In today's world, women are opting for C-Section. Read to understand what life is like after c-section, how it affects other deliveries in the future. How long it takes to fully recover.
The best mode of delivery for both mother and baby is a normal delivery where the baby is delivered through the vaginal canal. The mother undergoes fewer traumas and at the end of delivery has no internal scars. The pain stops when delivery is complete and so the mother is more able to handle her baby. The baby undergoes some ‘maturing process’ as he/she negotiates the way through the bony pelvis and out through the vaginal canal. Babies born normally are more adapted to life outside the womb. In pregnancy oxygen and food are delivered directly to the baby from the mother’s placenta. When born, they must breathe their own oxygen and also feed on their own for survival.
There are situations though when the mode of delivery must be cesarean section. These situations are too many to enumerate in this write-up but a few are:
- A very large baby,
- Mother’s small pelvis,
- When the baby is leading with the bottoms,
- When the placenta is situated below the baby,
- When in labor the baby goes into distress,
- Among others.
A cesarean section involves bypassing the bony pelvis and delivering the baby through the abdomen. This involves cutting the abdominal wall (usually along the bikini line) and cutting the lower area of the uterus to get to the baby and then removing it through the opening to the outside of the abdomen. After removal of the placenta, the uterus and abdominal wall are repaired and made ready for healing.
After delivery, whether normal or through the cesarean section the uterus which was large enough to contain a 3.5-kilo baby or more and was visible to everyone starts to shrink. At the end of six weeks after delivery, the uterus is then the height of 8-9cm or the size of a small pear. If delivery was through cesarean section, the original scar on the uterus at delivery which was about 10cm has now shrunk to about 2cm.
Delivery by cesarean section can be quite painful. Not only is there normal after pains due to uterine contractions but these contractions are on a scarred uterus. To make matters worse the opening of the abdomen makes the intestines ‘irritable’ and can get very bloated with gas causing even more pain. One can take heart though, the medicines for pain management are currently top-notch and cesarean section is no longer the horror it used to be some 10 or so years ago. Another advantage now is that most times the mother undergoes local anesthesia (spinal) instead of general anesthesia that would make one groggy as they awoke from anesthesia. The mother is able to see her baby immediately it is born just like in normal delivery. Six weeks after a cesarean section, a woman should not be feeling any pain associated with the operation.
Three months after a cesarean section, the uterine scar is well enough healed to carry another pregnancy. The pregnancy starts small and will not fill the cavity until 12-14 weeks after conception. The expansion of pregnancy is slow (a pregnancy lasts 40 weeks) so it is unlikely to interfere with the integrity of the uterine scar.
The dangerous period when the scar can tear (rupture) is during labor and this is more so if the scar is not more than 2 years old. Contractions of labor are extremely powerful. Since the area that has been cut to allow the baby out is a weak point, it can very easily tear. Any woman therefore who has undergone a cesarean section less than 2 years early should be scheduled for cesarean section delivery at week 38 or 39 before the onset of contractions of labor.
For a scar that is older than 2 years, a woman can be allowed to ‘try the scar’ for a possible vaginal delivery if certain criteria are met. All other conditions that would predispose to cesarean section delivery have to be absent. The baby must be of average size, not large to 4 kg in size. All these factors being normal, an x-ray assessment of the size of the inside of the bony pelvis is done at 37 weeks gestation – only if the head is the one near the pelvis. This x-ray is taken from the side of the pelvis in order to give measurements from the innermost part at the back of the bony pelvis (sacral promontory) to the innermost part at the front of the bony pelvis (pubic bone). This gives the diameter through which the baby’s head would have to negotiate. If this measurement is smaller than what would be considered safe to try the scar, then the lady is advised to undergo a cesarean section before the onset of labor. If the diameter is larger than the required minimum, then the lady can await natural labor and try the scar. This only if the reason for the previous scar was due to baby causes and not maternal, for example, if the reason was that the cervix would not open (cervical dystocia). Chances are that since it is the same cervix this time it will not open. If on the other hand the baby was distressed by a cord around the neck, then this is a fetal cause and the mother can try the scar.
Trial of a scar is only recommended if one has undergone only one cesarean section delivery. After a second cesarean section delivery, then all other future deliveries should be arranged cesarean section deliveries before the onset of labor. The trial of a scar is closely monitored. The labor must start simultaneously and on time. Labor must progress well both in the opening of the cervix and the baby’s head descending through the pelvis. If at any time labor is felt not to be progressing normally, then cesarean section delivery should be considered. After the delivery of the baby vaginally in a trial of scar, the uterus is explored to confirm that the area of the scar has remained intact.
One can deliver safely as many as 4 or 5 babies through cesarean section. Sometimes the bikini scar tissue might become too tough after several deliveries and thereby become impossible to stretch enough to allow the baby through. In this instant, the below umbilicus midline scar is preferred for the safety of the baby.
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