Sunday, 8 May 2011

Getting Pregnant After A Caesarian

First of all...

Congratulations on your little bundle of joy =)

It occurs to me as I begin this article, that there are two sorts of mothers seeking information about this subject.

The first = those who are a little bit love-drunk for their child(ren) and ready for more children.
The second = those who have recently endured a caesarian want to avoid of having to go through it all over again any time soon!! (And you would be forgiven for feeling that way!)

This has the potential to being a very long topic indeed and I shall do my best to keep it simple.


Fear with Conception

This is perfectly understandable. 1 in 10 pregnancies end in a caesarian and many of these are "surprises". Often the mother arrives at the hospital, birth plan in hand, to find her darling child is either being most uncooperative or worse, in danger. After experiencing the trauma of such an ordeal mothers are then faced with days of bed rest and the following six weeks of recovery.

A caesarian is a major surgery and carries great risks therefore the thought of having to endure such an experience all over again is enough to scare anyone. Be aware of your thought patterns and stop them in their tracks - at the end of the day, the bigger the obstacle, the greater the rewards.


I'm Ready...Can I Get Pregnant Again?

Most Doctors suggest waiting a full year between pregnancies (especially caesarians) for a number of reasons:
  1. Your body needs time to recuperate from the first pregnancy
  2. You may still be breastfeeding (though there are cases of mothers breastfeeding their newborn and 10 month old)
  3. There average scar takes about two years before it has finished healing.
You are of course advised to take the matter up with your Doctor if your past caesarian was recent. However, if it has been over a year, you are ready if you say you're ready!!

Please book an appointment with your Doctor for a pre-conception check-up. In the mean time, you can start stocking up on folic acid, cutting down on caffeine and check with your pharamcist to find out if any medications you are taking may interfere with conception and/or pregnancy. 



Will I Have To Have Another Caesarian?

I must point out that I am no Doctor...you will need to have this conversation with your OB. A number of factors are involved in determining whether or not you will require a second or even third caesarian. It is wise to visit your Doctor for a pre-conception health check before falling pregnant. During this check up, your Doctor should order an X-ray (amongst other blood tests and exams) which will determine the size of your pelvic bone.
In most cases, this pelvic opening will be wide enough for your baby's big ol' head to pass through and it's great to have this measurement on file during your last trimester - the Doctor will compare baby's head circumference to the width of the pelvic bone.

Another factor to consider is the position of your scar. Most Doctors will cut a small horizontal opening to deliver your baby - this is along the "grain" of your muscles and therefore heals faster. If your required an emergency caesarian (a hard core knock you on the head with a hammer and cut this baby out caesarian) your Doctor may have made a vertical incision.
This will be a very large determining factor when your Doctor decides whether or not you will need another caesarian - vertical scars are more likely to tear during labour.

Scary thought, huh? Don't let this concern you - this only occurs in a very small fraction of deliveries.

Vertical uterine scars are more difficult to recover from and have a higher risks of tearing during the next pregnancy and labour. You should confirm with your OB which technique he/she used because the incision in the uterus is separate from the outer incision.



V.B.A.C.'s  (Vaginal Birth's After Caesarians's)

So if there is a small danger of a previous uterine scar tearing in delivery, is it possible to still have a normal delivery? Absolutely. These deliveries are known as VBAC's. These deliveries carry a higher risk and therefore your midwife will need to closely monitor you for signs of a tear however it is absolutely possible - do not let this fact deter you from experiencing the joy of a regular birthing experience. Many, many women go on to have VBAC's and deliver perfectly healthy babies with zero complications.

VBAC's are not an option if you have:

  1. a vertical scar on your uterus
  2. are a repeat offender (you will be hard pressed to find a Doctor that will consider a VBAC after two previous caesarians)
  3. the reason for your first caesarian still poses a danger (ie. you have a virus that could be passed onto baby or your pelvic bone is too narrow)
If these reason's don't apply to you...then congratulations - you are eligible for a VBAC!
However, it's worth reminding you that few "birthing plans" ever go as planned. Don't be to hard on yourself if eleventh hour complications arise =)






How Many Caesarians Can I Have?

So glad you asked! Because of the risk of uterine scars tearing during labour - we discussed this already...don't panic - Doctors suggest stopping after three. Each scar on your uterus is like another crack on the windscreen, another weak spot to cause concern. During your third caesarian, your Doctor will discuss tying your tubes ("while I've got you here"says the Doctor!). The recommended limit is three.

The world record is belongs to a mother of six who lives in America and had all her children via Ceasarian delivery. This is not recommended for the reasons discussed...but it is definitely worth a mention. 

Each caesarian is more risky than the last and carries a greater risk of complications such a hemmhoraging - on this note, please know that there are other options besides a blood transfusion. Due the risks associated with blood transfusions and the advances medicine has made, more and more people are deciding to avoid blood transfusions.

There are in fact many alternatives including a cell-saver - a machine that cleans and recycles your own blood. How amazing is that! These options will need discussing with your Doctor prior to you lying on the operating table!




If you would like to know more about pregnancy and childbirth after ceasarens, I have gone into more detail here.

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