C-section vs normal delivery in Singapore: how to decide with your gynae

If you and your baby are well, KKH and NUH encourage a normal delivery, and a C-section is usually planned for a medical reason. So C-section vs normal delivery is mostly a question about your own pregnancy: why a C-section is being offered and how each recovery fits your first weeks at home. Whether you'd like more children matters too. KKH's obstetricians put the hospital stay at 1 to 2 days after a normal delivery and about 3 days after a C-section.

How to decide between a C-section and a normal delivery, step by step

1. Ask your gynae why a C-section is, or isn't, advised for you. SGH's obstetricians list the usual reasons: a previous C-section, a baby lying in the wrong position, placenta praevia (a placenta covering the opening of the cervix), twins or more, and some health conditions in the mother.
2. Ask what the risks are for you, given your history. SGH says complications are more likely when a C-section is done as an emergency, and with each previous C-section.
3. Raise it early if you'd like a C-section without a medical reason. NUH says your reasons should be talked through, along with the benefits and risks of each birth, and that counselling should be offered if you're afraid of giving birth.
4. Ask what happens if a planned normal delivery changes course. KKH expects most women to deliver vaginally, and puts the chance of an emergency C-section during labour at 10%.
5. Ask what to do if labour starts before a booked C-section. KKH says about 10% of women go into labour before their planned date, and asks you to go straight to its Delivery Suite without eating or drinking.
6. Tell your gynae if you hope to have more children. SGH lists a repeat C-section, a tear in the womb scar and placenta problems among the risks in later pregnancies.
7. Line up help at home for the first six weeks. After a C-section, KKH says not to lift anything heavier than your baby, and not to drive until your wound has healed, which can take up to six weeks.
8. Write your choice into your birth plan, with what you'd like if things change on the day. Our guide to writing a birth plan in Singapore covers what to include.
9. Compare the bills for your ward type with our delivery cost calculator.

When a C-section is planned, and when it's an emergency

A planned (elective) C-section is booked ahead. KKH's leaflet says your doctor books the date at an antenatal clinic visit. If your baby is bottom-first, our guide to a breech baby in Singapore explains what can be tried before a C-section is booked.

An emergency C-section is decided during labour. KKH gives two common reasons. Your baby's heart rate pattern on the monitor becomes worrying, or your cervix stops opening and the baby's head stops moving down. SGH says complications are more likely in an emergency C-section than in a planned one. Our guide to the C-section in Singapore covers the day itself.

Asking for a C-section without a medical reason

You can ask. KKH's leaflet on planned C-sections says one may be done at your request. KKH's obstetricians also write that vaginal births are usually encouraged, and that C-sections are done for medical reasons as your obstetrician judges them. NUH is firmer. It says a request on its own isn't a reason for surgery, and that women with no medical reason should be strongly encouraged to have a vaginal birth.

In practice, it's a talk with your gynae. Say what worries you, whether that's labour pain, a hard first birth or not knowing when labour will start. NUH says counselling should be offered for fear of childbirth. If pain is the worry, ask about an epidural; our epidural guide covers your choices. If timing is the worry, the RCOG in the UK says you can ask to have labour started in a planned way, which is induction of labour.

UK advice goes further than the Singapore pages. The RCOG says that if you've weighed the risks and still want a planned C-section, your team should support it, or refer you to a team that can. None of the Singapore hospital pages we read sets out a rule like this, so ask your gynae where they stand.

How recovery compares after each birth

A C-section is surgery, so healing takes longer. NUH says recovery from the operation takes at least 6 weeks, and that exercise and sex should wait until you've fully recovered. KKH's leaflet adds that numbness around the scar can last several months. In the UK, the RCOG says 1 in 10 women have some discomfort for the first few months.

After a normal delivery, the soreness is lower down. KKH's obstetricians list tears or swelling of the genitals, and a risk of incontinence later, as the downsides. Our guide to episiotomy and perineal tears covers stitches and healing, and exercise after giving birth has a plan for each kind of birth.

If your family is planning confinement at home, the extra hands help most after a C-section. KKH's leaflet says you'll need extra help and support from family and friends. Ask your partner, your mum or your helper to carry the laundry and the shopping for those weeks.

What each birth means for your baby

In the UK, the RCOG says most women recover well and have healthy babies either way. SGH and KKH both list breathing problems and injury, such as cuts, among the possible problems for a baby born by C-section.

