Vaginal and Cesarean Section Delivery

At times, it may have seemed like your pregnancy would last forever, but finally, your due date is approaching!  These final weeks are both exciting and frightening; you cannot wait to meet the new life you have been nurturing for so long, yet the prospect of childbirth can be daunting, especially for first-time mothers or for those whose pregnancy has offered unexpected challenges.  At Commonwealth OB-Gyn, conveniently located in Brookline Village just steps from downtown Boston, our goal is prepare you, physically and mentally, for all that labor and delivery brings, and to help you prepare yourself to bring a beautiful new life into this world.  

Preparation is key to a successful labor and delivery.  To facilitate your preparation, our Board Certified obstetricians will take the time to help you understand what you can expect during your delivery, help you understand your options for pain medication, and ensure that you are prepared for potential complications that may arise during labor, such as the need for induction or emergency C-section.  Our obstetricians are affiliated with Brigham & Women’s Hospital, one of the best labor and delivery hospitals that the Boston area has to offer, so you can rest assured that you will have very best obstetricians, nurses, support staff, and (if needed) emergency medical personnel available to you to ensure a safe delivery and a happy, healthy start to your baby’s long life!


Vaginal Delivery

Most obstetricians now generally agree that whenever possible, vaginal delivery is the best method of childbirth for both mother and child.  During vaginal delivery, regular contractions dilate (open) the cervix until the child can move head-first through the birth canal (vagina).  The initial phase of labor, the contractions, begin as weak cramps, gradually strengthening in intensity and frequency.  This phase can progress very slowly.  Most women should plan to go to the hospital when contractions are regularly spaced about five minutes apart or when their “water breaks”, although women in high-risk pregnancies or who have experienced previous rapid deliveries should contact their obstetrician immediately.

Many women find vaginal childbirth eased by the application of pain medication, usually in the form of an epidural and/or spinal block delivered intravenously into the lower back.  During the final few weeks of pregnancy, we will walk you through the various pain relief options available to you, help you understand the benefits (and risks) of all the alternatives, and work with you to develop a pain management plan for your delivery, as well as ensure that you understand additional options that may be required to adapt for unexpected circumstances. 

When Is Induction Required?

In most cases, labor begins on its own without the need for medical intervention.  In some cases, however, labor may not start on its own or begins but does not progress.  In these cases, your obstetrician may decide that induction is required.  Induction involves the use of medication to start contractions or to speed up contractions if they begin to stall.  Induction may be considered if:

  • You are one to two weeks past your natural due date
  • Your water has broken but contractions have not started
  • Your baby appears to have stopped growing
  • You have an infection in your uterus or other medical condition that puts you and/or your child at risk
  • There is not sufficient amniotic fluid around the baby (oligohydramnios)
  • The placenta has deteriorated or begun to separate from the inner uterine wall
  • You have a history of rapid delivery during previous pregnancies
  • Induction and other interventions do increase the risk of potential complications, so induction is only considered in those rare instances when the benefits to both mother and child outweigh the potential risks; we do not consider induction for convenience or ease of scheduling.  


    Cesarean Section (C-Section) Delivery

    In some cases, a vaginal birth is not possible, appropriate, and/or safe for mother and/or child and surgical intervention is required.  You may need to undergo a C-section if:

    • Your baby has not turned into a head-down position
    • Your baby is too large to safely pass through your pelvis
    • Your baby is in distress and needs immediate medical intervention

    During a C-section, the obstetrician makes a surgical incision through the abdomen wall and the uterus to remove the fetus directly from the uterus.  You will be awake but under a strong local anesthesia.  A C-section usually involves a longer hospital stay and recovery time than a vaginal birth, and may involve restrictions on movement and lifting for several weeks.     


    VBAC Delivery

    Traditionally, many obstetricians sought to avoid VBAC, or “vaginal birth after C-section”, due to what was believed to be an unacceptably high risk of uterine rupture.  Today, however, advances in surgical technique during C-section have significantly reduced the risk of uterine rupture during VBAC; creating a horizontal (transverse) incision lower in the uterus, as opposed to a vertical incision high on the uterus, greatly increases the opportunity for a safe and successful VBAC during subsequent pregnancies.  You may be a candidate for a VBAC if you:

    • Have had only one prior low transverse uterine incision
    • And your baby are healthy
    • Are experiencing a normal, low risk pregnancy
  • Are not experiencing any of the conditions that made the prior C-section necessary
  • Begin labor on or near your due date
  • VBACs are not recommended for women who have had a previous uterine rupture, have had a vertical incision in the upper part of the uterus, have had two or more C-sections, have an unusually large baby, or whose pregnancy is continuing well beyond the expected due date.  


    Contact Commonwealth OB-Gyn

    If you would like more information about vaginal and/or C-section childbirth aided by the skilled, caring obstetricians at Commonwealth OB-Gyn, or would like to learn more about our practice, our physicians, and our services, we encourage you to schedule your appointment today.  We look forward to hearing from you!

    Commonwealth Ob-Gyn