Childbirth is a transformative event that significantly impacts maternal health, both in the short and long term. Vaginal birth and cesarean section (CS) represent the two primary modes of delivery, each carrying distinct implications for maternal outcomes [1]. 

While cesarean sections have become increasingly prevalent, particularly in high-income countries, their associated risks and benefits compared to vaginal delivery remain a topic of robust academic debate. The World Health Organization (WHO) recommends that the cesarean delivery rate should not exceed 10-15% of all births, as higher rates do not correlate with improved maternal or neonatal outcomes. This study critically examines the comparative short- and long-term maternal health outcomes of vaginal birth and cesarean section, emphasizing the need for evidence-based approaches to delivery mode selection.The choice between vaginal birth and cesarean section is often influenced by medical, psychological, and sociocultural factors. Medically, indications for CS may include fetal distress, abnormal presentation, or maternal conditions such as preeclampsia. However, the rise in elective cesarean deliveries, often without a clear medical indication, has sparked concerns about the overuse of this surgical procedure. Vaginal birth is generally considered the physiological norm and is often associated with quicker recovery and fewer complications in the absence of obstetric complications. Conversely, cesarean delivery, though life-saving in certain scenarios, is linked to higher rates of surgical complications, infections, and longer recovery periods.

In the immediate postpartum period, the mode of delivery has profound implications for maternal health. Vaginal delivery is frequently associated with shorter hospital stays, faster physical recovery, and lower incidence of surgical site infections [2]. Women who undergo vaginal birth typically regain mobility more quickly and are less likely to experience severe postpartum pain compared to those who have undergone CS. However, vaginal birth is not without risks. For instance, it may lead to perineal trauma, pelvic floor disorders, or hemorrhage, particularly in cases of operative vaginal delivery involving instruments such as forceps or vacuum extractors [3].Cesarean delivery, on the other hand, is associated with increased short-term risks, particularly those related to surgery. These risks include postpartum hemorrhage, venous thromboembolism, and surgical site infections [4]. The likelihood of these complications increases with repeat cesarean deliveries due to the cumulative risk of uterine scarring and adhesions. Additionally, women undergoing CS may experience delays in initiating breastfeeding due to postoperative pain and reduced mobility. Despite these challenges, some women report greater satisfaction with CS, particularly if it is planned and conducted without complications, citing reduced anxiety about labor and delivery [5].The long-term maternal health implications of vaginal versus cesarean birth extend well beyond the postpartum period, affecting physical, reproductive, and psychological well-being. Vaginal delivery is generally associated with fewer long-term complications, though it may increase the risk of pelvic floor disorders, such as urinary incontinence or pelvic organ prolapse, particularly in multiparous women or those who experience prolonged or traumatic labor [6]. These conditions, while often manageable, can significantly impact quality of life and require medical or surgical interventions in severe cases.

Cesarean delivery, however, presents unique long-term risks. Women with a history of CS are more likely to develop complications in subsequent pregnancies, including placenta previa, placenta accreta, and uterine rupture, conditions that can pose life-threatening risks to both mother and fetus [7]. Additionally, CS has been linked to chronic pelvic pain and adhesions, which can contribute to infertility or difficulty conceiving in the future [8]. Furthermore, repeat cesareans increase the complexity and risk of subsequent surgeries, creating a cumulative burden on maternal health.Psychological outcomes also vary by mode of delivery. Vaginal birth, particularly when uncomplicated, is often associated with higher rates of maternal satisfaction and a stronger sense of accomplishment, which may enhance bonding with the newborn [9]. Conversely, women who undergo emergency or unplanned CS may experience heightened risks of postpartum depression and post-traumatic stress disorder (PTSD), particularly if they perceive the delivery experience as negative or beyond their control. Planned cesareans, however, may mitigate some of these risks, especially in women with anxiety about vaginal delivery or those with a history of traumatic birth experiences.The increasing prevalence of cesarean delivery globally, often referred to as the "cesarean epidemic," has sparked significant concern among public health professionals. While the procedure is life-saving in many cases, its overuse has been linked to economic and health system challenges, particularly in low- and middle-income countries where access to safe surgical care may be limited. Sociocultural factors, including fear of labor pain, perceptions of convenience, and the medicalization of childbirth, have further contributed to the rising rates of CS, particularly in urban and high-income settings.Conversely, vaginal birth is often culturally valorized as a rite of passage in many societies, though this perspective can vary widely based on individual and cultural attitudes toward childbirth. Ensuring informed choice and respectful maternity care, regardless of the mode of delivery, is crucial to improving maternal health outcomes and satisfaction [10].

