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What ARE the Risks of Vaginal Birth?

To give equal time in the Risks-Of department, I ask my follow-up question to “What ARE the risks of Cesareans?” – so, what are the risks of having a vaginal birth? In the natural birth arena, much attention is paid to the risks of cesareans… and rightly so… but in the effort of fairness and truth, vaginal births are not without risk, either. Contrary to the saying, “Birth is as safe as life gets,” I’m of the school that believes there are a lot less risky things in life than having a baby. We’re nearly immune to the realities of the inherent dangers in childbirth anymore, by virtue of where we live… with back-up doctors, anti-hemorrhagic medications, antibiotics, clean operating rooms and plenty of skilled physicians and nurses to attend to us. But, looking around the world, a “simple” vaginal birth is an event that brings terror to women and their families. Even with my beliefs and no matter how hard I try to understand, the concept of one woman in 14 dying is unfathomable. The United States’ risk of dying in childbirth is one in 2100.

I asked the question in Facebook and here are the answers, including great answers from nurses who are on the front lines of both types of births. My asides in italics. 

K: Defining risk as being exposure to the chance of injury or loss, I would say, there is a chance you may have a tear down there, if you are not prepped for birth, that is.

S: You can have a tear down there even if you are 'prepped for birth'.

K: Vaginal tearing, shoulder dystocia, hemorrhoids.

S: There are risks of nerve and tissue damage during/from the second stage, blood pressure-related concerns, risk of pelvic/tailbone damage, tearing, bleeding, infection... among others, but those risks are rather rare.

K: Bleeding and infection are risks of any birth, not specific to vaginal delivery.

S: True, but having a vaginal birth still poses those risks. The question was about the risks of vaginal birth, not about risks EXCLUSIVE to vaginal birth.

K: True, I guess I should have said your perineum being prepped... though it is still a risk either way.

NgM: I am quite confused about what a “perineum being prepped” is.

S: Having a baby to take care of afterwards. (admittedly, not exclusive to vaginal birth)

NgM: I found it interesting that women injected comments of the positives of vaginal birth. Not surprised at all, however.

R: Brachial plexus birth injury, incontinence,  permanent nerve damage to clitoris, Pelvic Floor Dysfunction...

C: A really ugly lady garden after.

C: I’ve got to say though, having experienced both routes, it’s vaginal all the way for me.

K: You are at great risk of giving birth the way nature intended.

Childbirth is not without risks, but the evidence points to vaginal birth as the shortest recovery time, fewest complications, and best for both mom and baby. C-sections save lives, but are far from an uncomplicated alternative.

NgM: Another interesting interjection.

C: Urinary and anal incontinence. Painful vaginal area. Loss of vaginal tone (worked with a doc that would use that as his leading cesarean argument).

S: I think we'd have to define risks involved with vaginal delivery at home vs. vaginal delivery at the hospital as well.

You'd also have to look at these risks based upon statistics and how often they occur and then also each individual and their history.

My maternal side's birthing history is an excellent one. German genes and extremely easy birthing experiences. My "risks" are lessened in that aspect. Someone with different genes and a familial history of difficult births will then probably inherit some of those difficulties associated with their birthing history as well. Smaller pelvises/frames will have a tad more difficulties than larger pelvises/frames will.

General risks are cord prolapse, placental previa, nuchal limb presentation that could cause deep tissue tears, and perineal tearing as well. These are not hereditary.

Abnormal Uteri can cause complications. Then looking at PCOS, cysts, and more - they can all increase "risks", as well.

Birth, no matter how you slice it, is a risk. It doesn't matter if you birth vaginally or surgically. Death, infection, complications come from both choices.

Being educated about your body, about birth, and about possible signs of complications will put you ahead of most. Knowing and understanding your family history and what YOU are comfortable in dealing with during birth (epidurals, IV's, interventions of any kind) will help YOU have control of the birth.

