Caesarean vs vaginal birth:

C-sections may result in fewer lawsuits, but they’re not always the best care option

On a Sunday morning in Johannesburg in June, a heavily pregnant Zodwa Mahlangu* woke up planning to go to church. Mahlangu was not due to have her baby for another week.

But on that winter’s morning, she discovered she was bleeding.

Mahlangu, who was 23 years old at the time, immediately phoned her midwife, who instructed her to monitor the bleeding and keep her informed of any new developments.

“I knew that the baby was coming. So, I told my partner and my friend who I asked to film the birth,” she recalls.

As the evening progressed, her contractions started and gradually intensified overnight.

“I could not sleep. I was exhausted,” she says. “Eventually, on the Monday morning we made our way to the birthing centre.”

Mahlangu had planned for a water birth at a private birthing clinic.

When she arrived at the facility, the midwife examined Mahlangu and called her doula, a birthing companion who gives emotional and psychological support to women in labour.

As her contractions got stronger, Mahlangu wanted to give up.

“I was in a lot of pain,” she remembers. “I told my doula that I couldn’t take it anymore.”

“But she looked at me and rubbed my back. ‘Yes, you can,’ she said. ‘Yes. You. Can.’”

The advantages of a vaginal birth outweigh those of a C-section, research has shown. According to a 2013 study published in the journal Obstetrics and Gynecology, elective Caesarean sections can result in complications with future pregnancies such as uterine rupture, placental implantation problems (when the placenta grows in an abnormal position in the uterus) and, in some cases, the need for a hysterectomy.

Hysterectomies are 10 to 20 times more likely to be given to women who have had Caesarean deliveries than those who have had vaginal births, a 2012 study in the American Journal of Perinatology found. The research revealed that heavy bleeding happens more often with Caesarean deliveries, but the risk of haemorrhage is lower in planned Caesareans.

Yet gynaecologists and obstetricians are becoming increasingly wary of performing vaginal deliveries.

Linda van Wyk* knew she wanted a Caesarean section from the moment she realised she was pregnant. “I was scared of the pain of having labour contractions,” she explains. “At 38, I was also older than most other future moms. The thought of a vaginal birth wasn’t my cup of tea.”

Van Wyk told her gynaecologist that she would like an elective C-section, which would schedule the date of her baby’s delivery ahead of time. “I didn’t get maternity leave so I had to maintain myself and plan carefully for the four months I was taking off work,” she says.

Paul Swart, a gynaecologist at Steve Biko Academic Hospital in Pretoria, says many women in South Africa who can afford medical aid opt for a C-section because of the convenience of having a planned birth.

Of the births paid for by medical aids in 2015, 68% were done by Caesarean section, according to the 2016 annual report of the Council for Medical Schemes, a body that regulates medical schemes in South Africa.

“This figure is the average for births [funded by medical aids] in the private and public sector, as we do not receive a split between public and private hospitals from medical schemes,” says Elsabe Conradie, the council’s manager for stakeholder relations.

“Many expecting mothers want to make sure that their babies are not harmed during delivery and C-sections give them that peace of mind. People don’t manage uncertainty well. It gives them a sense of control to know when the baby will be born,” says Swart.

Van Wyk finished work on Sunday evening and on Monday morning, at 4am on January 4 2010, she made her way to the hospital to deliver her baby at 6am. “I told my doctor that a C-section would allow me to meticulously schedule my daughter’s birth and work until the last moment, and she never told me that I couldn’t do this,” she says.

But it’s not only mothers like Van Wyk who prefer Caesarean sections. Many doctors favour them, too.

Fear of litigation and the need for a clean record of safe deliveries are the main reasons doctors choose to perform elective C-sections, studies have shown.

Many physicians say C-sections reduce the risk of being sued, even if a vaginal birth would be the optimal choice.

But vaginal birth also comes with risks, found a study published in the