Long term effect of C-sections (multiple)

[Lisa P.]

Does anyone know what the long term effects and/or risks are from having more than one c-section? I am PG with #2, #1 was a section (13 years ago) and I am pretty sure we are going to try for #3 at some point down the road.

For this baby, I have decided to try VBAC, but only if I go into labor on my own - I won't be induced due to a greater risk of uterine rupture. Given the choice of induction and a c-section, I will choose the section. After 2 sections, I am pretty sure the chance of a successful VBAC will be slim to none, so if we do end up having 3 kids, that means 3 sections altogether.

I have heard that an abundance of scar tissue from the surgeries can cause abdominal pain, and of course there are all the general risks associated with major surgery. I am just wondering if there are any other health problems they are finding that occur in women who have had more than one section?

Thanks,
Lisa

[Jane]

Boy,this is all off the top of my head....here goes!
Most of the complaints I have heard, just from friends, is that every c-section decreases the attractiveness of their tummies. I think that could more accurately be applied to pregnancy in general, but I think there is some truth. That's just ladies gossiping-talk. Oh, and each one increases the area that's numb afterwards.
On the clinical side, I have heard of greater chances of incontinence, since the bladder is peeled off the uterus each time there is a surgical birth. It's not the multiple times doing it, it's just more chances for complication.
On birthlove this week there is a long list of how to have a good c-section. One woman mentions that her subsequent sections hurt lots less than the first, just because her nerves were already cut. Take that for what it's worth, plain ol' hearsay on my part.
I vaguely remember that a c-section uterine scar can interfere with implantation for some women. Do surgeons always cut on the same line? Then it wouldn't make a difference how many. Huh, wonder it there's an answer to that. Gotta find that one out. I 'm interested to see what everyone has to contribute.

[theflower]

One of the biggest reasons I will choose VBAC is the increased risk to subsequent pregnancies. Here is an excerpt from Can-o-Beans article here on Mothering.

Increased Complications in Subsequent Pregnancies
A history of cesarean section dramatically increases the risks of severe subsequent pregnancy complications that are normally quite rare. Placenta previa, which has an incidence of 0.25 percent among women with unscarred uteri, rises to 1.87 percent after one prior cesarean.56 There exists a dose-response pattern; with one prior cesarean, there is a 4.5x risk for previa; after two prior cesareans, the risk rises to 7.4x; after three, the risk is 6.5x. With four or more cesareans, the risk rises to nearly 45x the risk of previa in an unscarred uterus.57

A low-lying placenta is also more likely to lead to placenta accreta. According to a 1997 study, the presence of a uterine scar independently increases the risk of placenta accreta from 0.01 percent in unscarred uteri to 0.25 percent when there is at least one prior cesarean section. 58 Again, the number of prior cesareans has been shown to increase the risk of accreta.59 Placenta accreta may lead to severe hemorrhage, with subsequent hysterectomy being required in 50 to 82 percent of cases.60 It can also lead to maternal death.

Placental abruption is also significantly increased in women with a prior cesarean section compared to women with no scar. The rate of abruption in Finland was found by Hemminki et al. to be 0.17 percent for women without prior cesarean and 0.49 percent for women with a prior scar.61 According to the National Center for Health Statistics, the rate of abruption in the US from 1989 to 1990 was 0.6 percent overall; infant death occurred in 10 percent of these cases. In 2001, Ananth et al. found an abruption rate of 0.65 percent, with a perinatal mortality rate of 11.5 percent. Although 55 percent of these were due to early delivery, the rate of death for full-term infants in the group with lowest mortality was still 25-fold higher in cases of abruption.62 Compare the risk of these complications to the rate of rupture for women attempting VBAC found by Lydon-Rochelle et al. (0.6 percent) and the rate of fetal death associated with rupture (5 percent). Although not usually life threatening, there are other complications to consider for subsequent pregnancies. Increased rates of secondary infertility have been reported after prior cesarean, as well as higher rates of miscarriage and ectopic pregnancy.63

http://mothering.com/11-0-0/html/11-4-0/vbac-lash.shtml

[lorijds]

Something I rarely see mentioned is the increased incidence of adhesions. Adhesions are areas of scar tissue that can become painful. The scar tissue over grows, in effect, and can cause vague or sharp pain in various areas of the abdomen. It can attach itself or twist itself around fallopean tubes, intestines, etc, and really cause alot of pain. There isn't much to be done for it, except take pain medication. Sometimes women will have surgery to cut back a large amount of adhesions, but of course each surgery can cause new ones.

I cared for a woman last year whose adhesions (from a c-section 20 years ago) pinched off her large intestine, she had to have emergency surgery when it was finally diagnosed. She had been complaining of abdominal pain for years, and basically everyone told her it was due to scar tissue and she would just have to live with it.

This is a side effect of major abdominal surgery that rears its ugly head sometimes 30 years or more from the original surgery. And I think it is one of the worst ones, because of the chronic nature of it and the lack of treatment options. I also have NEVER heard a woman, when obtaining info regarding c-sections and the possible risks, who has been informed of this possible side effect.

Just something else to think about when pondering a c-section. Of course, if a section is necessary, it is a risk that must be taken. But I just wanted to let you know that it is definately a risk, and with each additional surgery it becomes greater.