As natural as birth is, so is death and even complications. Try not to worry, as it can be harmful to the baby. Just be educated though.

E: I think incontinence was a risk with either route? It seems like I've read that its pregnancy rather than birth that causes it. Ditto hemorrhoids, certain pelvic organ prolapses....

K: Well, I had a accreta with my third child and have never had a CS. I did not realize that was a risk in someone without a C/S history but have since learned differently (the really hard way.)

A: Shoulder dystocia!

J: Pelvic organ prolapse, tears.

J: I have had one mom from my classes who stretched her pelvic ligaments so far after birth that she was not able to walk for a few days after. Six months after her baby's birth she is still doing special exercises.

NgM: Thanks to all the women who participated... are we missing anything?

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Reader Comments (14)

Death. Always a risk for mom and baby.

July 28, 2011 | Unregistered CommenterDawn

Unfortunately, Birth Rape (or assault of any kind, during birth, if you have issues with the use of the term Birth Rape) is becoming a fairly common risk during vaginal births in many settings.

I had permanent damage done to the cartiledge of my pelvic joints during a vaginal birth courtesy of an over zealous nurse 'holding' my knee... behind my spine, but the same thing could have happened if I had fallen or slipped during a lunge.

Cervical tearing is a risk in some births.

Amniotic embolism.

Uterine Rupture (interestingly, the only person I know first hand who had this happen was a first time, unmedicated mother who ruptured in the middle segment of her uterus... and was told she could still VBAC)

Prolapsed cord.



Burst blood vessels.

Complications of rising blood pressure/intercranial pressure during pushing.

Detatched retina (especially in women who have had non-lazer retinal repairs done previously)

Broken tailbone.

July 28, 2011 | Unregistered CommenterStef

I'm really surprised no one mentioned more extreme fetal risks. In the vast majority of cases a vaginal delivery is much safer for both mom and baby. However, in the rare cases of cord prolapse, placental abruption, or other uteroplacental insufficiency the baby is at risk for severe neurologic injury (cerebral palsy) or even demise if an emergent cesarian is not performed.

Also, with regards to maternal risks, in the case of a severe preeclamptic mother who is remote from delivery there can be the risk of seizure or stroke if delivery is delayed by attempting a vaginal delivery.

Risk of a rectovaginal fistula in the case of a prolonged second stage.

And I didn't see the risk for uterine rupture listed.

I realize that I'm listing rare risks. ...and I'm very much an advocate for vaginal delivery. But I think that the natural birth community often fails to recognize that the c-section has its place and saves lives. Yes, it is performed MUCH more often than necessary. But it is sometimes necessary.

July 28, 2011 | Unregistered CommenterAshley

I didn't see symphisis pubis dysfunction on the list.

July 29, 2011 | Unregistered CommenterMethylEthyl

Definitely experiencing urinary incontinence as a result at just 26 years of age. It really stinks to not be able to run/jump.cough/sneeze or throw up without losing control.. I'm going through therapy to try to get tone back. I honestly didn't know it could be this bad. I still don't regret my VBAC at all, but it does make me nervous because I was hoping to have at least 3 more kids. Do I really want to be completely incontinent by 35? Ugh.

I know pregnancy itself doesn't help, but three hours of pushing and a baby that came out sunnyside up at 10 lbs put the nail in the coffin!

July 29, 2011 | Unregistered CommenterMargaret

I think this list covered most of the big ones that I've heard about from my friends' bad experiences and my own (nb. most of my friends have had good vaginal deliveries, but amongst the others I know of cervical tearing, broken tailbone, torn ligament, complete uterine prolapse, and loss of anal continence due to severe tearing.) Baby can also have birth injuries such as severe head compression (which I've heard can be helped by a good infant cranial osteopath after the birth), broken clavicle, etc.

I had a uterine infection and haemorrhage after my vb, not after my c-section, but I understand that this is really unusual - in fact, one of the statistics prejudicing me against an elective c-section was just how much more likely I was to have an infection and severe blood loss again after a section.