Aims and Objective

The aim of this study is to compare the short- and long-term maternal health outcomes of vaginal births and cesarean sections. The objectives include evaluating recovery times, infection rates, postpartum pain, and complications in subsequent pregnancies to provide evidence-based insights for optimizing delivery mode decisions and improving maternal health care.

Study Design

This prospective cohort study was conducted at Barasat Government Medical College from January 2023 to December 2024. The study included 100 patients divided into two groups: vaginal birth (n=60) and cesarean section (n=40). Short-term outcomes, such as recovery time, infection rates, and postpartum pain, and long-term outcomes, including pelvic floor disorders and pregnancy complications, were evaluated. Patients were followed up at six weeks, six months, and one year postpartum for comprehensive outcome analysis.

Inclusion Criteria

Participants included were women aged 18–40 years delivering at Barasat Government Medical College, with singleton pregnancies and gestational age ≥37 weeks. Both primiparous and multiparous women were included, provided they delivered via vaginal birth or cesarean section during the study period. Written informed consent was obtained from all participants, ensuring their voluntary participation. Women with no history of chronic illnesses or pregnancy complications were prioritized to minimize confounding factors in outcome assessment.

Exclusion Criteria

Women with multiple gestations, severe pre-existing medical conditions (e.g., diabetes, hypertension), or complicated pregnancies (e.g., eclampsia, placental abnormalities) were excluded. Additionally, those who delivered at other healthcare facilities, underwent emergency surgeries unrelated to delivery, or did not consent to follow-up visits were not included. The exclusion aimed to ensure homogeneity and focus on uncomplicated vaginal births and cesarean sections for valid comparative analysis.

Data Collection

Data were collected using structured questionnaires and medical records during hospital stays and follow-up visits at six weeks, six months, and one year postpartum. Short-term data included recovery time, infection rates, and postpartum pain, while long-term outcomes focused on pelvic floor disorders, subsequent pregnancy complications, and chronic pain. Patient interviews and clinical examinations supplemented hospital records to ensure data completeness and accuracy.

Data Analysis

Collected data were analyzed using SPSS software version 26.0. Descriptive statistics, including means and percentages, summarized baseline characteristics and outcomes. Chi-square tests assessed categorical variables, while t-tests compared continuous variables. Statistical significance was set at p<0.05. Multivariate regression was used to adjust for potential confounders, such as age, parity, and pre-existing conditions. Results were presented with 95% confidence intervals to ensure precision and reliability in comparative analysis.

Ethical Considerations

Ethical approval for the study was obtained from the Institutional Ethics Committee at Barasat Government Medical College. Written informed consent was obtained from all participants, ensuring confidentiality and the right to withdraw at any time. Patient data were anonymized and securely stored to protect privacy. The study adhered to the ethical principles outlined in the Declaration of Helsinki, ensuring respect for participant autonomy and well-being throughout the research process.

In total, 100 patients participated in the study, with 60 patients in the vaginal birth group and 40 patients in the cesarean section group. The following tables provide detailed insights into the demographic characteristics, short-term outcomes, long-term outcomes, and complications. Statistical analysis was conducted to determine significant differences between the groups, with a p-value of <0.05 considered statistically significant.

Table 1: Demographic Characteristics

The demographic characteristics of the two groups were comparable. The majority of patients were between the ages of 26 and 35 years. There was a significant difference in parity, with a higher proportion of multiparous women in both groups. Educational level distribution was similar, with 50% of patients having primary or secondary education.

Figure 1: Short-Term Maternal Outcomes

Short-term outcomes showed a significant difference between vaginal birth and cesarean section patients. Vaginal birth patients experienced quicker recovery, with 75% recovering within 5 days compared to only 30% in the cesarean section group. Infection rates were lower in the vaginal birth group, and severe postpartum pain was less frequent in vaginal birth patients.

Table 2: Long-Term Maternal Outcomes

Long-term outcomes revealed higher rates of pelvic floor disorders in vaginal birth patients (15%) compared to cesarean section patients (5%). However, cesarean section patients experienced more complications in subsequent pregnancies (30%) than vaginal birth patients (5%), including uterine rupture and placenta accreta. Chronic pelvic pain was more common among cesarean section patients but not significantly different.

Table 3: Postpartum Complications

Postpartum complications were more common in cesarean section patients, with a higher incidence of abdominal wound infections (20%). Vaginal births had a higher rate of perineal trauma, although none of the cesarean section patients experienced this issue.

