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Childbirth

Share experiences and get support around labour, birth and recovery.

Really stupid questions about the mechanics of healing from a C-Section....

37 replies

Rohan · 25/03/2008 14:05

I've actually never had a section, but a good friend of mine is due soon and weighing up the pros and cons of VBAC vs RCS. She has been told her scar is 'very thin'.......this makes me wonder about things I'd never wondered about before. Bear with me whilst I think this out, I'm probably being very thick...

So, when a section is performed, the uterus is large and extended, obviously, so a large cut is made in it to allow the baby out. After the birth, the uterus contracts back to a non-pregnant state, about the size of a lemon, right? So what happens to the scar? Surely if the uterus contracts back very quickly, the incision would not be healed properly, what would happen then? Is that how adhesions become a problem?

Does the uterus just deflate like a balloon? In which case, the scar....internal stitches and such.....do they remain the same size on the unpregnant uterus? For example, does a four inch cut remain a four inch cut even when the uterus has contracted, or does the cut contract too, does the incision become a one-inch cut that swells back to a four inch with future pregnancies? How is this possible, if scar tissue doesn't stretch? Does it kind of...wrinkle?

And correct me if I'm wrong, but the only way that anyone can tell you about the state of your internal scarring is to open you up and look at it, yes?

Sorry I'm ever so confused, I wonder if you can even understand what I'm asking. When I gave birth, the instant the placenta was out, my stomach just went poof! and I got back in my jeans the next day (don't hate me!) Did my uterus contract quickly? If so, what would happen if the uterus contracted back within the same timeframe for a CS?

Or is there some other procedure I know nothing about?

Sorry to be so duh

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whomovedmychocolate · 25/03/2008 15:40

Okay, I know a fair bit about this because I've both had a section and scar dishenience (breakdown).

These days, caesarians are done on the low part of the pubic area (mine is actually on my pubic bone, prodigiously low, the midwives were stunned). They are also transverse (sideways). So generally you end up with a discreet smiley scar, rather than a classical (vertical) cut.

The reason for this is that the uterus has different sorts of muscles at the bottom as the top. The top has vertical muscles (imagine a hot air balloon made of long vertical strips - a bit like that) while at the bottom, the muscles run horizontally - (think ribbed condom stylee).

During labour the lower muscles pull upwards to expand the cervix and allow the baby out. (That's what your contractions are about) while the upper muscles massage and push the baby downwards and towards the cervix. It's really a wonder of engineering how it works so well together.

Anyway, caesarian wounds are stitched in layers these days - normally at least two. In some cases a drawstring technique is used which binds muscle fibres together is such a way that the area where the scar is is not all that flexible but is very strong.

Disadvantages to his are of course that it is bloody sore while it's healing and it can lead to a lumpier scar and numbness.

During late pregnancy any scar will thin and stretch - your skin reacts to it's normal state, you wouldn't expect to lose 20 pounds and still have a scar in exactly the same place would you?

With a caesarian you get bruising too which can cause extra swelling on the uterus so it doesn't go back so quick as with a normal delivery.

Scar tissue lacks collagen so it can't stretch so easily. This can lead to partial dishenience (scar breakdown). Where the scar entirely breaks down through all levels you can get uterine rupture (read: bad, bad thing). But it's very rare with recent surgeries because of the technique used.

If she has only had one CS and it's not within the last twelve months she's probably okay. The cut btw is not large, but the scar may be if she stretched it post partum (I did - gardening).

I tore some internal stitches after I fell pregnant the month after a laporoscopy - it bloody hurts I can tell you. But with internal stitches, no you can't see a thing from the outside, except you can get a bruise if the stitches are close to the skin because obv it'll bleed. Again these things heal themselves.

What your friend will probably be offered is a 'trial of labour' or 'trial of scar'. It's entirely up to her, but second caesarians are much more risky - in terms of death, hysterectomy etc. than VBACs so it may be worth her having a go. Chances are it will all be fine.

I have, as I said, scar dishenience (I'm 22 weeks) but it is normal to experience some changes in a cs scar during pregnancy. So I'm not particularly worried about it.

Hope that helps (bet you wish you hadn't asked now?)

threestars · 25/03/2008 21:24

OMG, wish i hadn't read! 2nd cs day after tomorrow!
But what an amazing explanation, wmmc. Knowledge is power...

suwoo · 25/03/2008 21:29

WMMC, that was indeed a fabulous explanation. I have had 1 vag delivery and a subsequent C section. Most of your post (thankfully)wasn't relevant to me, but was really interesting to understand the stitching and healing process. Thanks.