July 29, 2011 | Unregistered CommenterT

RE: Incontinence. I believe those roots may be more heredity than vaginal birth. I have it very bad and have since 28 and I hardly pushed my babies out at all. They were born early and small and I had hoped to avoid this condition. Sadly, I haven't and it is a real impediment to life.

July 29, 2011 | Unregistered CommenterVanessa

Coccydynia (broken or damaged tailbone, happened to me), pubic symphisis separation, torn arteries, uterine rupture, torn cervix, placenta abruptio, placenta previa, retained placenta, uncontrolled postpartum blood loss, unresolvable dystocia.

Just off the top of my head. Hehe!

July 29, 2011 | Unregistered CommenterJen Chendea

Not me personally, but an estimated 9000 new cases of obstetric fistula in Ethiopa each year and approx 2-3 million women suffering from this in developing countries would be one serious complication that most people in the US rarely see nowadays.


July 30, 2011 | Unregistered CommenterKaren

I feel compelled to correct Ashley's comment on pre-eclamptic women. For a body that is so stressed it's on the brink of a seizure or stroke, surgery puts even more stress on the body and magnifies that risk. Every attempt at a vaginal birth should be made unless the condition is progressing so quickly there isn't any more time to wait or there is some other contraindicating factor that would make a vaginal delivery impossible. When I had severe PE with CNS involvement, my risk of stroke/seizure was so high they wouldn't even let us turn the lights on in the room. My liver was on the brink of shutting down, and my platelet count had dropped below 40,000. I was told to pray the induction worked because surgery would kill me.

August 1, 2011 | Unregistered CommenterJen

Symphisis pubis dysfunction--isn't that a risk of pregnancy and not of vaginal birth? I had it and had a vaginal birth with an epidural and still felt/functioned better after my daughter was born simply because I wasn't pregnant anymore!

August 1, 2011 | Unregistered CommenterAmelia

Symphasis pubis dysfunction is not a risk of vaginal birth, else women wouldn't have it during first pregnancies. Amelia is right in that it's a risk of pregnancy.

August 2, 2011 | Unregistered CommenterMarie

Cervical laceration - I had no idea that this could even happen! I am so thankful that I delivered at a hospital with a competent CNM who found the source of the hemmorhage quickly and got me into an operating room with an O.B. Even with prompt care, I nearly wound up needing a blood transfusion.

I guess that this experience is why I'm a staunch advocate for well-trained midwives. I hear a lot of complaining about CNMs being "medwives," but when it's your life (or your baby's) on the line, you'd better hope that your care provider really knows her stuff. While I would personally never have a homebirth, I support a woman's right to do so. I just think that she deserves care from a professional, and there are too many lay midwives who are nothing but amateurs.

August 4, 2011 | Unregistered Commentermoto_librarian

I'm kinda surprised no one's mentioned the risks to the baby. They're rare (we see less than 200 babies out of the 45,000 born in the province where I live each year, I work in a Level III NICU, most of the babies we see are premature), but still happen.

Intraventricular hemorrhage (IVH) (almost unheard of in term babies, happens more and more often the more premature a baby is)
Hypoxic Ischemic Encephalopathy (HIE) (either as a result of birth gone horribly wrong, or sometimes as a result of forceps or vacuum delivery when things are starting to go wrong and they have to get the baby out FAST)
Bruising (especially on premature babies)
Broken bones (I have seen broken collar bones, broken arms and femurs, the femurs was part of a genetic thing though)
Death (as a result from cord/placenta accidents, prolapse, HIE, infection, etc etc etc)
Asphyxia (leading to HIE)
GBS infection (almost unheard of in a c-section born, positive mom whose membranes were still intact, our decision making pathway on whether to give antibiotics in the first 48 hours of life is very dependant on VB vs CS, membranes intact or not, antepartum antibiotics or not)

March 2, 2013 | Unregistered CommenterNICU Nurse

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