Caesarean section (CS), also known as c-section, or caesarean delivery, is the surgical procedure by which a baby is delivered through an incision in the mother’s abdomen, often performed because vaginal delivery would put the baby or mother at risk. Reasons for this include obstructed labour, twin pregnancy, high blood pressure in the mother, breech birth, and problems with the placenta or umbilical cord. Caesarean delivery may be performed based upon the shape of the mother’s pelvis or history of a previous c-section and a trial of vaginal birth after a c-section may be possible. The World Health Organization recommends that a caesarean section be performed only when medically necessary. Some c-sections are performed without a medical reason, upon request by someone, usually the mother (Salim: 2014). American Congress of Obstetricians and Gynaecologists and the Society for Maternal-Fetal Medicine: 2014).

Prevalence and incidence

According to the Council for Medical Schemes (2020), caesarean deliveries in the population covered by medical schemes is extensively higher than the South Africa public health facilities average, and international experience. The high number of caesarean deliveries in the private sector may be indicative of inefficient use of healthcare resources, supplier activated demand, lack of coordinated maternal care and poor choices by members of medical schemes. Caesarean deliveries attract higher healthcare costs for hospitals, specialists, pharmaceuticals, and other healthcare services compared to normal vaginal deliveries. According to Meng et al., (2019), caesarean sections are performed when life-threatening, for instance, foetal distress, and or maternal exhaustion or perinatal complications are present. On the contrary, elective CSs predispose women to avoidable risks of infection, surgical and anaesthetic complications, reduced likelihood of breastfeeding, and risks for the baby.

Hlatshaneni, (2018), and Wasserman, (2019) stated clearly that the rising rates of CSs in the private sector have been a concern during the past few years. The World Health Organisation estimated that CSs in any region of the world should not be greater than 10 to 15% in clinically indicated cases (Betran et al., 2015). Ravit, Audibert, Ridde et al. (2018) estimated that nearly 15% of pregnant women will experience obstetric complications during their pregnancy and CS delivery will be a lifesaving intervention for between 3.6% and 6.5% of cases. The rate of CS deliveries of 76.9% in the population covered by medical is among the highest in the world.

Normal vs caesarean delivery

Normal delivery is giving birth to a full-term newborn baby (37-42 weeks from the last menses of the mother) through the vagina without the use of forceps or vacuum for assistance. It is the most preferred option of delivery in the United States, that is, almost two of every three deliveries are normal.

Caesarean delivery is a surgical procedure to deliver babies through a horizontal or vertical incision on the mother’s belly. The operation is used almost solely to save the mother and baby’s life. During this surgery, the mother’s belly muscles are separated to make a second cut (incision) on the wall of the womb. Then, the baby is extracted through the womb wall, and the womb and belly are closed with stitches. It is often necessary when a vaginal delivery would put both the baby and mother at risk.

The continuing increase in patient-initiated caesarean sections without medical indications

According to Kornelsen, Hutton, & Munro (2010), the occurrence of patient-initiated elective caesarean sections is a benchmark for these trends of increasing maternal choice of birth. It is predicted that 18.5 million caesarean sections are carried out annually in the world, and 3.6% of the procedures are performed without any medical or surgical indications (Walana, Ekuban, & Acquah et al.:2017). Lauer, Betrán, Merialdi, Wojdyla, & Betrán (2017) referred to the World Health Organization (WHO) report in which it is recommended that caesarean delivery rates should not exceed 10-15% while the WHO instituted that caesarean section as an essential treatment in pregnancy and is recommended at a rate of 5–15% of all births.

The caesarean section rate has increased in different parts of the world, both in developed countries and in developing countries. Already in 2013, Zhao & Chen observed that caesarean sections increased worldwide and that the above observations have been well documented over the past two decades. Walana, Ekuban, Acquah et al.: (2017) said explicitly that the increasing trend of CSs has generated much controversy regarding the causes of such tendency. Vaginal delivery is safest for the foetus and for the mother when the newborn is full-term at the gestational age of 37 to 42 weeks. Vaginal delivery is preferred considering the morbidity and mortality associated with operative caesarean births has increased over time (Desai & Tsukerman: 2021).

Benefits of vaginal birth for the mother

Going through labour and having a vaginal delivery is a long process that can be physically tiring and is hard work for the mother. But one of the benefits of having a vaginal birth is that it has a shorter hospital stay and recovery time compared to a c-section. With the correct and appropriate health education, the mother should experience birth positively.

Although state laws vary, the typical length of a hospital stay for a woman following a vaginal delivery is between 24 and 48 hours. If a woman is feeling up to it, she may elect to leave the hospital sooner than the allowable time permitted in her state, Bryant told Live Science (Live Science: 2021).

Women who undergo vaginal births avoid having major surgery and its associated risks, such as severe bleeding, scarring, infections, reactions to anaesthesia and longer-lasting pain. And because a mother will be less woozy from surgery, she could hold her baby and may begin breastfeeding.

Benefits of vaginal birth for the baby

Some advantages for a baby who is delivered vaginally is that a mother will have more early contact with her newborn than a woman who has undergone surgery, and she can initiate breastfeeding sooner, Bryant said (Live Science: 2021).

During a vaginal delivery, muscles involved in the process are more likely to squeeze out fluid found in a newborn’s lungs, Bryant said, which is beneficial because it makes babies less likely to suffer breathing problems at birth. Babies born vaginally also receive an early dose of good bacteria as they travel through their mother’s birth canal, which may boost their immune systems and protect their intestinal tracts.

The benefits of vaginal delivery include:

• Fewer risks from surgery
• Early breastfeeding
• Shorter stay and quicker recovery

Nurses and midwives should carefully explain the benefits and the possible risk/complication associated with CSs to clients at the antenatal clinic. All available birthing methods should also be explained giving the merit and demerits to the clients during antenatal clinic sessions.