Birth after three C Sections, one with scar infection. Hazards?

[duchesse]

Following from my sister's attempts to have a VBAC in Thailand last year, as detailed in this thread, I'm back to ask for advice.

The silly mare She is accidentally pregnant again, due I think in January, ie less than two years after the last one was born. The last one was also born by caesarian, and to cap it all she got a scar infection due to not taking the prophylactic antibiotics she was prescribed at the time.

I am really worried about scar rupture in these circumstances. Am I right? What should we be gently encouraging her to do? My first response would be to try to get her to come back to the UK for this birth, to ensure that she takes advantage of any antibiotics she is advised, and to generally look after her so that she is not overdoing it near the end of her pregnancy.

Frankly I am am terrified that there is going to be a disastrous outcome from this pregnancy. I think it's a dead cert that this one will be a C section as well, and I'd rather she were somewhere with decent medical facilities than stuck in the middle of the South China sea hours from the nearest modern hospital.

Please advise and help as much as possible.

I had a scar infection after my first C section, after being induced, I think that I was told that the risk of infection is greater after emergency c section rather then an elective section. I had DD after a section two years later and did not have any infection problems again. Was not offered prophylactic antibiotics for either section, but did mention the infection to anyone who would listen second time round so that my scar was kept an eye on.
I don't know the risks of having another section so close to the first but for what its worth I had a friend who had two sections exactly one year appart and she was fine !
I did take a range of herbal supplements prior to my second section to aid recovery, healing and boost my immune system, you could send these to your sister.
Sorry no really pearls of wisdom but I am sure she will be fine.

Thanks for your answer, moo, and experiences. This will be her fourth though, and I thought they didn't like doing more than 3 in Britain. Once the baby's in there though, it's got to get out somehow...

Also I should say that she lives in a tropical country, and that staph infection seems rife and very usual there. All the children get impetigo for example, sometimes spectacularly nastily. Last time she visited, her 3 yr old had a massive (2 inches in diameter, deep-set) impetigo boil on her leg, and my sister seemed to be fairly unconcerned by it. My other sisters and I were not so laid back about it and encouraged her to take the child to the doctor, and she accused us of over-reacting.

less than 2 years between sections is ok, it usually is absolutely fine. why would she not take her ABs though? in this country you get given the ABs, but can't remember if it is intravenously during the section

i don;t think an infection would mean a greater risk of scar rupture, but a VBA3C under those circumstances on a tiny island would not be something i would feel comfortable with, especially after her labour last time

however, it seems that her c.s last time was fine? and the facilities were fine?

i don't think the risk of rupture increases massively with each section, but in her shoes, i would proably be having an elective and taking my meds!!

That's very reassuring about the risk not rising much with each pregnancy, unicorn. I shall have to find some reassuring research about that now...

Hi duchess you may want to look at This. Its the royal college of Gynaecologists VBAC guideline but on page 3 thre are some stats on the rupture risk following multiple caesarians.
Also I had a couple of book on VBAC which have similar information which I gave to Bonzo so if she has finished with them maybe she could send them to you.

Is you sister thinking of another VBAC attempt ?

duchesse, I have had 4 CSs.

Ds1 for breech, I feel it was botched, infected and left with 7 inch scar

Ds2 attempted VBAC resulting in scar rupture, luckily MWs very on-the-ball and emergency CS. More competent surgeon this time, did a nicer job than the first

Ds3 emergency CS for placenta praevia at 32 weeks

Ds4 planned CS at 39 weeks, lovely experience.

I did think of trying for a HBA3C and enquired on the Homebirth section of some boards but as even the seasoned Homebirthers seemed a bit at the idea of me having a VBA3C , never mind a Homebirth, I went for the "safer" CS option.

Here in Ireland, multiple CS's are more common and one woman has had 13! There are increased risks, of course but problems still seem to be relatively rare.

Oh, by the way, there is hardly any risk of rupture during the pregnancy itself, only in labour.

By the sounds of it, Chipmonkey, your recommendation is for planned CS before she goes into labour then? Sounds like a very good option all round. Requesting a VBA2C last time was pushing it a bit in Thailand, but a flat refusal this time to give her a trial of labour should at least mean that they have a nice neat date for the birth. Hanging around for four weeks in Bangkok last time waiting for her to go into labour nearly bankrupted them.

duchesse, much as I love the idea of natural birth, after all I've read, I would recommend a planned CS. As Riven says, if something goes wrong, it can go very wrong very quickly. The risk of scar rupture in labour is still small, even after 3CS's but if it does happen it is very dangerous for both mother and baby.