In this episode of The Care Circle by Motherhood Hospitals, host Sneha sits down with Dr. Deepika Alva, Consultant Obstetrician and Gynaecologist at Motherhood Hospitals, HRBR Layout, Bangalore, to unpack the many ways babies are born, from spontaneous vaginal births to C-sections, induced labour, assisted delivery, and VBAC (vaginal birth after C-section).
With compassion and clarity, Dr. Deepika helps listeners understand that no one mode of delivery is superior to another. What matters is making an informed choice, in collaboration with your doctor, that prioritises safety and emotional well-being.
Expect real talk about birthing plans, pain relief options, muhurat deliveries, labour positions, postpartum recovery, and the partner’s role after delivery. This episode is your all-in-one birth prep guide – judgment-free and full of expert wisdom.
Here are the key takeaways you shouldn’t miss from this episode:
Dr. Deepika Alva, Consultant Obstetrician and Gynaecologist, Motherhood Hospitals, HRBR, Bangalore
Dr. Deepika Alva completed her MBBS from JSS Medical College, Mysore, and her post-graduation MS (OBG) from Vydehi Medical College, Bangalore in the year 2013. Dr. Deepika Alva has worked as an Assistant Professor in the department of OBG, KSHEMA Medical College, Mangalore.
Dr. Deepika Alva has an experience of 10+ years, in the field of Obstetrics and Gynaecology. Dr. Deepika Alva has expertise in handling high-risk pregnancies, the process of natural birthing, vaginal deliveries, and cesarean sections. Dr. Deepika Alva also provides care regarding pre-pregnancy counseling, and infertility treatment and handles gynecological procedures like hysterectomy, menopausal disorders, menstrual disorders, and adolescent gynecology.
0:15 – “Normal delivery or C-section?” The question every new mom hears
1:05 – Why understanding birth options without judgment is crucial
1:42 – Overview of delivery modes: vaginal, induced, assisted, C-section
2:24 – Difference between normal and vaginal delivery
3:15 – Induced labour: When and why it’s recommended
4:24 – Assisted delivery: When forceps or a vacuum are used
5:12 – VBAC: Who is an ideal candidate?
6:43 – Risks of VBAC, especially uterine rupture
7:46 – TOLAC vs VBAC: What’s the difference and how it’s managed
8:58 – A real VBAC story — and why proper monitoring is essential
10:05 – Planned vs emergency C-section explained
10:57 – CDMR (C-section on maternal request): doctor’s take
12:13 – Muhurat C-sections: navigating cultural beliefs and medical safety
13:15 – Balancing patient preference and clinical safety
14:15 – Myth or Fact: C-section edition
15:53 – Natural birth: What it actually means medically
16:36 – Epidurals: How and when they’re administered
17:13 – Epidural myths busted: You can still push, feel, and deliver
18:34 – Labour positions that help ease birth
19:18 – Is lying down the only delivery position? Not necessarily
19:52 – What goes into a birth plan and why flexibility matters
21:00 – How to emotionally prepare for unexpected birth changes
21:59 – Partner’s role in recovery: Emotional & practical support
23:04 – Recovery differences between vaginal, C-section, and VBAC births
24:20 – Final thoughts: Your birth, your story, and it’s always valid
(0:15) Snehaa: Acha bacha kaise hua? Normal delivery tha ya C-section? It’s one of those questions every new mom gets asked. And the answers? They’re as unique as motherhood itself. Some births unfold with soft music and deep breaths, others with epidurals, surgical precision, or sudden surprises.
But here’s what truly matters. Every birth story is valid, powerful, and deserving of respect. Welcome back to the fifth episode of the Care Circle, a podcast series by Motherhood Hospitals, where we bring real conversations and expert insights on women and children’s health.
I’m Snehaa, your host for today’s episode. In our last episode, we spoke about the third trimester and birth planning. Today, we dive deeper into the modes of delivery to understand them better, without judgement.
Because whether it’s a natural birth or a C-section, what matters is making the right choice, together with your gynaecologist.
