The aims of csections.org
In the UK at present, 1 in 4 women will give birth by Caesarean Section. We believe it is essential that women are able to participate in discussions about their births prior to and during their labour. In order to do this effectively we believe women need more information about caesareans. We hope that this in turn may help to reduce the trauma and negativity experienced by those women who have a caesarean when they would rather have had a vaginal birth.
There are still women having caesareans when they do not want them and in some cases when they do not really need them. And for those who do want a caesarean they are often unfairly judged as simply being "too posh to push" when the reality is often far more complex. We hope this website will provide women with some of the information they need about caesareans in order to feel more in control of their births.
To quote Jeannie Douche, from the New Zealand College Of Midwives Journal, "Caesarean birth has evolved in just over a decade from a major abdominal operation with profound negative consequences for women, to become an increasingly acceptable choice of birth method" 89.
csections.org aims to provide:
- Information about women's rights when requesting and refusing a caesarean
- Information about the procedure and recovery
- Some real birth experiences
- Ultimately a more balanced perspective on caesarean delivery
Q
What will my scars be like and will a caesarean cause internal scars (adhesions) as well as an external scar?
A
A caesarean scar tends to be approximately 20cm in length and initially be red or pink and slightly raised. The incision site will vary from person to person. Typically it is a slightly curved horizontal incision along the bikini line. You will be shaved prior to the surgery - it might be worth asking your partner to do this before going to hospital as otherwise it is likely to be done "dry" by a nurse with a Bic razor. As you recover from the surgery the colour becomes increasingly muted and should eventually turn into a fine white line along your bikini line. Where complications arise due to infection etc. this line may take longer to heal and may remain red and inflamed for longer. However in most cases the scar line should be the fine white ine you would expect with any skin incision within a year of the surgery. On rare occasions a vertical caesarean incision will be required, but the colouration pattern will follow similar lines. Homeopaths can recommend treatments for the scar area.
Some women experience slight puffiness around the scar area for some time. This generally disappears. The puffiness is associated with water retention rather than damaged muscle and the degree of puffiness can increase slightly with exertion (hence the importance of moderate rather than rigorous exercise in the months following a caesarean). This puffiness usually disappears over time.
Diet can significantly enhance the health of skin in general so your diet, before, during and after pregnancy can impact your skins recovery.
In addition to the external scar, fibrous bands of scar tissue develop internally as part of the natural healing process (known as scar tissue). These can sometimes be felt around the scar area as slight raised patches, but they are not visible externally. In many cases this scar tissue is harmless. However in some cases it may adhere to other internal organs and cause pain and may also cause complications for subsequent pregnancies and caesarean sections. For example a second baby delivered by caesarean can expect to take 5.2 minutes longer to be delivered and a third and fourth might be as much as 8.4 and 18 minutes longer respectively due to the care required to cut through previous scar tissue.
If you are planning multiple caesareans it may be worth asking your consultant about the possibility of using a product such as "Seprafilm" (though it is far from standard practise in the UK). This is a product increasingly in use in America, the aim of which is to prevent adhesions developing 77. It looks rather like a thin fabric and is wrapped around relevant areas to prevent adhesions occurring. Within a day it turns into a protective gel and within a week the body absorbs it. Similar products are already in use for other types of abdominal surgery.
All major tissue layers are stitched during the surgery. The exception to this is the stitching of the peritoneal layer (the white waxy coating visible on the outside of organs). Debate is on going about whether or not this should be stitched together during caesarean surgery. Until recently it has been thought that allowing this layer to heal naturally reduced the incidence of adhesions, but this hypothesis has been based upon recovery from non-caesarean surgery 78. However a recent study led by Deirdre Lyell, MD, assistant professor of obstetrics and gynaecology at Standford medical school USA) found that patients whose peritoneum was stitched following their first caesarean delivery were significantly less likely to develop adhesions. "closing the peritoneum offered five times as much protection against the formation of adhesions as leaving it open. It also offered three times as much protection against dense adhesions, which are considered the most difficult to treat" 79.