Timing matters for breathing. The RCOG says a planned C-section is usually offered at or soon after 39 weeks. Babies born earlier more often need help with breathing in the neonatal unit: 1 in 24 at 38 weeks, compared with 1 in 56 after 39 weeks.

KKH's leaflet says that if you and your baby are well, the midwife brings your baby to you for a cuddle. The RCOG says you're no more likely to have breastfeeding problems after a C-section than after a vaginal birth.

Future pregnancies: VBAC or a repeat C-section

A C-section shapes your next birth. KKH's obstetricians say you're more likely to need another C-section later, while a normal delivery makes later ones easier. SGH lists the risks a womb scar brings to later pregnancies, including a repeat C-section, the scar tearing, problems with the placenta and a pregnancy implanting in the scar. The RCOG adds that the chance of placenta accreta, where the placenta doesn't come away after the birth, rises with every C-section.

Trying for a vaginal birth after a C-section is called VBAC, and whether it suits you depends on your scar and on how your next pregnancy goes. Our VBAC guide has KKH's success and scar figures. Planning a big family? Tell your gynae now.

When to see a doctor

Before the birth, go to your delivery hospital straight away for any of these. Don't wait for your next check-up.

• Your baby is moving less than usual. KKH lists this as a reason to go to its Delivery Suite, and our baby kick counter helps you keep track from day to day.
• Vaginal bleeding, a fever, a severe headache or changes in your vision, or tummy pain (KKH).
• Leaking waters or signs of labour from 22 weeks. KKH asks you to go straight to the Delivery Suite.
• Labour starting before your planned C-section date. KKH asks you not to eat or drink, in case you need surgery.

After a C-section, call your hospital or go back for any of these:

• Heavy bleeding from the vagina, or pain low in your tummy. NUH says this could mean an infection that needs antibiotics.
• Pain or tenderness in a calf, shortness of breath or a cough. NUH links these to blood clots.
• Bleeding that lasts more than six to eight weeks (KKH).

At KKH, go to the Delivery Suite on Level 2 of the Women's Tower from 22 weeks. KKH's Urgent O&G Centre in Basement 1 is open 24 hours, and it sees problems after pregnancy too. Booked elsewhere? Call your gynae's clinic or go to your hospital's delivery suite; our guide to premature labour signs lists where to go at KKH, SGH and NUH. NUH says to call 995 if your condition needs immediate medical attention. Our guide to postnatal recovery after birth lists warning signs after either kind of birth.

Frequently asked questions

C-section or natural birth, which is better?

Neither suits everyone. When you and your baby are well, KKH and NUH encourage a vaginal birth, which has a faster recovery. SGH says a C-section is planned when a normal birth is unsafe for you or your baby. Our guide to natural birth in Singapore covers preparing for a normal delivery.

Can I choose a C-section in Singapore?

You can ask for one. KKH's leaflet says a planned C-section may be done at your request. NUH says a request on its own isn't a medical reason, and that the reasons behind it should be discussed. Raise it early in your pregnancy, so there's time to talk it through.

When is an elective C-section done in Singapore?

KKH says your doctor books the date at an antenatal clinic visit. The Singapore hospital pages we read don't give a set week. In the UK, the RCOG says it's usually at or soon after 39 weeks, so ask your gynae what they plan for you.

What's the recovery time for a C-section vs normal delivery?

NUH says recovery from a C-section takes at least 6 weeks, and KKH says not to drive until the wound has healed. After a normal delivery, KKH says you usually go home in 1 to 2 days and recover faster. Your postnatal check is at 4 to 6 weeks after a C-section, or 6 weeks after a normal delivery.

How common is caesarean section in Singapore?

NUH's page quotes Ministry of Health figures showing that 30.5% of deliveries were caesareans in 2001 to 2003, and that 26.5% of NUH's own deliveries were caesareans in 2008. We didn't find a newer official figure.

Is a C-section less painful than a normal delivery?

During the surgery, most women feel no pain. KKH says the injection in your lower back numbs you from the waist down, so you feel pulling and tugging but no pain. The pain comes afterwards, in the wound, and KKH gives regular painkillers for it. In labour, an epidural gives fuller relief than gas or a pethidine injection, which KKH says give up to 60%.