Risks of Cesearean Section

[Rochwen]

Every book tells you a c/s is 4 times more 'dangerous' than a vaginal birth but I never know what they mean by that.

So, what exactely are the risks, side effects and long-term problems of a c/s for mother and child? Also, surely a planned c/s will be safer than an emergency one?

Oh, and just how likely is it to get a urinary infection because of the catheter?

Thanks,

Rochwen

I think they mean that all surgery involves risks. I have had an emergency and an elective c-section. No side effects or long-term problems from either and no urinary infection either. A planned c-section is probably a calmer experience but not necessarily safer, I felt incredibly well looked after both times.

You should have a good long chat with your midwife or HV about your concerns and I'm sure they will make you feel reassurred.

I don't know that a c/s is any more dangerous than a vaginal birth for the baby. For the mother, there are a few possible problems, including damage to the bladder, scar infections, problems with the epidural ... I'm sure there are more possible problems.

I don't know why you'd get a urinary infection from the catheter. It makes your urethra feel funny, but it's sterile when it goes in, so I don't know that it would cause a UTI.

Cockney, I think the reason for the chance of a urinary infection after after having a catheter has to do with the fact that the urether gets stretched and stressed, the same reasoning that is behind so called 'honeymoon cystitis', i.e. sex that was a little too rough or frequent IYKWIM. This might be total rubbish but that's what my MALE Doctor once told me.

Well, from what you say the complications of a c/s don't sound too much different from a vaginal birth, i.e there is a chance of incontinency after vaginal birth as well, an epi or tear scar can get infected as well and you can have problems with an epidural during a vaginal delivery as well, no?

The reason I'm asking, really, is that my consultant is very unwilling to let me have a c/s, saying it is so dangerous, so I need to read up on the risks to show him (why is it always a man) that I have informed myself. I know I could go to a medical library but I guess I'm just too lazy, lol.

So any info is appreciated.

Rochwen, I have had both a c-section and a vaginal birth. The risks I encountered were that I heamoraged, with the c-section and It took over 6weeks to get back on my feet. As with any major operation there are risks, but I have had many friends that have had c/s and have been fine. My stomach was really sore as the c/s is cutting through your stomach muscles and layers of fat in which my scar got infected. My vaginal birth was totally different I was on my feet within a day doing everything for the baby and went home after 2days from hosp but with the c/s I was in hosp for a week because of the complications. My c/s was however an emergency one after labouring 24hours.

Caesareans aren't 'really' dangerous any more - they are quite safe but there are still risks involved. It is major abdominal surgery and so all the usual risks involved with surgery will be there.

In 'Expecting' it states that : "the chances of complications such as urinary infections and wound infections are higher with a section than with a vaginal delivery. Babies who are born by caesarean section have a higher incidence of respiratory problems too". Plus you are recovering from an operation when you have a new baby to look after.

If you need to have a caesarean though, the benefits will outweigh the possible risks. Like you said there are risks to everything and what really matters is what actually happens to you and how you can get support to handle that.

Have you looked at www.caesarean.org.uk ? There is lots of info on there about caesareans.

HTH

p.s. On that website the FAQ section looks useful.

Message withdrawn

I think that the issue is really that if things do go wrong with a c-section, then they can be really serious. I do remember balking slightly when I signed the consent form for my section when it was pointed out that 'in extreme cases' they might have to perform a hysterectomy. It was explained to me that this would only be done in life-or-death situations, but nonetheless it did make me feel a bit uneasy. All operations carry risks (of infection, haemmorage, etc.) and a c-section is a fairly major operation. I'd have thought that the risks are reduced if the operation is carried out under local anaesthetic (some people react very badly to general anaesthesia). However, in the main nowadays c-sections are safe and relatively easy to get over. I had no complications from my c-section. On the other hand, I would go for a vaginal delivery (had a VBAC 22 months after my section) any day. I found the recovery time shorter, was able to go home the same day, to lift my baby and toddler, etc. But everyone's experience is different, and if you have good reasons for wanting a c-section, I don't think your consultant has the right to prevent you from having one. Can you ask for a second opinion?

The link that beckymumof3 gave was very good - there's an article in the "articles" section - "caesarean" - "general" called "Caesarean section or vaginal birth - What difference does it make?" which seems very comprehensive.

Due to my son trying to come out face first they rushed me up to theatre for an emergency c-section. I welcomed it at the time and found the actually surgery a bit scary but not painful. I lost alot of blood though and had to have a transfusion after as in total i lost 1.5 litre which is more than you would lose during a vd. It was pretty painful after too..plus the side effects like shaking, itching, not being able to wee. I had a catheter but no after effects of that! The worst was that due to having a cs babys lungs didnt empty (or something like that) and he kept chocking in his crib, but due to my spinal block i couldnt move to get him so had to keep screaming for the midwives to come help!

