Hello Doctor,I am having my first pregnancy and I am so scared of having to push the baby. I want to have a Caesarean section instead of the natural way of giving birth. I would like to know if it’s fine to do this yet I don’t have any complications. Are there any side effects? Sandra Umohoza, 24Kibagabaga resident--------------------------------------------Dear Sandra,Since it is your first pregnancy, you are apprehensive. It is usual to be scared during first pregnancy.  Other women may scare you with real or imaginary stories of difficult labor. But majority of women all over the world deliver vaginally. Caesarean   section is done only if the lady has some problem to deliver normally or there is risk for the baby to be born. Caesarean section is a surgical procedure where abdomen is cut open to extract the baby. It carries all attendant risks of a surgery.Firstly an injection is given in lower part of spinal cord to make the lower abdomen numb and devoid of pain. This injection itself carries risk of causing headache after the procedure and chronic backache later. Rarely can it damage nerves of legs causing paralysis. During surgery, if a major blood vessel is cut accidentally, there is risk of life threatening bleeding. After surgery, there can be infection at the site causing fever, swelling and pain.  Inadvertently a baby’s scalp can be damaged by the surgeon’s knife resulting in lifelong defects.  The duration of hospitalization and recovery to normal routine is prolonged with a caesarean delivery. One is not supposed to do heavy work for about 3 months after surgery to avoid weakening of muscles at the site of operation. Sometimes the abdominal muscles become weak after a surgery and the woman may suffer from incisional hernia weeks to months after it. Here part of intestine can bulge from scar of incision leading to an ungainly swelling, discomfort and risk of intestinal obstruction.During healing of the post surgical wound inside, at times adhesions may form at the site, i.e. layers of abdomen may adhere to one another. This is a risk for leading to intestinal obstruction later on. Bladder and bowel disturbances can also occur due to it.Moreover after a caesarean section, there may be difficulty in subsequent pregnancies. If caesarean needed for any other problem later on, doing it again with a previous caesarean scar becomes challenging for any doctor.  It is said that even bonding with a newborn or feeding may   take time after caesarean delivery because mother feels sick after operation and is not able to move much. In contrast a vaginal delivery has many advantages. Hospitalization is for minimum time, return to normal routine is rapid. Not much after care is needed. When a baby passes through normal birth canal, his lungs are exercised due to uterine contractions. As adult, he has much less risk of having asthma.The only disadvantage is that it is painful and messy.  So go ahead with normal delivery. Pain of few hours gives lifelong joy of motherhood.Dr. Rachna Pande is a Specialist of Internal Medicine-Ruhengeri Hospital