Lori

[theflower]

My sil had her intestines blocked from an adhesion. She was in the hospital for a week on morphine before they did exploratory surgery and realized what was wrong. Adhesions are a very real problem with any abdominal surgery.

[stafl]

Adhesions are a very real risk with any abdominal surgery. Some women do not feel pain at all, some are crippled by it. After my first lap (for endo) the adhesions were so bad I could barely walk!

There are things that can be done for them! I found a doc who is a specialist in reproductive lap surgery to perform my second lap. He used a special adhesion-prevention product after removing the endo and adhesions that were everywhere inside me.
http://adhesions.org/
http://womenssurgerygroup.com/

The doc who performed my emergency c/s also told me that the risk of adhesions was very slim. I know that I am indeed having some adhesion-like pains, and will be going back to my surgeon to have them removed after I am through with nursing.

[julie128]

tubal pg

With each cs, you are more likely to have a tubal pregnancy. Chances are still low, though.

[RainCityMama]

By the way - Just because a woman has had two c-sections doesn't mean that VBAC is no longer an option - As a member of ICAN (International Ceserean Awareness Network) there are a number of women who have had successful VBACs after multiple c-sections I think the biggest obstacle is finding a care provider that is willing to go the distance for you, but it's not impossible.

From my own personal experience having had a c-section followed by a home VBAC there was simply no comparison - a vaginal birth for me was SOOOO much easier and left me feeling so much better than my surgical birth.

Good luck to you!

[galadriel]

Jeepers, this thread has scared the crap out of me! I had one c/s, a month ago. Eek!

[frogertgrl]

Most women I know who had C-secs ('emergency' or elective), have had ectopic pregnancies after the C sec. And what really sucks is that some have had two ectopics and both tubes blew out so now they are on the infertility path. Some just have one tube to TTC.

Ubertulip, didn't the attending OB inform you of these risks (increased risk for placenta problems, ectopics) prior to surgery? Or maybe the consent form you signed has these risks - that might be a place to look.

Mardsen Wagner has written extensively on this subject. I just need to find it! I recall a huge piece he wrote for The Lancet, that had all the risks to the mother from C-secs, including the ones listed in this thread.

And forget about the risks to the precious baby in a C-sec! Makes me want to cry everytime. 30% increase of lifelong asthma? No thanks. Let the sweet babe come down the canal and get all the benefits they are birthrighted to receive.

[frogertgrl]

here's a piece from Wagner in Midwifery Today:

http://www.midwiferytoday.com/enews/enews0325.asp

There are also risks women carry to subsequent pregnancies due to scarring of the uterus including decreased fertility, increased miscarriage, increased ectopic pregnancy, increased placenta abruptio, increased placenta previa (1,2,3).

For women choosing CS, all of these risks exist in all of their subsequent pregnancies even if the original CS was not an emergency. The increased risks of ectopic pregnancy, abruptio placenta, placenta previa and ruptured uterus are all life-threatening to both woman and baby.

[RainCityMama]

Sort of taking this thread in a different direction, but what really peeves me is why more women are not PROPERLY informed? When the doctor that performed my unnecessary c-section 'scared' me into it she made it seem like the only risks I was facing would be due to 'waiting' for a vaginal birth - If only I knew then what I know now
It seems to me that women should be FULLY informed before they even go into labor that a c-section has lifelong affects on your reproduction from your future fertility to the way you may wish to birth any future children and it isn't just a 'quick fix' for a stalled out labor or an exhausted mama, but then I think that's what some doctors actually think! :

My parting thought - go with a midwife that has an abundance of patients and don't leave your home, that's what worked for me!

[galadriel]

frogertgrl

After 36 hours of labor (24 at home) and an epidural that didn't work, I wasn' t really too concerned with future pregnancies. At that point I was in a completely altered state. Anyway, I'm fortunate in that I feel great about my birth experience, even though I had planned a home waterbirth, and my daughter is doing fantastically well, no bf problems at all and we're healing beautifully so far. Indeed, if things weren't going so well, I'd probably feel more angry.

I don't believe that most women who have had c/s births have ectopic pregnancies. I believe in our bodies' ability to heal, and heal well. Lots and lots of women go on to have straightforward VBACS and HBACS, without all or any of these complications.

[frogertgrl]

RainCityMama,


ITA and c-secs are so often, given as a solution to a stalled labor or a mama who is too tired to go on. Told her uterus 'just is too tired' and baby won't come out so off to the surgical removal.

Ugh.

[hvl25]

i have had 2 c/s

and it was true for me that the second one hurt alot less than the first one. I could walk in the hospital without feeling like I was about to die and I was doing laundry the same week I came home ( know not the smartest thing), not carrying it , just moving from washer to dryer. My OB did cut on the same line as the first one and the scar is barely visible for me anyway. I did notice the area of numbness is farther up than last time, no biggie for me. True, my tummy does not look the greatest, but I could stand to lose about 20lbs and I have had two babies over 9lbs and the last one was 3 weeks early and she was 8lbs8oz.


also, I did have placenta previa at 12 weeks but by 17weeks the placenta had moved and everything was fine

[KatherineinCA]

In the last 8 1/2 years, I've had three c-sections, (along with a D&C and three laps). As for side effects I've noticed so far, I have had an ectopic pregnancy, and have struggled some with adhesion pain. And I also have noticed an improved recovery each time.