Ask the Doctor: I’m afraid of a third C-section

I am a 33-year-old pregnant mother of two boys aged three and five. Both deliveries were by c-section. I was determined to have a natural birth for both but I couldn’t. With the first, I failed to progress in labour and the second, my baby was diagnosed with a birth defect and a cesarean had to be done to help reduce any further complications during delivery. Now I’m onto baby number three and I have been told that if I get another cesarean, it might be dangerous. What if I have to get another one? How many C-Sections can a woman have? I’m a little frightened. Evelyne, 30, Remera Dear Evelyne, Caesarean section is an option with the doctor to deliver a baby by surgical operation in case the labour is not progressing as desired, or if there is a risk for survival or with the health status of the mother or child. It saves a woman from excruciating labour pains. It is a myth that a woman cannot breast feed immediately after a C-section; she can do it very well. Risk of uterine prolapse later in life is less in women who have undergone caesarean delivery as compared to normal delivery. But it is not a hazard free procedure. There are immediate risks after C-section as in any other surgery. This includes bleeding during and after operation, infection at the site of the operation or an infected wound after surgery. The urinary bladder, urethra, e.t.c., parts in proximity to the uterus and can be damaged leading to many problems later on. Tearing of the uterus can cause problems in subsequent pregnancies. Chronic infection of the inner lining of the uterus can set in resulting in chronic lower abdomen pain and painful menstrual cycles. Like any other surgery, there is a risk of blood clots developing and part of it lodging in the lungs or brain leading to respiratory failure or stroke. Due to the spinal anesthesia given, one can develop an allergy to the drug used or paralysis of the legs if the nerves are damaged. Over time, with post C-section one can develop adhesions in the abdomen resulting in chronic pain and even occlusion of intestines. During subsequent child birth, it can lead to rupture of the uterus. Chronic infection of the fallopian tubes can lead to extra uterine pregnancy, i.e. pregnancy at any site outside the uterus and even sterility later on. Risk of postpartum depression and problems of bonding with the baby is higher with a C-section. Regarding the safety of the baby, a C-section is very safe and there is just a small risk of cut or nick over the baby’s head. However not every woman who delivers by a C-section develops these complications. The statistics are 2-3 to about 9/1000 women for different complications. Many more women deliver safely with a caesarean section and they, along with the newborn, remain safe and healthy. The doctor, while taking a decision on a C-section, will consider the advantages and risks in the current situation. If the benefits outweigh the risks, he will definitely opt for a C-section. The operation would be done with all due precaution to prevent infection. The woman is screened before hand for any chronic infection, diabetes or hypertension, conditions which increase risk for infection or other postoperative complications. Mostly antibiotic is given before the operation to cover for any possible infection. An emergency kit is always placed nearby to deal with any intra or post operative emergency, should it arise. Therefore be carefree. You can consult a doctor and discuss all chances of delivering normally or by C-section. Dr. Rachna Pande is a Specialist in Internal Medicine at Ruhengeri Hospital

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Ask the Doctor: I’m afraid of a third C-section