(1:14) Snehaa: Joining us today is Dr. Deepika Alva, Consultant Obstetrician and Gynaecologist at Motherhood Hospitals, HRBR Layout, Bangalore. With over a decade of experience, she’s guided a lot of women through vaginal deliveries, assisted births, and even VBAC, always with calm and compassionate care.
Dr. Deepika, welcome to the Care Circle, and we are so glad to have you with us.
(1:38) Dr. Deepika Alva: Thank you, Sneha. These conversations matter so much.
(1:42) Snehaa: So, doctor, let’s begin with the basics. When expecting parents come to you asking about delivery options, what are the main types they should know about?
(1:51) Dr. Deepika Alva: There are generally two main types of delivery in pregnancy as you are aware. Now, vaginal delivery gets further categorised into spontaneous vaginal delivery, induced vaginal delivery, or an assisted vaginal delivery using forceps or vacuum extractors.
The caesarean section similarly gets categorised into two: a planned elective caesarean section or an emergency caesarean section.
(2:13) Snehaa: That’s helpful to have that overview, doctor. I think it takes some pressure off when you know all the options exist for good reasons.
Now, let’s start with vaginal births, doctor. I think many people think that normal delivery and vaginal delivery are equal. Are they different, do you think? And can you walk us through what spontaneous vaginal delivery means?
(2:35) Dr. Deepika Alva: So, both the terms, vaginal delivery and normal delivery, means it’s a natural process of childbirth, where the baby is emerging from the mother’s body through the birth canal or the vaginal canal. These two terms are essentially the same, but from a medical perspective, there’s a slight difference. So, normal delivery means it refers to vaginal delivery that occurs naturally, without the need for any forceps or vacuum cup. So, it’s basically a natural, unassisted vaginal birth.
Whereas, a vaginal delivery is a medical term for the process where the baby is born through the birth canal. It can be with the use of forceps or without it.
(3:13) Snehaa: What about induced labour? I have heard mixed reviews about it. Some people think that it’s more painful, some feel it’s more unnecessary. Can you help us clarify when and why a doctor might recommend inducing labour instead of waiting for it to happen naturally?
(3:29) Dr. Deepika Alva: So, induced labour means when a gynaecologist will help you start labour using medical methods, rather than letting it begin naturally.
So, it’s typically done when there are concerns about the health of the mother or baby, and it’s commonly done for reasons like high blood pressure during pregnancy, gestational diabetes, infections encountered during pregnancy, or a post-term pregnancy, or even for stalled labour, meaning the labour is progressing too slowly or stops altogether.
So, yes, induced labour can have a little more intense contractions than natural labour. That’s because it’s starting off more quickly and should be stronger right from the beginning. Whereas, natural labour pains or contractions are building up gradually over time.
Let’s please understand pain is something very subjective, and it varies from woman to woman and pain management options are always available.
(4:21) Snehaa: That’s a great insight, Doc. I think many people don’t realise there are medical reasons beyond just convenience. Now, when does an assisted vaginal birth become necessary, and how safe is it for both mother and the baby?
(4:35) Dr. Deepika Alva: So, assisted vaginal birth. Now, this is a kind of vaginal birth where instruments like forceps or vacuum cups are used, and this is to guide the baby out of the birth canal. This is typically used when a vaginal birth is prolonged or when there are concerns about mother’s or baby’s well-being.
Situations like maternal distress, foetal distress, prolonged second stage of labour. That means the cervix is fully dilated, but the baby is taking too long to come out, or if there is maternal exhaustion, we use assisted vaginal birth techniques to bring the baby out. Safety-wise, yes, it is safe.
(5:10) Snehaa: I’m glad, Doctor, you mentioned safety. I think that reassurance is important for parents to hear. Now, coming to VBAC, which is also known as vaginal birth after caesarean, this seems to be gaining more attention lately. Who would you consider an ideal candidate for a VBAC?
(5:26) Dr. Deepika Alva: Patients who have given birth by caesarean section in the previous pregnancies can try to have a normal delivery in the present pregnancy. Now, this is what is called vaginal birth after caesarean section. So, there are some factors contributing to selecting a good VBAC candidate.
Primarily, history of one previous caesarean section and not more than that, and the cut that we give on the uterus should be something called as low transverse incision. Second, spontaneous labour increases the chance of VBAC. Third, a history of previous vaginal birth.