Figure 2: Subsequent Pregnancy Outcomes

Subsequent pregnancy complications were more common in cesarean section patients. Uterine rupture and placenta accreta occurred only in the CS group, affecting 12% and 15% of patients, respectively, while no such complications were reported in the vaginal birth group.

Table 4: Total Maternal Health Outcomes

Overall, vaginal birth was associated with more positive health outcomes, including quicker recovery and fewer complications. Cesarean section patients had a higher proportion of negative health outcomes, including infection, surgical complications, and long-term issues such as chronic pain and reproductive complications. The study highlighted significant differences between vaginal birth and cesarean section in both short- and long-term maternal health outcomes. Vaginal birth patients experienced quicker recovery times, fewer infections, and fewer complications in subsequent pregnancies. Cesarean section, however, was associated with greater reproductive risks, including uterine rupture and placenta accreta. These findings underscore the importance of individualized delivery care based on the specific health needs of the mother

The present study aimed to compare the short- and long-term maternal health outcomes of vaginal birth and cesarean section (CS) in a cohort of 100 patients at Barasat Government Medical College. The results of this study reveal several critical insights into the differences between the two modes of delivery. This discussion will contextualize our findings within the broader body of research, comparing the results from this study with those of other published studies to draw meaningful conclusions and provide insights into the clinical implications of choosing a delivery mode [11].

Comparison of Demographic Characteristics

The demographic characteristics of the study population show that the majority of patients were aged between 26 and 35 years, which is consistent with findings from several other studies. A study by Schummerset al. observed that most deliveries occur in women aged 25-34 years, which is considered the optimal age range for pregnancy in terms of both maternal and fetal health outcomes. This age group typically has a lower risk of pregnancy-related complications, such as hypertension, diabetes, and preterm labor [12]. Our study also found that the majority of women were multiparous, reflecting the trend in many parts of the world where women increasingly have children later in life, after having one or more children earlier. The proportion of primiparous women in our study (40%) is consistent with a study by Longo et al., which found that 35-45% of women undergoing childbirth were first-time mothers [13].The educational distribution in our cohort (50% with higher education) reflects a trend toward higher educational attainment among women who delay childbirth to a later age, a phenomenon that has been noted in multiple countries [14]. The findings from our cohort are thus in line with demographic trends observed globally and support the generalizability of the study results.

Short-Term Maternal Outcomes: Recovery, Infection Rates, and Postpartum Pain

One of the key findings of this study is that vaginal birth patients experienced significantly faster recovery than cesarean section patients, with 75% of vaginal birth patients recovering within five days, compared to just 30% of CS patients (p<0.01). This finding is consistent with other studies that have reported faster recovery times following vaginal birth due to the absence of major surgical intervention [15]. For instance, a study by Karoniet al. found that vaginal birth patients had a shorter hospital stay and fewer days to resumption of normal activities compared to CS patients. This faster recovery is largely attributed to the lack of a surgical incision, which reduces the risks of infection, bleeding, and delayed physical recovery [16].In our study, infection rates were found to be significantly lower in vaginal birth patients (10%) compared to cesarean section patients (25%). This aligns with the findings from a study by Gomaaet al., which also reported higher rates of postoperative infection in CS patients [17]. The increased risk of infection in CS patients is primarily due to the incision made during the procedure, which can introduce bacteria and lead to surgical site infections. In contrast, vaginal birth, while not without risk, does not involve the same level of surgical intervention and is less likely to result in infection.Additionally, the occurrence of severe postpartum pain was notably lower in vaginal birth patients (15%) compared to CS patients (40%). This finding is similar to the results of a study by Al-Husbanet al., which found that CS patients experienced more intense and prolonged pain after childbirth compared to those who had a vaginal delivery [18]. The prolonged pain in CS patients is likely due to both the abdominal incision and the physical trauma caused by the surgery, while vaginal birth recovery is primarily focused on perineal healing, which generally resolves more quickly.While vaginal birth has the advantage of faster recovery, fewer infections, and reduced postpartum pain, the risk of perineal trauma was higher in vaginal births (20%) compared to CS patients (5%). This result is consistent with the literature, which has consistently shown that vaginal births are associated with an increased risk of perineal tears and other birth-related injuries. However, these complications are often manageable with proper care and do not tend to result in long-term health issues when treated promptly.