BetsyBoop · 25/03/2008 21:42

just to add that your belly will go back quicker after a vaginal birth than a CS, as the pushing bit "snaps" the abdominal muscles back together again, where you (obviously) don't have any of that with a c/s.

At least that's how the physio explained it to me. I had split abdo muscles after the last delivery (6 fingers separated, which is apparently quite bad but DS was 10lb 10.5oz ) & she said if I'd had a vaginal delivery they would have probably have been just about back together again afterwards, but it could take up to 6 months after the c/s - DS is 4.5months & I'm less than one finger now, so we are nearly there....still got the lovely c/s "overhang" though

whomovedmychocolate · 25/03/2008 22:07

threestars - ah you'll be fine. I was literally running round the recovery ward two hours later, they kicked me out and upstairs because I was so obviously 'well'.

If you know you are having a cs, recovery is much quicker too (mine was an emergency). Also with scheduled cs you get better healing because you haven't been through the trauma of trying to give birth/being knackered/drugged/poked and prodded for many hours.

Am quite amazed that after staying up all last night with a sick DD, I was that lucid this afternoon (esp referring to the ribbed condom type muscles ).

Oh and BetsyBoop - my surgeon stitched my stomach muscles together so I did have the flat tummy a week later people crave, but it was bloody sore because of it!

Rohan · 25/03/2008 22:17

Thankyou whomovedmychocolate! I'm glad I asked...it's the whole healing incision on a deflating organ that gets me all

You certainly do know a lot about it

My friend is being less-than-gently shoved in the RCS direction and she's pretty up in the air about it all. Maybe I'll send her in the mumsnet direction That's why I was questioning the 'thin' scar comment. Hmm. She basically doesn't want an EMCS again, and you know what they say is the only way to avoid an EMCS....

Especially seen as her last EMCS was the result of a three day induction for postdates, and resulted in an eleven and a half pound baby but also PTSD..

Tricky! Thanks for the detailed info

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whomovedmychocolate · 25/03/2008 22:26

Ah - she wants to have a look at the VBAC websites and look up the figures on risks - basically she is 20 times more likely to need an emergency hysterectomy - new baby plus menopause, plus another major abdo surgery - if she has a second section, planned or not.

If she is getting heat from consultants, she can do what I did and refuse to see them, or refuse to discuss it with them. She can quote the NICE guidelines that women should be encouraged and supported to try VBAC unless there are compelling medical reasons not to.

Many consultants (mine included) think a pregnant woman who has had a previous CS as a uterine timebomb waiting to explode when he has had a long shift and best managed by booking in a date for the removal of the problem using a scalpel. Sorry to be blunt but it's easier from their PoV to manage the risk if you just agree to be cut again.

But for the mother it's not the same. BTW, she knows she should NOT be induced if she has had a caesarian - under any circumstances? It massively increases the risk of rupture of the uterus - particularly using syntocin induction. Also obviously for her, like me, induction just doesn't work. There's no point pretending the drugs have got better or that her bodily reaction to them has changed because it simply won't have.

Feel free to point her in my direction if she wants some info.

BetsyBoop · 25/03/2008 22:35

WMMC - very jealous, wish my surgeon had given me a "tummy tuck"

repeat c/s also increases the risk of PPH (as does a large baby if she's having another biggy) as I found out to my cost, so my recovery from my el c/s second time round was far worse than my em c/s first time. (Planned & hoped for VBAC went out the window when DS got to 40+10, for numerous reasons - long story - so ended up with el c/s instead)

Rohan · 25/03/2008 23:11

SHE knows to avoid induction - haha - but the cons doesn't. She's having regular growth scans and it's another big one, they want to induce her at 38ish weeks if she goes for VBAC. Bangs Head against wall

She's very well informed - I'm mostly well informed despite stupid thread title - but it's the emotional aspect of it all with the PTSD, urgh. There were problems with siting the spinal and she had breathing problems on the operating table, very scary. No good options in this situation.

I'll send her in this direction if I can broach it properly, I'm seeing her soon. Thanks for the information

OP posts:
Gunnerbean · 25/03/2008 23:50

I'd have a c-section again tomorrow - no question about it.

Healing was fine and no problems whatsoever.

