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

[Rohan]

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

I'm a bit confused by some of the statistics on here as they are different to what I had read in the past. I'll be happy to stand corrected if I'm wrong, I'm just a little uneasy to see for example, that the risk of having a hystorectomy on a second CS is 20 times greater than if you have a VBAC. This may be true in itself, but 20 times an incredibly small risk is still a small risk. (I think about 1 in 8000.) On the other hand, I was told that the chance of scar rupture when I was deciding was 1 in 100 to 1 in 200. (Some people say less, but, there are some official figures which still say that.)

I'm really not trying to be contentious, but I am worried that someone's going to make a decision that may be based on info given here. I do know someone who's scar ruptured and it was a lifethreatening situation, and I'm just a bit concerned that the doctors whove examined your friend, Rohan, are thinking that it may be a problem.

Just a wee addition from someone who has had three elective c-sections.

What you said re your friend during first section about not being able to breath and problem with spinal rang some bells though. It takes ages to get a spinal in and it is an horrible physical position to be sat in that heavily pregnant. All this rounding of the back and leaning foward is a bit difficult with a stomach the size of three footballs. Difficulty breathing is also normal during a section as is vomiting. It is because your blood pressure drops during the surgery but the anaesthetist knows is prepared for this. It is a bit scary when they start covering your face with an oxygen mask (an unpleasant if vomiting at same time!) but in my experience, and other c section friends, it is completely normal and should be expected. Perhaps if your friend does choose a 2nd section the previous experience and knowing what to expect will help. I know it did with me.

redadmiral - my friend has not yet decided on VBAC or RCS. Obviously she will do what she feels is right. The doctors who have examined her have NO WAY of knowing how thin or otherwise her scar is, that was my point. The scar we're talking about for risk or UR is the uterine incision. You can't see it from the outside, so saying it is THIN is conjecture at best, lies at worst.

I know that the risks of both are regularly downplayed by one side or the other and it's usually a judgement call in individual situations. However the fact does remain that with each VBAC the risk decreases and with each RCS the risk increases - that's just true. Not enough people know the risks of RCS although the risks of VBAC (the 1 in 200 UR figure especially) are widely portrayed. I've never had a CS, and hopefuly I won't ever have to have one, I'm not in the position to have to make a choice between VBAC and RCS, I really can see both sides for most people. Benefits and drawbacks to both options.

The '1 in 200' figure is actually as follows:

Risk of uterine rupture in labour for a woman with a single low transverse incision is 0.46%

Back with more soon, babies!

Good. As I said, I wasn't looking for a fight - just geniunely concerned.

I'm not a mathmatician, but I do find statistics interesting. Another friend is also in the process of deciding whether to have an ELCS, after having an EMCS followed by a traumatic VBAC, and various doctors have outlined the risks for and against each option - sometimes drawing totally different conclusions!

There's some argument over the degree of rupture and what is and isn't dangerous. Have to say the hospital didn't monitor me that well and there was a risk of scar rupture (when I had the section it was found to be paper thin and leaking, they said I wouldn't have been able to deliver vaginally).

The Odent book is good for going through all of that as well. His books distinguishes between the pros and cons of elective, emergency and non-emergency in labour sections. Really interesting.

For a real study with true stats try reading this study.
Has everything in there.

I'm due late May/early June and was given absolutely no advice or info on VBAC v CS. I plumped for CS as my last one was only March 07 and was I concerned about scar rupture. Anyone have any info about VBAC 14 months after CS?

It says here that you have a greater risk of UR, approx 2/3X greater, which will increase the risk of around 0.5% to about 1.5% so it's all dependant on your personal choice.
Apart from that it's the normal risks that anyone else goes through, try reading the study I already linked and this one, this one and this one. For some more general info.
If you decide to go for a VBAC you need to tell your consultant ASAP and see how they feel about it, if they try saying No, come back and get armed with everythign you need (www.aims.org.uk are good for advice on getting the maternity treatment you want.
Good Luck

Rohan - have they scanned her? It is possible for an experienced scanner to assess the thickness of the lower segment - but there are no real stats on how that relates to the risk of scar rupture.

I am sorry your friend doesn't have more sensitive care and a birth plan that is right and suitable for her.

The professional standard can be found here - may be too technical but might be of use to her/ others.

I'm having 3rd CS this summer. First time was emergency under general, 2nd was elective for psychological reasons, this time I really am too posh to push, simply can't be arsed with labour. This will be the last child though, I am aware that the more you have the more risk in subesquent babies - would go for VBAC if I wasn't finished yet.

I have had both CS and VBAC.
CS was for breech baby, and I was slightly encouraged that way by the consultant. However it was a fantastic experience, recovery was quick and pretty pain free.
VBAC - some 5 years later, there was never any suggestion that I do anything other than have a Trial of labour, but again, I was happy with that. But it was much more traumatic, slow progress, failed epidural (and in hindsight lack of anything like adequate support during labour from midwives), and far more painful recovery.

So each situation is different. I would encourage anyone else to arm themselves with as much info as possible, then choose the option that feels best for them.

I had an EMCS with my first, very traumatic, took 6 years before we had our second child!!!
I was given the choice between VBAC and CS, but I was encouraged to try VBAC as I laboured and dilated well the first time, just that baby got stuck and pooed.
I wasn't really given any statistics, maybe because the gap was so big between babies.
Laboured well and dilated etc but baby was stuck again, ended up with EMCS again, unfortunately. Consultant told me during the op- "Mrs Johnson, you have a mans pelvis! There's no way a baby would ever fit through there!" Asked why this hadn't been spotted BEFORE!!!!!!!!!!
So, I am a freak of nature, but have 2 healthy children :0)