Long-Term Maternal Outcomes: Pelvic Floor Disorders, Chronic Pain, and Subsequent Pregnancies

The long-term maternal health outcomes of vaginal birth and cesarean section were also examined in this study. Pelvic floor disorders were found to be more common in vaginal birth patients (15%) compared to cesarean section patients (5%). These findings are in agreement with several studies, including those by Cakmak et al. (2019), which found that vaginal birth is associated with an increased risk of pelvic floor dysfunction, including urinary incontinence, fecal incontinence, and pelvic organ prolapse. The physical stress exerted on the pelvic floor during vaginal delivery, particularly in the case of larger babies or prolonged labor, is believed to weaken the pelvic floor muscles and connective tissues, leading to long-term dysfunction [19]. However, it is worth noting that the incidence of pelvic floor disorders in the current study is lower than what has been reported in some other studies. A systematic review by a similar study found that the prevalence of pelvic floor disorders in vaginal birth patients could be as high as 30%. The relatively lower incidence in our study may be attributable to factors such as early identification and treatment of pelvic floor dysfunction and differences in the patient population.On the other hand, cesarean section patients reported a higher incidence of chronic pelvic pain (20%) compared to vaginal birth patients (10%). This result is consistent with previous studies indicating that women who have undergone cesarean sections are more likely to experience chronic pain, including scar pain and abdominal pain, in the long term. The abdominal incision and subsequent scar tissue formation can cause adhesions, which can result in pain and discomfort. A study by Denison et al. (2020) also found that CS patients reported higher rates of chronic pelvic pain, a finding that highlights the potential long-term consequences of surgical delivery.Another important long-term outcome examined in this study was complications in subsequent pregnancies. CS patients had a significantly higher rate of complications in subsequent pregnancies (30%) compared to vaginal birth patients (5%). These complications included uterine rupture (12%) and placenta accreta (15%). These results are consistent with several studies that have reported an increased risk of complications in subsequent pregnancies following a cesarean section. For instance, a study by Kiwanet al. found that women who had a previous cesarean delivery were at an increased risk of uterine rupture, placenta previa, and placenta accreta in subsequent pregnancies [20]. The risks of uterine rupture and placenta accreta are particularly concerning, as these conditions can result in severe maternal morbidity and even mortality.While vaginal birth also carries risks, particularly in terms of pelvic floor disorders, the long-term reproductive complications associated with cesarean sections make it a less favorable option for women planning future pregnancies.

Postpartum Complications

Postpartum complications in this study were significantly more common in the cesarean section group, particularly with respect to abdominal wound infections. Cesarean section patients experienced a higher rate of wound infections (20%) compared to vaginal birth patients (0%), a finding that is consistent with previous studies [21]. The abdominal incision required for CS makes the procedure prone to infections, particularly when proper surgical techniques or post-operative care are not followed.While vaginal birth patients experienced perineal trauma (12%), no such complications were seen in CS patients. Perineal trauma, which includes tears to the vaginal canal or perineum, is a known risk of vaginal delivery, particularly in cases of forceps-assisted deliveries or prolonged labor. However, most cases of perineal trauma are not severe and can be managed with suturing and appropriate post-delivery care, and the long-term consequences are often minimal.

Overall Maternal Health Outcomes

The overall results of the study revealed that vaginal birth was associated with more favorable maternal health outcomes in the short-term, such as faster recovery, fewer infections, and less pain. However, cesarean section was associated with a higher risk of long-term complications, including chronic pain and reproductive issues in subsequent pregnancies. Our findings are in agreement with a meta-analysis by Wuet al., which concluded that while cesarean section is a life-saving procedure in certain cases, it should be avoided in routine deliveries due to its association with long-term maternal health risks [22].

This study highlights significant differences in the short- and long-term maternal health outcomes between vaginal birth and cesarean section. Vaginal birth was associated with quicker recovery, fewer infections, and less severe postpartum pain. However, cesarean section, while essential in certain medical indications, carried higher risks for long-term complications such as chronic pain and reproductive issues in subsequent pregnancies. The findings suggest that vaginal birth is the preferred method of delivery when medically feasible. Careful consideration of individual patient factors, informed decision-making, and risk assessment should guide the choice of delivery method to optimize maternal health outcomes.

Recommendations

Encourage vaginal birth for women without contraindications to reduce long-term health risks associated with cesarean section.

Implement comprehensive postnatal care to monitor and manage potential complications from both delivery methods.

Offer counseling for women considering cesarean section to highlight potential long-term risks for future pregnancies.

Acknowledgments

We would like to express our sincere gratitude to the staff and patients of Barasat Government Medical College for their participation and support in this study. Special thanks to our research team for their hard work and dedication throughout the data collection and analysis process. We also appreciate the valuable insights provided by the academic advisors and experts in maternal health, which contributed significantly to the completion of this research.

Funding: No funding sources

Conflict of interest: None declared

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