A planned c-section would have been alot nicer as I wouldnt have had 12 hours of stressful labour beforehand which would have made the cs a peaceful rather than hectic experience!

I am still having a few problems now as my cs scar doesnt want to heal and its become infected but have been given some more anti-biotic for that now!

If I ever have another..a planned c-section would be welcomed

I have had 2 caesareans. one emergency (2 years ago) and one elective (2 1/2 weeks ago). no problems with either one. I had to nag them a bit for the elective, but it was a wonderful experience and well worth the burdon of having to nag.

Do you have a medical reason for caesarean or simply a personal preference?

Uwila asked:'Do you have a medical reason for caesarean or simply a personal preference?'

Well, a bit of both really. Had big cone biopsy for suspected cervical cancer a few years ago. Cervix now scarred. Both mw and consultant think that there is a chance it won't dilate. Consultant wants me to 'trial by labour' first even though most women in my situation end up with c/s and the very few that manage without one usually have very long drawn out labours followed by instrumental deliveries. So, I would rather avoid the 'long drawn out labour bit' before I get a c/s anyway. Neither am I keen on long drawn out labour followed by a 'high forceps' delivery. I'd much rather have a planned c/s than any of that.

The consultant knows this but I think he just wants to keep the c/s rates down.

However, I do firmly believe that it should be the mothers decision what kind of birth she wants, be it a home birth or a c/s.

... but back to the question, so what are the 'usual complications of major surgery'?

...and Becky, thanks for the web address, will do some research there as well.

I hope you don't mind me asking about the medical reason. Reading what I wrote now, that was perhaps a bit bold of me... sorry if I put you on the spot.

Let's see complications: we'll it will hurt quite a lot to sit up (or use your abdominal muscles in any way for a week or two). And, you'll be left with a bit of numbness / itching around the scar for some time. The numbness could be permanent.

Having said that, I personally think that caesareans are under rated. I think there is a big push to get caesarean rates down and I just can't understand why -- except of course the cost to the NHS. I also think the risks of vaginal delivery are understated in an effort to convince people to try for "natural" delivery.

It might help if you get your hands on the latest copy of the nice guidelines on caesarean.

I had an emergency c/s 20 months ago.

After the surgery, i felt (believe it or not) no pain whatsoever. Apart from the burning sensation when sitting up/coughing and laughing. No problems with catheter either.

Was numb for ages around my scar, and, although some of the feeling has come back, im still reletively numb in that area. I had no complications whatsoever.

I hate needles though so you can imagine my face when i needed iv fluids and a spinal lol!!

I have had no numbness or itching at all after two. I'm a big fan of sections - first medically necessary, second elective, but unfortunately I went into labour and had a night of hell and agony (back labour) before having a fantastic section - I strongly believe my dd (no2) was very badly positioned and would never have come out any other way without a horrific delivery and possible damage to her and to me.
The minute I told my consultant I would not consider any kind of instrumental delivery in any case, she immediately put me down for a section, which I think says a LOT. Also, she said, "sections have twice the risk...but twice nothing is nothing...they are very safe" - and she was very eminent.
On the downside, there is a risk of baby having wet lungs and needing special care (much reduced by having your section at 39 weeks), and some believe that the pressure of contractions, the hormonal cascade of contractions and the birth process itself is very important in setting the emotional and physiological 'temperature' of your baby - stimulating nerve endings, muscles, and priming the brain. This is by no means proven but it is something you might like to think about.
And they don't cut your stomach muscles, btw. The only muscle that is cut is the womb. The stomach muscles separate quite easily.

Uwila, no probs, did not feel put on the spot.

Aloha, thanks that was very useful. I also told my midwife that I would not consent to any instrumental delivery so it's only the choice between a planned c/s or a 'trial by labour' (totally don't see the point) followed by an emergency c/s.

Possible risks, both of which I unfortunately have experienced in my two electives:

1 - post-operative wound rupture. When the MW went to take out my stitches, the whole wound just kind of unravelled. There had been no sign of strain or infection by the way.
My small bowel could be seen when this happened (not by ME thank GOD ), it was very scary. My husband was waiting outside to take me and ds home, and until someone thought to explain to him what all the rushing about was he thought I had died.
I had to be taken back to theatre as an emergency and restitched and after that all was well. The elective had been for ds' persistent transverse lie and was unavoidable.

