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Discussion Starter · #1 ·
Hi. Forgive me for not looking through all the information to find out about this, but I am limited with time and this seems to be too complicated for me to find info on...so...

I'm 38 wks. Having a second c-section in about a week. My first c-cestion was a low horizontal incision and ended up infected so badly that we went to the ER. Got on antibiotics and everything was fine. Part of my problem-as embarassing as this is- is that my belly hangs over the incision and causes increased risk for infection. My doctor told me today he recomends a vertical incision this time due to this factor. He thinks it'll heal better for me. If the incision doesn't get air, it won't heal. I'm scared out of my whits!!!!!!! I feel like he wants to hack me up. I don't know why I feel that way, but I just feel like he's going to carve my body all up. I already have the one incision scar. I have a 17mth son at home and the c-section will be hard enough without adding that to the mix. Doesn't it take longer to recover? Won't it hurt more? I really need to make nursing work this time-isn't that really difficult with that incision? What do I need to ask before this all happens? Please help me to feel better about this>>> Amy
 

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Does he mean a vertical incision on the outside and then a horizontal on the inside? I guess I just don't really get his reasoning... I would think most PP woman would have skin hanging down... I know I did for a couple of days...
 

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Discussion Starter · #5 ·
WOW!!! that was fast!!! Thanks!

I'm high risk due to a clotting disorder called factor V lieden. Due to this, I'm on blood thinners to keep clots from harming the baby. They have much more control of the blood thinners that I'm on if I am a scheduled c. If I go into labor on my own and am still on the blood thinners, it's risky. My first one was a section because of the baby's reaction to the induction. The baby was in distress and needed to come out.

This is a different doctor. My other OB moved. This doctor won't do a vbac due to the risks, so it's going to be a c-section for sure. This is fine with me. I'm just wondering about the vertical incision as opposed to the horizontal.

Before I ever was pregnant, I lost a whole bunch of weight. The "hang down" only got worse after the first baby. And with this pregnancy, it's really bad. I'll probably have to have plastic surgery some day to take care of it.

Hopefully this is enough info to go on. You guys are awesome!!!
 

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Are you feeling fine with the notion of a repeat cesarean birth? Just curious. I googled factor V leiden and found some stories of vaginal birth.

If you are, then I would just tell my doctor that I would be more comfy with the horizontal incision. Unless there's a really valid medical reason, I think you could opt for the incision you'd prefer.
 

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Discussion Starter · #7 ·
I'm fine with it. My doc won't even consider otherwise. At this point, vaginal is out of the question. At least I know what I'm up against. I'm in Ohio and the malpractice for docs is all out of control. I've come to terms with another section. It's true about factor V not having to be a section.

The doc did say he'd talk to me about it right before the surgery. I'll be sooo nervous then that I'll probably forget to ask questions. I could always insist on the horizantal incision. He just feels like it will be at a greater risk for infection. That would be his medical reasoning.
I wonder if I really work at keeping it dry? Does it need to get air to heal correctly or just stay dry?
 

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I gained one hundred pounds even with DS 1. I had huge overhang after my section. I just made sure that when I was recovering, I let it air out as much as possible, and once I was up and about, ... hmmm. how to describe this? Make sure you have big enough undies to keep material touching the skin under the flap, so it isn't skin to skin. Basically to soak out any sweat/moisture and keep it from chaffing. You could even use bandages loose under the flap (should hold themselves in place, really ) to keep it sterile and dry.

I would absolutely consider it a better risk to brave possible infection, than a classic section cut. With the one, you have some control over the outcome. Keep it clean and dry and you should be fine. With the other, you have none. what is done is done.

Just my opinion, I have no medical background BTW, so it is all conjecture on my part.

Good luck with your birth!
 

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Scar infection isn't all that rare after cesareans, so don't be embarrassed! While I don't have any groundbreaking advice, I'm going to recommend really taking it easy after your surgery. Focus on your recovery and that's it!! (Well, I guess you can take some time to love your new baby up if you must.
)

Congratulations on your upcoming birth!
 