This is meant for patients if it is their third pregnancy, where the previous one delivery has been a vagina and the second one has been a caesarean, their chances for VBAC increases. If they have adequate pelvic size, and there’s something called an inter-delivery interval, meaning an interval of at least 18 months is recommended between the previous delivery to the present one, the longer the better. So, these are some factors that we consider which will determine that it is a good candidate for VBAC.
(6:31) Snehaa: That’s really encouraging to hear that it’s possible for many women, but I imagine not everyone can try VBAC, though. Are there any risks associated with VBAC?
(6:41) Dr. Deepika Alva: Definitely. So, VBAC carries potential risks and the most serious risk of it all is uterine rupture. With a scar from the previous caesarean section on the uterus, it opens or tears during labour. This endangers both the mother and the baby. It can lead to increased blood loss, injury to other organs like bladder and the bubble.
This might necessitate an emergency caesarean section in such scenarios. So, definitely all women can’t opt for it, and there are certain risk factors which increase the risk of VBAC. History of multiple caesarean sections, vertical uterine incision on the uterus, prior history of uterine surgeries, or any medical conditions in the current pregnancy requiring caesarean section, a big-sized baby, advanced maternal age, and if the woman is significantly overweight, these are all the risk factors for VBAC and such women can’t opt for it.
(7:33) Snehaa: That individual assessment sounds really important. Can you also walk us through how a trial of labour after caesarean, which is also called TOLAC, is planned and assessed?
(7:43) Dr. Deepika Alva: So, TOLAC stands for trial of labour after caesarean. The difference between TOLAC and VBAC, TOLAC is a trial that we are giving to the women with a history of previous caesarean attempts for a vaginal birth.
If TOLAC becomes successful, then that birth is called a VBAC or a vaginal birth after caesarean. So, how do we assess women to go through stages of TOLAC? It all starts with patient selection, where we are considering individual risk factors and determining if the VBAC is a safe and appropriate choice for such women. We make the patient understand the potential risks and benefits of VBAC, help them make an informed decision about this mode of delivery, and it’s also necessary for us to understand that we need to have a suitable healthcare setting where there’s access to emergency care, including a surgical and a fissure team to manage all kinds of complications that we might encounter, and that effective maternal and foetal monitoring is required to detect any signs of uterine rupture.
(8:45) Snehaa: That sounds like a very careful and measured approach, doctor. Have you had any successful VBAC stories in your practice that you would like to share with our listeners?
(8:56) Dr. Deepika Alva: Yes, we had an interesting kind of a story. I don’t know what was successful, whether it was our attempt or the patient’s.
So, there’s a patient who was in the ninth month, did have some medical complications and the wish for going through a VBAC. We were still contemplating on seeing she’s a good candidate for VBAC, and we were yet to decide about it. But in the meantime, the patient set into labour, was at home, not monitored, and she landed up in our casualty at the very end stage of her delivery, fully dilated and the baby’s head quite low down.
She did deliver vaginally, but she did have some complications post that, some amount of bleeding and all of that, which we tackled. So yes, effectively it was a successful VBAC, but then our question or the moral of the story is, was it an effective and a safe TOLAC, a trial? This is something that we don’t encourage. Patients in labour with the history of previous caesarean, kindly do not take the labour as lightly.
Please reach out to the hospital at the earliest signs of labour so that you’re better monitored and safely monitored.
(10:02) Snehaa: Very interesting story, doctor. Now let’s explore a delivery method that’s becoming increasingly common, which is called C-section delivery. Now, what’s the difference between a planned C-section and an emergency one?
(10:14) Dr. Deepika Alva: So the main difference lies in the timing and the reason for the caesarean section. A planned caesarean section is scheduled much in advance, usually before the labour begins. It could be for any factors like breech presentation, previous caesarean section, truance, placental conditions, certain medical conditions of the mother and baby in the present pregnancy.
Now, an emergency caesarean section is performed when complications arise during labour. It requires immediate delivery. Situations like foetal distress, failure to progress in labour, cot prolapse, or sometimes conditions like or maternal complications like high BP, uncontrolled diabetes might need an emergency caesarean section.
