual circumstances.

Recovery

While women can often get up six hours after a caesarean birth, recovery generally takes longer than recovery following an uncomplicated vaginal birth.

You will usually spend longer in hospital and need to allow time for your abdominal incision to heal.

Some women can also experience ongoing discomfort or pain around the surgical site, and occasionally a raised or thickened scar (keloid or hypertrophic scar) can develop. There is also a small possibility of internal scar tissue (adhesions), which can occasionally contribute to pelvic discomfort or fertility difficulties.

Want to learn more?

For more detailed and reliable information, we recommend using reputable sources such as the Australian Institute of Health and Welfare (AIHW), Australian Bureau of Statistics (ABS), RANZCOG and other Australian government and professional health organisations.

Please remember that online information is general in nature. Your obstetrician can provide advice based on your individual medical history, pregnancy and preferences, and you can contact us on (08) 6270 0123.

Whatever your birth journey looks like, we are here to support you and your baby every step of the way.