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I also had hangover after my births, and my doctor simply told me to keep a sanitary pad tucked in there and change it every time I went to the bathroom. I ended up using my cloth liners for my babies diapers, they worked really well! And, if you do start to get an infection, use honey on it!! Totally bizarre advice I know, but I got an infecton my last birth and my OB said to put a dab of honey on it every time I changed the pad, and it healed up in days!! She said it would work better and faster than hydrogen peroxide which I had been using. I guess there is some research on it. For OB's mine were pretty darn conservative!!

Also, I would insist on a horizontal incision. I really don't have any reasoning, but it seems to me that it would be easier to protect, especially with breastfeeding.

Anyway, good luck. There is a c-section support thread on page two where you can post questions, etc..... to a group of us that have been there and done that.
 

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your body your deal. it sound likes you want a horizontal- so get it.
I would write it down now and make sure whoevers with you lets him know- repeatedly.

When is the c/s supposed to be?

hugs mama.
 

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you could obtain a wrap for your belly that could help keep the skin lifted off of the incision (one of those wide white elastic post-op wraps with velcro). Or even use a wide ace bandage to "catch" the skin and pull it up and then use the rest of the ace wrap to hold it in place. You may benefit from having a consult with a wound care nurse. They may be able to help you brainstorm more ideas that would keep the area healthy after the surgery.
 

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Discussion Starter · #14 ·
Yeah, after thinking(stressing) about this, I'm leaning toward insisting on the horizontal.
I'm not sure the doc will be as complient.
I've told my husband when we talk to him to insist with me and not let the doctor change my mind.
My doc is a bit of a bully and likes to be right.
He doesn't like it when people "challenge" his authority. I have a feeling when I tell him I want the horizontal, he's going to not like it.
He said something about the baby being high and that the vertical would be easier anyway.
Well, my thought is that the baby could move down a lot. the section isn't until the 23rd.
Easy??? I'm not paying him to go easy on HIM.
I've just got to grow some balls when I'm talking to him.
My husband will be great to have there.
He hears my griping about this guy all the time.

Thanks for all the support. Now I'm just stressing about talking him into doing the horizontal.
Is there anyone who doesn't stress about something this close to giving birth???
 

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Quote:

Originally Posted by amycurlygirl
Yeah, after thinking(stressing) about this, I'm leaning toward insisting on the horizontal.
I'm not sure the doc will be as complient.
I've told my husband when we talk to him to insist with me and not let the doctor change my mind.
My doc is a bit of a bully and likes to be right.
He doesn't like it when people "challenge" his authority. I have a feeling when I tell him I want the horizontal, he's going to not like it.
He said something about the baby being high and that the vertical would be easier anyway.
Well, my thought is that the baby could move down a lot. the section isn't until the 23rd.
Easy??? I'm not paying him to go easy on HIM.
I've just got to grow some balls when I'm talking to him.
My husband will be great to have there.
He hears my griping about this guy all the time.

Thanks for all the support. Now I'm just stressing about talking him into doing the horizontal.
Is there anyone who doesn't stress about something this close to giving birth???
Do NOT let this OB bully you into a vertical incision, inside or out. They are FAR more likely to have complications in larger women than horizontal. Read this study: http://www.greenjournal.org/cgi/content/full/102/5/952

I had a fat-phobic OB bully me into a vertical skin incision and I got a huge seroma (fluid pocket) behind it. It took 12 weeks to be fully healed and I had to have it packed twice daily that whole time. I will not have another c-section again unless it's the safest option but if I do have another, I will not consent to a vertical incision. And a vertical uterine incision is simply unsafe and can put your future pregnancies at risk.

I honestly think many OBs think fat women have no sense of hygeine. You can keep a maxi pad over your incision or dry it with a cool hair dryer or a number of other therapies to keep your incision healing well.
 