(10:55) Snehaa: This difference is very important, doctor. Now, there has been a lot of debate on social media lately about C-sections done by choice rather than for medical reasons. What’s your take on caesarean delivery on maternal request, or we can call it as CDMR, as it is known. Is it valid, or something we need to be cautious about?
(11:17) Dr. Deepika Alva: So, CDMR are caesarean sections that are performed at the mother’s request without a medical or obstetric indication for this procedure. So it’s basically or essentially a caesarean section, which is chosen by the mother even when we feel a vaginal delivery safe for her. Her reasons could be multiple, desiring to schedule the birth, fear of labour pain, or concerns about any potential complications of vaginal birth.
Regarding its validity, it’s quite a debatable issue in recent times. It’s definitely not a standard medical practice and we do not encourage it. We are expected to counsel patients and then help them make a decision.
Regarding the decision to perform CDMR, it involves two things at the least. One is the patient’s autonomy, where she has a choice and to deliver in the way she wishes to, and as an obstetrician, I have a duty to do what is best for the mother and child.
(12:11) Snehaa: I appreciate that balance perspective, doctor. In some cases also families choose a specific date and time for delivery based on cultural or astrological beliefs, which is also called as Muhurtam deliveries. How do you approach these requests as a clinician?
(12:27) Dr. Deepika Alva: So, scheduling a delivery usually a caesarean section with specific auspicious time based on astrological advice, Muhurat deliveries. Definitely not based on the obstetrician’s advice.
So there are certain risks in it because it’s a surgery, definitely and generally not recommended to have such Muhurat deliveries, but if still a woman wants to have a planned delivery, we still would recommend them to wait at least till 39 weeks of gestation so that the baby’s lungs and other organs are fully developed not before it.
(12:59) Snehaa: That sounds like a thoughtful approach, doctor, and then how do you strike a balance between respecting a mother’s or a family’s personal preferences and ensuring safety through medical guidelines when planning for a C-section?
(13:13) Dr. Deepika Alva: There are certain steps to balance the patient’s preferences and medical guidelines. First and foremost, let us understand the reasons as to why a woman is choosing a caesarean section over normal delivery.
Is it because of the pain factor during labour, or is it because of previous working experience which was bad, or is it a personal factor? Once we understand the reasons, it’s necessary then for us to provide accurate information regarding these things. Discuss with her the alternate options, like pain relief methods during labour. If a woman still prefers caesarean section after thorough discussions, and if it’s aligning with our medical guidelines, then it can be considered.
(13:49) Snehaa: Now there’s so much chatter around C-sections, and some of it is helpful, but a lot of it is also confusing and scary. Let’s do a quick round of myth and fact to clear the air for our listeners. I will read out common beliefs, and you will tell us if that’s true or not.
C-sections are an easy way out, doctor.
(14:10) Dr. Deepika Alva: False. Caesarean sections are definitely a major surgical procedure and not an easy way out of childbirth. They involve surgical risks and longer recovery period, so it is but it’s not a simple alternative to vaginal birth.
(14:26) Snehaa: If a woman has a C-section, she can never deliver vaginally again.
(14:30) Dr. Deepika Alva: V-back is always a possibility. While a V-back may not be possible option for all women, it is still considered.
(14:36) Snehaa: A woman can plan a C-section just for comfort or to avoid labour pain.
(14:41) Dr. Deepika Alva: So while some women may choose an elective caesarean section for convenience or to avoid labour pain, it is generally not recommended for non-medical reasons, especially there are no complications within the pregnancy.
(14:53) Snehaa: C-section recovery is always longer and more painful than vaginal birth
(14:57) Dr. Deepika Alva: So pain pain-wise it is not always the case that they are more painful, but it being a surgery, yes, the pain levels are more than in a vaginal birth but again pain levels are subjective it depends on our overall health complications and the various types of pain management methods that we provide. It is something that varies from person to person. Recovery time, yes, it is longer than a vaginal birth.
(15:19) Snehaa: A mother can’t bond or breastfeed immediately after a C-section.
