C-Section vs. Vaginal Birth: What's the Difference?

People often wonder about the difference between C-section (also called cesarean section) and vaginal birth. Ask a group of parents about their birth stories, and chances are at least one (or more) of them delivered by C-section, a procedure used to deliver a baby surgically. In fact, about one-third of all babies in the US are born via C-section. However, most are born vaginally, a process that is also sometimes referred to as "natural birth" (especially when the birth is unmedicated).

While the majority of pregnant people plan to deliver their babies vaginally, others plan a C-section for a variety of reasons. Most C-sections are planned due to medical necessity or personal preference (this is called an elective C-section), while others are performed on an emergent basis (this is called an emergency C-section). Learn more about the differences between vaginal births and C-sections.

Types of C-Sections

Most babies are born vaginally, and it's recommended to avoid having a C-section when not medically necessary. However, if complications occur, either in the pregnancy or during labor, a C-section may be planned or done on an emergency basis. A person can also elect to have a C-section, whether or not it's medically indicated.

Planned or elective C-sections

Doctors may recommend a scheduled or planned C-section if it's considered safer for the pregnant person or baby than vaginal delivery. For example, pregnancy with multiples, fetal macrosomia (a large baby), breech presentation (the baby is feet-first instead of head-first), previous C-sections, complications with the placenta, or maternal medical issues like high blood pressure, heart disease, or diabetes may warrant a planned cesarean delivery.

Additionally, some pregnant people choose to have an elective C-section, for personal reasons, such as extreme fear or anxiety about labor or childbirth, the desire to avoid injury or trauma to the vagina, vulva, or perineum, or even gender dysphoria. While health care providers will typically encourage trying for a vaginal delivery over an elective or medically unnecessary C-section, what's right for the pregnant person also matters. This is a personal decision that the pregnant person gets to make with their medical provider.

Unscheduled C-sections

It is important to note that not all unplanned or unscheduled C-sections are emergencies. For instance, if your cervix stops dilating, you and your healthcare provider may decide that a C-section is warranted, even though you and your baby are just fine. Long labors are another reason for an unscheduled C-section, especially if you are exhausted. Again, you and your baby may be fine but it makes more sense to have a C-section.

Emergency C-sections

Emergency C-sections are done when something happens during labor to necessitate delivering the baby right away. For example, the fetus or pregnant person is in distress, or there are other worrisome problems like placental abruption or a prolapsed umbilical cord. The procedure itself is essentially the same as a planned C-section, except that it typically is done much more quickly.

The Birth Process: C-Section vs. Vaginal Birth

Whether you give birth by C-section or vaginally is just one variable of many that impact your overall experience, but the basic process of giving birth looks very different when comparing the two methods.

Vaginal delivery

During a vaginal birth, the pregnant person will experience all three stages of labor. The cervix thins (effacement) and opens (dilation) while uterine contractions, which can feel like super-strong menstrual cramps, digestive distress, and/or intense backache, move the baby down toward the vaginal opening, where it eventually emerges after pushing. The umbilical cord is eventually clamped and cut (though this can be delayed). After the baby is delivered, the placenta should follow within 30 minutes before additional interventions may be needed.

While the basic principles remain the same, vaginal delivery can look very different from person to person and can include many different types of interventions. For example, people can give birth vaginally without the use of pharmacological pain relief (unmedicated) or they may opt for medications such as nitrous oxide, IV pain medication, or an epidural to help manage pain.

Labor can begin spontaneously or be induced. As a result, vaginal birth may be aided by interventions like medications to ripen the cervix or start or enhance contractions. A baby's vaginal delivery can also be assisted by tools like forceps or a vacuum or procedures like episiotomy.

Labor and vaginal delivery can last 12 to 14 hours (or longer) for first-time parents. It's often quicker for subsequent births, but not always. Just like every pregnancy is different, each birth experience is also unique—and often doesn't go exactly as planned or expected even if you've done it before.

With an uncomplicated vaginal delivery, you'll probably be able to hold your little one immediately after birth. You can usually initiate breastfeeding at that time if desired.

C-section delivery

A planned C-section operation usually takes about 45 minutes from start to finish, with the baby being born in the first 10 to 15 minutes. In an emergency C-section, on the other hand, the baby may be delivered in just minutes.

The vast majority of C-sections are performed while the pregnant person is awake. You will usually receive an epidural or a spinal block to numb the lower half of the body while remaining alert. In very rare cases (and usually only in emergency situations), general anesthesia may be used.