I think that stitches from an episiotomy can often be more painful and more complications can arise at a later date from that too.

I've only got one child though. Can't comment on how the scar is affected by subsequent pregancies but I've got friends who've had 2 or more c-sections and they've not reported any problems either.

I can't speak too highly of the whole procedure and recovery.

DrippingLizzie · 25/03/2008 23:55

Ditto, Gunnerbean. I had two very straightforward C-sections and I love my big smiley scar...

yurt1 · 26/03/2008 00:00

I've had 3 sections.
First straighforward.

Second now. Had lots of scar tissue. Adhesions between the bladder and uterus which led to lots of extra bleeding and a painful recovery

3rd section after trial VBA2C) . The scar was 'paper thin' and fluid was somehow leaking through it (I guess it must have in part broken down or something I never really undertstood this) but they said adhesions were not a problem. The op was done by someone senior because of the potential for complications. Apart from needing some iv antibs it was fine.

LiegeAndLief · 26/03/2008 12:39

Sorry slight hijack - WMMC can I ask who your consultant is? If/when I have a second I am hoping to manage a VBAC at the JR, will be under silver star I think the same as you? Am already worried about meeting resistance and I'm not even TTC!

Good luck with yours

Hope all goes well for your friend Rohan.

whomovedmychocolate · 26/03/2008 14:56

VictorianSqualor is having a VBAC under Silver Star I believe at the minute. But your consultant will not necessarily be the person who does the CS. But it was Victoria (Mills I think - I'm sure VS will be along and confirm her name - she had a CS with her too). But the consultant is Professor Redman, or Mr Impey depending on quite how sickly you are

LiegeAndLief · 26/03/2008 16:11

Thanks. Must have been sickly as I saw quite a lot of Prof Redman last time , although I think I was also meant to be under Catherine Greenwood - only saw her once. Presumably it will be the consultant you're under who "allows" you to have a VBAC?

Don't know what I'm wittering on about this for! Not quite ready for dc2 yet...

whomovedmychocolate · 26/03/2008 17:17

Actually it's your decision whether you have a VBAC. There are very few real reasons not to try - complete placenta previa and very premature labour are the only ones I can think of which prevent trying.

VictorianSqualor · 26/03/2008 17:28

I had Miss Hurley as my cons first(normal JR cons), she was great about a VBA2C, am now under Katherine Greenwood(silver star cons), again happy for a VBA2C, the only thing they have sid is that due to my abnormal dopplers they want baby out by 40weeks which was something we have all agreed on. Try not to worry too much about meeting issues at the JR, Vacaloca is under a different cons (Impey I think) and took along the RCOG guidelines, showed him them and is now having a HBA2C.

I think the JR are probably used to us VBACers what MN by now

LiegeAndLief · 27/03/2008 09:11

Thanks VS, hopefully there will have been quite a few MN VBACers through silver star by the time I turn up! Lots of luck with yours

whomovedmychocolate · 27/03/2008 20:13

Liegeandlief - sorry to disappoint you but I'm having a home VBAC through Silver Star (they are horrified at the prospect hahahah) so by the time you have yours they'll probably ask you at booking:

(1) Are you a mumsnetter?
(2) Do you have any strange desire to have a baby in your dining room 38 miles from the hospital.

VictorianSqualor · 28/03/2008 08:06

LOL!
Vacaloca is having her HBA2C as I type!!!!

yurt1 · 28/03/2008 09:16

If you're thinking of VBA2C or VBAC I'd really recommend Odent's book on the cesaerian. Pupuce recommended it to me when I was pregnant with ds3 and it was excellent. Even though I didn't manage the VBA2C and ended up with a 3rd cs the book made me realise I'd still made the right decision (for me) in giving it a go .

mumofdjandbabies · 28/03/2008 09:34

I do hope she gets on well!

Yurt where could I buy this book cant find it on ebay /ill try amazon?
whats its exact title x

also how are you Vs?
How preg are you now?

yurt1 · 28/03/2008 10:14

the book I don't know if there's a paperback version available.

mumofdjandbabies · 28/03/2008 10:25

ah ok thanks

its a biggy then!

I might see if the library has it

cheesesarnie · 28/03/2008 10:28

whomovedmychocolate- wow great post!thats really interesting!
ive had 3 csections.would like 4th.gps etc not happy but consultant is so were still thinking about it.lots.over and over and over