(15:23) Dr. Deepika Alva: False. Mothers can absolutely bond and breastfeed immediately after C-section. While there may be some temporary challenges, it is generally possible to start breastfeeding soon after birth while you’re still in BOT or pre-pregnant role.
(15:36) Snehaa: Those clarifications are so helpful for our listeners, doctor, thank you so much. Now, many women today ask for natural births. What exactly does that term mean from a medical perspective?
(15:48) Dr. Deepika Alva: So, natural birth is a childbirth with minimal or no medical intervention, such as induction of labour pains or pain medication method that we give during labour. So it’s basically a physiological process where you’re dependent on the body’s capacity to deliver the baby. We’re emphasising more on body’s natural coping mechanisms during labour and delivery, especially for pain relief techniques that is bathing exercise, relaxation methods, massage, movement. This is natural birth.
(16:18) Snehaa: That’s a much clearer definition than what we usually hear. There’s also curiosity around pain-free or painless labour. Could you explain what an epidural is and when it’s typically administered?
(16:31) Dr. Deepika Alva: So, epidural is a technique of pain-relieving medication that is injected into a space around the spinal cord. Now that is called an epidural space. What it does it blocks the pain signals to the brain.
So this allows women during labour to remain comfortable, where she will feel her contractions, but they just won’t hurt, and epidurals are generally given around three to four centimetres dilation, that is, in active labour.
(16:56) Snehaa: That sounds very reassuring, doctor. There are so many mixed opinions around epidurals.
Now we are going ahead with another myths versus facts round, doctor. Are you ready?
(17:07) Dr. Deepika Alva: Yes, ready Snehaa.
(17:08) Snehaa: A woman is not strong if she asks for pain relief.
(17:11) Dr. Deepika Alva: This is a harmful myth. A woman’s strength is definitely not determined by whether or not she chooses pain relief. It’s completely a personal decision based on her pain tolerance, reference and our medical advice.
(17:22) Snehaa: A woman can only get an epidural at the start of labour.
(17:25) Dr. Deepika Alva: That’s a myth. Epidural can be administered at any point during labour, like at the start or in the middle of labour. There may be a few situations where an epidural would not be an option, like if the baby is about to be delivered or if there are some specific medical contraindications.
(17:42) Snehaa: She can’t feel or push during delivery if she takes an epidural.
(17:46) Dr. Deepika Alva: While epidurals can reduce the sensation of pain, they don’t necessarily eliminate all the ability to push. We will be able to adjust the dosage in such a way that she has pain relief, but while still enabling her to feel the contractions and push when needed.
Definitely with the support from the nursing staff. There’s no such evidence to say that they increase caesarean section rates. If a caesarean section is anyway needed, it is for other complications which is unrelated to epidural.
(18:14) Snehaa: Thank you so much, doctor, for clearing that up. Those myths really needed addressing. Now, talking about the labour room experience. What role do different labour positions like squatting, cat cow or using peanut balls play in easing labour?
(18:29) Dr. Deepika Alva: So we have different labour positions which help to ease labour. Amongst them, it is the upright positions like standing, walking, squatting. These positions help to promote foetal descent by increasing the pelvic opening and reduces the mother’s back pains.
Then there are other positions that support the mother and baby, like hands and knees or all fours it’s called as. Kneeling down, sitting on a birthing ball or side lying with a pillow in between. These also help to rotate the baby and open the pelvis, and help in the baby’s head descent.
(19:03) Snehaa: That’s fascinating, doctor, but is it true that while positions can be varied during labour, the final birthing stage happens in the conventional position?
(19:13) Dr. Deepika Alva: Yes, the final stage of birth, which we call the expulsion stage, is often associated with a conventional position. That means the mother is lying on her back or semi-reclined, but there can be variations in this position. While this back-lying position is quite common, we can also choose to sit or squat for delivery purpose as long as the obstruction is comfortable and it allows for a safe delivery.
(19:36) Sneha: That flexibility during the process sounds so important. Now speaking of planning, how important is it for expecting mothers to create a birth plan, and what should ideally go into why?