The surgery itself won't hurt due to the pain medication, but you may feel pressure during your C-section and a tugging sensation when the baby is pulled out.

In an operating room, the doctor makes an incision above your pubic bone and into the wall of the abdomen. Another incision is made in the wall of the uterus through which the baby is delivered. Then, surgical staff cut the umbilical cord, remove the placenta, and close the incision. They'll typically put up a screen so you won't see the surgery being performed, but barring any complications, you'll be able to hear and see your baby as soon as they're born and hold them soon afterward.

In non-emergent cases, you may have the option to incorporate experiences like immediate skin-to-skin contact and witnessing the birth. This is sometimes known as a "gentle C-section."

Recovery: C-Section vs. Vaginal Birth

Recovery time is difficult to predict because individual people experience labor, delivery, and postpartum differently. In addition to how a person gave birth, the person's medical history and postpartum support as well as the length of labor and any complications that occurred during labor or delivery will impact how long postpartum healing takes.

Recovery after vaginal delivery

After an uncomplicated vaginal birth, most people stay in the hospital for 24 to 48 hours, but full recovery is a much longer process. Postpartum symptoms include vaginal bleeding (known as lochia), cramping, swelling, soreness, constipation, hormonal changes, and more. If you experienced significant vaginal or perineal tearing or an episiotomy, you likely will have to deal with stitches as well.

People should take it easy for at least a few weeks after vaginal delivery. It typically takes at least six weeks to return to some sense of normalcy, with regards to hormonal and bodily changes, but often postpartum recovery requires more time.

Recovery after C-section delivery

If you have a C-section, you'll experience many of the same side effects of vaginal birth, such as vaginal bleeding and soreness. You'll also have wound soreness. You may feel a little nauseated and weak during the first few days; coughing, sneezing, and laughing may cause pain.

You'll typically be encouraged to get up and start moving around within several hours after the surgery, even for short periods. Walking is important to prevent blood clots in your legs, boost circulation, and help with digestion.

You'll probably be able to go home in two to four days. Your sutures aka stitches will dissolve on their own, and if you have staples then those may be removed prior to going home, depending on the type of incision you have. Steri-Strips are typically placed over the surgical incision after staple removal. You'll get a prescription for pain medication, and it's recommended to spend the next few weeks focusing on resting, wound care, and taking care of your baby.

Although the pain will linger for a while, you'll probably be feeling much less discomfort and your incision will have healed in about a month. However, again, the full postpartum recovery period lasts at least six weeks, but often a few weeks longer after having a C-section.

Complications: C-Section vs. Vaginal Birth

A variety of complications can occur in either a vaginal or c-section delivery.

Potential complications from a vaginal delivery

In a vaginal delivery, the pregnant person may experience perineal tears, or they might need an episiotomy, an incision made to enlarge the vaginal opening. These complications often require stitches and can cause significant pain.

Other complications associated with vaginal delivery include retained placenta (when the placenta doesn't separate from the uterine wall on its own) and postpartum hemorrhage. Pelvic floor dysfunction and pelvic organ prolapse are also possible after vaginal birth, although these don't typically occur in the immediate postpartum period.

Potential complications from a C-section delivery

Possible complications after a C-section include infections of the uterine lining and incision, excessive bleeding or hemorrhage, injury to the bladder or bowel during surgery, negative reactions to anesthesia, and blood clots like deep vein thrombosis (DVT) and pulmonary embolism. People who had prior C-sections also risk uterine rupture (their C-section incision rips open), which can cause life-threatening bleeding.

Placenta previa (when the placenta partially or entirely covers the cervix) and placenta accreta (when the placenta implants into the uterine muscle instead of the lining) are also more common in subsequent pregnancies after C-section, says David Colombo, MD, Director of Maternal-Fetal Medicine at Spectrum Health in Grand Rapids, Michigan.

Keep in mind, however, that C-section complications, particularly severe ones, are rare, and the surgery is considered generally very safe.

While C-section risks to the baby are minimal, infants sometimes develop respiratory issues, especially if they're born before 39 weeks. Labor and vaginal delivery help release fluid from the baby's lungs. Since many C-section parents don't go through labor, their babies don't reap the same benefits. Rarely, C-section babies could be injured during surgery, and they sometimes have temporarily low Apgar scores.