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Previous Caesarean

Patient Education

Previous Caesarean Delivery :

This is now becoming a very common indication for repeat caesarean section. Most patients with one prior caesarean delivery may deliver safely vaginally in the later pregnancies. This is more likely if the prior caesarean section was for a non-recurrent or temporary condition of that pregnancy, such as:


  • Malpresentation.
  • Foetal distress.
  • Bleeding from the placenta.


The options should be discussed by you and your doctor prior to onset of labour. If a vaginal birth trial is opted for certain guidelines need to be followed discussed later in this section. In some cases, you and your doctor may opt for an elective or planned repeat caesarean. This is more commonly done if you have had:


  • More than one caesarean previously.
  • Your baby is now larger.
  • Not in a favorable presentation.


The type of prior caesarean is also important, as with an incision, the risks of attempting VBAC are more.Other uterine surgeries done in the past such as myomectomy or septum resection may also influence the decision for type of delivery.


Risks:

Caesarean births are much safer now than they were a few decades ago, In fact, hardly a century ago, having a caesarean was like a death sentence for the mothers. Today, the procedure carries a ‘risk’ of less than 1 in 2500. Yet, this risk is 4 times more than the risk of death after a normal vaginal delivery.

However, when talking about risks, one must keep in mind that statistics show that most people die at home or in bed. That doesn’t mean that by not staying home or not sleeping you can escape the inevitable!

While talking of risks what needs to be seen in the risk-benefit ratio. The ultimate aim is to have a healthy mother and healthy baby. In a given situation, if the benefits offered by caesarean birth to the mother, the baby or both are more than the risks; the procedure needs to be done regardless. Individual medical conditions like uncontrolled blood pressure or profuse bleeding from the placenta may make a vaginal birth more dangerous for the mother.


Risk for Mother :

  • Infection: Post-operative infection of the uterus, or nearby organs like the bladder may occur. Use of antibiotics has reduced this risk.
  • Increased bleeding: Some blood loss is inevitable at birth, but it is twice as much at caesarean as compared to a vaginal delivery.
  • Complications of the anaesthesia used
  • Urinary tract: Difficulty in passing urine, urinary retention, infection may occur. Rarely, surgical damage to the bladder or ureters may occur, particularly in cases of repeated surgery.
  • Bowel function: Post operatively, the bowel movements may become sluggish or slow down completely. This leads to distension, bloating and abdominal discomfort.
  • Respiratory tract: Occasionally, due to aspiration of stomach contents, pneumonia may result. This is more common with general anaesthesia.
  • Wound problems: There may be a blood clot or pocket of pus in one or more stitches. In more severe cases there may be infection of the whole abdominal wound, and partial or complete dehiscence (splitting open) of the wound.
  • Blood clots: They may form in the leg veins, or collect in the uterus. Clots in the pelvis organs or veins may travel to the lungs causing embolism, a serious complication. This is reduced by early ambulation.
  • Delayed recovery: The hospital stay after a caesarean birth is usually twice as long as after a vaginal birth. In case of a ‘bikini’ incision, the average stay is 5 days, with a vertical midline incision, it may be 7 days or more. Full recovery of daily activities may take 4 weeks or more.
  • Long term: Increased chance of repeat Caesarean section.


Risk for Foetus :

  • Prematurity: The baby may have been delivered too early if there was miscalculation of the due date. Sometimes, despite knowing that the baby will be premature, an emergency caesarean may be needed, such as, for bleeding from the placenta, uncontrolled hypertension, etc, in the mother’s best interest.
  • Low Apgar Score: The baby may have depressed activity at birth, as measured by the Apgar score.This could be due to the anaesthesia, other medications, or pre-existing factors. This need not indicate any long-term problem, however.
  • Breathing difficulty: Transient tachypnoea of the newborn (rapid or irregular breathing) is more common with caesarean birth. This is thought to be due to lack of the ‘squeezing out’ of lung fluid, which occurs in vaginal births. This usually settles in a few days.
  • Foetal injury: Although this is rare, the baby may be accidentally nicked while the surgeon is opening the uterus. With malpresentations, or deeply engaged head (as in caesareans after a long and difficult labour ) there may be some trouble delivering the baby, a minor foetal bruising or injury.

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