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Discussion Starter · #16 ·
WOW! That's some fantastic info!!!
The doc is all into studis like that. I'm not sure he has time to look at it before the c/s. I won't be seeing him again until right before the surgery.
Thanks for your story. That pretty much sinches my decision!
12 weeks???? You poor thing!
What's up with these docs anyway???
They'd just rather get out to the golf course faster I guess.
I'll keep you all updated. Stay tuned.
So glad I found this board!!!
 

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I Respect your decision about your upcoming birth, so I'm not going to "go there."

Just wanted to say that I heard using a blow dryer on the incision site can help with infection.

Best wishes to you and I hope things go smoothly.

Your "overhang" aka "shelf" is completely NORMAL and is absolutely no reason for any type of vertical incision.
 

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Quote:

Originally Posted by amycurlygirl
WOW! That's some fantastic info!!!
The doc is all into studis like that. I'm not sure he has time to look at it before the c/s. I won't be seeing him again until right before the surgery.
Thanks for your story. That pretty much sinches my decision!
12 weeks???? You poor thing!
What's up with these docs anyway???
They'd just rather get out to the golf course faster I guess.
I'll keep you all updated. Stay tuned.
So glad I found this board!!!
Amy, I hope I didn't scare the heck out of you with my story! (((HUGS))) Just wanted to let you know that vertical incisions suck suck suck!

Hope your upcoming birth goes smoothly. Don't let the doc bully you. (Even if he's got a hot golf game lined up!)
 

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I would like to point out that that study is 3 years old, and something more might have come out since then. It does appear, though, based on that that the rate of infections are higher for the vertical skin incision.

I think it depends upon your size, honestly. Don't be so hasty to trash talk the doc; if by easy, he means less blood loss and fewer minutes open, then that might be a factor to consider, especially with your history. While fat-phobia is NOT acceptable, it is also a fact that the larger a patient, the more difficult certain procedures are and sometimes those procedures need to be altered based on the individual, for the ultimate safety of the patient.

Can you get another opinion from a different doc, preferably one not affiliated with this one? Especially if yours seems unwilling to discuss the pros and cons of the vertical skin incision. Do you see, or have you ever seen an oncologist or a hematologist for your blood condition? If so, maybe discussing it with him/her would be the best option. Frankly, the doc with the specialty in your condition will be much more knowledgable about safe surgical practices and have good recommendations on tips for healing than an OB who sees your condition a couple of times a year maybe.

It sounds to me like you have gotten lots of good ideas here in regards to how to keep a transverse skin incision healthy. I just had a couple of thoughts to add to them.

If you use something to buffer the skin folds (which I would also recommend), my first choice would be organic, cotton maxi pads. My second would be cotton cloth diapers or diaper inserts. The fewer perfumes and chemicals to irritate the skin, the better. Wash your hands well before and after every contact with your incision or the area near it.

I would also recommend you start taking a probiotic about a week before your surgery, and continue until your incision heals. Make sure you are getting plenty of fluids, protein, and vit C--these help your body heal. In the article, it stated a higher iron count also was associated with fewer complications--so make sure you are getting plenty of iron rich foods.

Get your skin healthy now. If that skin fold is already irritated, that may be another reason for him to recommend a vertical incision. IF there is yeast or irritated skin, it needs to be gone before the surgery.

Sorry, I'm a bit rambling and here-and-there; but in answer to your question regarding what exactly is important, both keeping it dry AND open to air is important. The increased friction, skin temperature, and moisture all contribute to infection. Some pathogenic bacteria grow better in lower oxygen levels, so keeping it open to air also discourages these types of infections. So allowing it to get some air, using a blowdryer, buffering it with some sort of pad or cloth, and supporting your abdomen (without stretching or putting pressure on the incision) will *all* help keep your site healthy.

Good luck! Happy birthing!

Lori
 
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