(19:48) Dr. Deepika Alva: So, what is a birth plan? This is a way for patients to communicate their wishes to the doctors during the labour and delivery process. So this is like creating a birth plan, it helps empower a woman because she’s informed of all her choices and options during labour, and these are best suited for low-risk pregnancies.
Now, what should a birth plan include? First thing, who would you like to be present in the room, the delivery room? That is your support people. Your pain management options. Are you looking for natural techniques or epidural? Delayed cord clamping, skin-to-skin contact of the baby, which is already done by most of us and the need for episiotomy.
Some patients may not want an episiotomy, so we can have a discussion on that. These are things that get included in a birth plan, but please understand flexibility is the most important aspect of your birth plan because in labour and delivery, things always don’t go the way according to plan, and situations change quickly. So, birth plan must come with an open mind.
(20:47) Sneha: Since doctor, you said that things don’t go according to the plan. How do you prepare a mother emotionally and mentally for such changes in delivery mode?
(20:55) Dr. Deepika Alva: So it’s crucial for us to provide them with education, emotional support, some practical strategies. So we’re generally making them understand the labour process, the delivery process and the postpartum period, how it looks. This helps them reduce anxiety and uncertainty about the entire process.
Help them make a birth plan, understand their preferences. They should have a sense of control over the entire process. Keep an open communication with the mother and the husband.
Give them reassurance, encourage, address their fears, and please let us set realistic expectations. We have to make them understand that birthing is unpredictable and things may not go as planned, and this helps them to manage their expectations as well.
(21:37) Sneha: Now that shows communication sounds crucial. Recovery isn’t just physical, it’s emotional too. So, doctor, how important is the husband’s role during the recovery phase, especially after different modes of delivery? Are there specific ways they can support the new mother better?
(21:53) Dr. Deepika Alva: Yes, a partner’s role is very important. They should provide the emotional and practical support to a new mother. Emotionally, yes, please recognise and understand that postpartum period is physically and emotionally very challenging. Provide an active listening and provide comfort. Come into the practical assistance from the partner.
Start helping with household tasks, running errands of the house, baby care like diaper changes, bathing, soothing of the baby, allowing mother to rest and recover. Let the mother have her breaks, relax and focus on her own well-being, encouraging her to eat healthy and rest. Please limit the number of visitors, and this is a very important thing; please recognise the warning signs of postpartum depression.
(22:37) Sneha: Those are some practical tips we got from you, doctor. Thank you so much. Now, every mode of delivery comes with its own healing journey.
Could you help our listeners understand what recovery looks like after each birth, whether it is vaginal birth, c-section or even VBAC? Are there any key differences or tips you would suggest?
(22:59) Dr. Deepika Alva: So, recovery experiences will vary depending on a vaginal birth, VBAC or a caesarean section. Vaginal birth and VBAC are essentially almost similar, and caesarean section is slightly different. So, the recovery experiences will vary after vaginal birth, VBAC and caesarean section, but VBAC and vaginal birth are almost similar experiences, whereas caesarean section is slightly different.
Considering the hospital stay after a vaginal birth or a VBAC is generally between one to two days, whereas for caesarean section becomes two to four days. The recovery for vaginal birth and VBAC happens within six weeks, for caesarean section takes slightly longer, somewhere around six to eight weeks. So, what are the common issues that we encounter post vaginal birth or VBAC? It could be usually perineal discomfort and some vaginal bleeding, whereas for a c-section, it is going to be pain at the incision site, the potential risk of some infections and definitely longer period of limited activity.
What tips can we provide for all these recoveries? Please prioritise sleep, relaxation so that your body can heal. Healthy diet is very important, stay hydrated, follow the pain management recommendations that we provide, watch for infections, and please seek help and emotional support whenever needed.
(24:14) Snehaa: This is helpful to set proper expectations. It sounds like each journey is truly individual.
Your birth experience is yours, whether it unfolds exactly as you planned or takes completely unexpected turns. Both can be beautiful, both can be challenging, and both lead to the same incredible moment: meeting your baby. If today’s episode helped ease your decision-making stress, we are glad.
Thanks for joining us on the care circle. Follow us for more conversations that honour the real, messy, beautiful experiences of parenthood. Until next time, stay healthy and take care
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