2 - Baby arrives with respiratory distress and needs oxygen/time in SCBU. They say this rarely happens with term, healthy babies but dd was both and she spent 48 hours in SCBU after going a bit floppy and grunty five minutes after being delivered. Very, very bad time for us as our second baby had been stillborn the previous year at 21 weeks so you can imagine...

Both of the above situations could not have been predicted and were not related to my general health or fitness, or to any issues with the babies. Or bad care, although I did hear subsequently that the surgeon for the first elective was "let go" as his ego exceeded his capabilities...

And don't even get me started on the revolting, debilitating, clostridium difficile squits I developed after being pumped FULL of antibiotics after dd started grunting. Yes, the one that is currently in the news.

You did ask Rochwen! I personally feel you are entirely justified in asking for a c-section and that all women should get the birth they want. But I think you can understand why I'm not keen on the procedure! Ds and dd are fine, that's the main thing, and so am I.

Marina, thanks for sharing your experiences, sorry you had such a rough time. I find all this info very useful. Thanks again.

among the risks of normal surgery one of the risks is thrombosis - so impt to wear the rather attractive surgical stockings (make sure they're tight) and get moving asap after surgery.

How could I forget the hose, bundle

This happened to me:-

Spinal headache: Approximately 1% of patients will develop a headache within 24 hours after the spinal anesthetic. The cause of the headache is a slow leak of spinal fluid out the hole left by the needle. Changes in the shape and size of the needle have greatly reduced the incidence of this problem. Although a spinal headache is not life threatening, it can be quite uncomfortable. It is almost always more painful in the sitting or standing position than lying down. For many years, it was assumed that lying flat for 24 hours after a spinal injection would reduce the risk of spinal headache. We know now that position does not increase the risk. The headache will resolve spontaneously but this may take weeks. If the headache is mild, it may resolve quickly by drinking more fluids and taking caffeine. If the headache is severe and incapacitating, an alternative treatment is the "blood patch", which can usually resolve the headache within an hour. The blood patch is about 99% effective in relieving the headache, but often causes a pressure feeling in the lower back for a day. Serious complications from the blood patch are very rare and include infection or irritation of spinal nerves.

It was horrendous - I have never in my life had a headache like it - I had to have 2 blood patches as the first one didn't work. I also threw up for a week after the birth. My dh's company ended up giving him compassionate leave after his 2 weeks paternity leave was up as I was in such a bad way.

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had one emergency and one elective and having another elective in August......

It still is major abdominal surgery and the risk associated with anasthetic and the actual surgery must be real and there. However, it is a very 'practiced' operation, which occurs in most hospitals 2/3 times a day.

Benefits include little or no pain, certainty of delivery date (sad, but important), no painful contractions, no tearing or other damage to your bits and pieces (not to be underestimated).

Downsides are slower recovery, higher liklihood of problems with breastfeeding, less natural painkiller created........

I don't have an option with mine, as having had 2 CS before, they were very unlikely to let me try a natural birth plus I'm having a steralisation at the same time!

I understand their reluctance to put someone through major surgery, just as a matter of choice, but if you can prove that you will probably end up having one anyway, an elective would be a lot calmer I would imagine.

Rochwen - I know this isnt really an answer to your question...but just to put it in perspective....I had a VD with ventouse and an episiotomy ( supposedly very small but I was too scared to look or ask how many stiches). I had pain on intercourse for about 6 months after the birth.Dh was was very understanding and sypmpathetic but it was very distressing for us both

Rochwen - 'usual complications for major surgery' I guess would involve what others have mentioned: problems with anaesthetic, wound problems, wound infections, etc.

I think that most obstetritians (sp?) (and women?) would prefer a CB to a high forceps if that may be your other option!! Though if your problem could be dilation of the cervix then it wouldn't be possible for baby to come out that way and hopefully no high forceps for you!

rochwen - sorry I'm not emailing you this but I'm quicker on here!

DH said when you're writing your letter of request to your consultant, make sure that you write down that your consultant is refusing to discuss childbirth complications with you (foetal distress, scalp monitoring, ventouse, forceps, tearing, episiotomy, 3rd degress tears, subsequenet perineal repair, bruising, incontinence, painful sex, the time span these complications will affect you post-delivery).

If he won't discuss these complications, then he is in serious breach of GMC guidlines:

"Patients have a right to information about their condition and treatment options. The amount of information you give each patient will vary according to factors such as the nature of the condition, the complexity of the treatment, the risks associated with the treatment or procedure, or the patients own wishes."