Incisions And Scars

During a Cesarean operation, the cut into the uterus is usually made in a horizontal direction over the lower portion of the uterus. The outside scar does not necessarily run in the same direction as the incision into the uterus. It is this uterine scar that is of concern. In certain emergency situations, the cut into the uterus is made vertically over the middle or lower portion of the uterus. This vertical type of incision, also called the "classical incision" is considered more unstable than the commonly performed horizontal incision. For this reason doctors usually recommend that women who have had a classical incision have a repeat Cesarean.

The main concern about horizontal uterine scars was whether they would hold up under the strain of labour. In fact, studies to date prove that in the vast majority of cases they do. The risk of separation or even rupture of the horizontal scar is very low, in the range of .05 to 1.0 percent.

If there is serious doubt about the type of scar, it can be examined through a five or ten minute office diagnostic technique known as hysteroscopy before getting pregnant.

Advantages Of VBAC

Vaginal birth after Cesarean, also called VBAC (pronounced VEE-BACK) has many distinct advantages over repeat Cesarean.

The major hazards of C-section to the baby relate to the risks of respiratory problems or the risks of prematurity if the pregnancy was dated incorrectly. These hazards would probably be the same with a premature vaginal birth.

The risk of the mother dying from Cesarean birth is very small. However, the maternal death rate associated with Cesarean section is two to four times that associated with a vaginal delivery.

With the aftermath of major surgery as well as the birth of a baby to deal with, a Cesarean mother has to cope with more pain and weakness following delivery.

Having a C-section increases your risk of getting a chronic and disabling pelvic infection six fold, unless preventative antibiotics are given before the surgery.

Moreover, few doctors realize the devastating impact a C-section may have on some women emotionally and psychologically.

As delighted as women are to have their babies safe and sound, they may feel a confusing mixture of shock and deep disappointment.

"Surgical deliveries have profound psychological effects on all women whether the surgery is actually necessary and life-saving or not," says Claudia Panuthos, a well-known child birth counsellor. "After the section," she goes on to say, "a woman grieves for her loss of control, her loss of dreams of normal birth, her loss of teamwork with her mate during labour, and the loss of early contact with the baby."

Not Enough Doctors Follow The Guidelines

In spite of the eight year old Canadian guidelines, statistics show that obstetricians have not changed their style of practice very much. Cesareans are still the third most common operation for Canadian women. Most doctors agree with the guidelines, at least in theory, but have been slow to change their practices.

A recent Canadian study (Canadian Medical Association Journal, (#142 Jun/90) reviewed C-section births in an Ottawa hospital and found they ranged from 12 to 20 percent. Seventy five percent of these C-sections were done due to failure to progress in labour, a pelvis that was too small, or failed induction of labour. However, the researchers found that C-sections were being done for women with a small pelvis without proper trial of labour, or failure to progress in labour without any sign of the baby in distress. If these practices were modified, the researchers felt the C-section rate could be reduced to about eight percent.

Of the 313 women admitted to a major teaching hospital in Toronto, 71 percent were eligible for a trial of labour. However, only 42 percent of the women were allowed to have one (Canadian Medical Association Journal, Aug 15/93).