According to the World Health Organization, when medically required, cesarean sections effectively prevent maternal and newborn death. Cesarean section rates in India and the rest of the world have been steadily increasing over the years. Cesarean births occurred for 21.5% of all births in India, according to the 2021 survey, well exceeding the WHO’s suggested cut-off of 10-15%.
“As primary births by caesarean section increase, we see an increase in repeat cesarean sections in subsequent pregnancies, which contributes significantly to India’s high overall cesarean section rate,” explains Dr Geeth Monnappa, Consultant Obstetrician and Gynaecologist, Fortis Hospital, Richmond Road, Bangalore, dispelling doubts about when to plan subsequent pregnancy following a c-section and the possibility of increasing the likelihood of a vaginal birth.
Benefits Of Vaginal Birth After Cesarean Section
1. Short hospital stay
2. Less bleeding
3. Lower infection rates
4. Early recovery
5. Reduced risk of adhesions and placental complications in subsequent pregnancies and surgeries
6. Lower maternal morbidity.
However, all women will not be ideal candidates for a vaginal birth following a previous cesarean delivery.
Planning The Next Pregnancy
Planning the subsequent pregnancies is extremely important after a cesarean section. The incidence of scar rupture increases if the duration between two deliveries is less than 12 months, and this is often emphasised at time of discharge or at the first postnatal visit. The chances of a successful vaginal birth during the subsequent pregnancies post a cesarean section reduces if the duration between two deliveries is less than 18 months, hence it’s always advisable to delay the next pregnancy by at least 18-24 months. This also helps the mother restore her health and regain iron after delivery.
Regular antenatal visits to optimise the wellbeing of both the mother and the baby is of the utmost importance if the previous birth is by a cesarean section. In addition to the normal blood tests and ultrasound that are a routine in any pregnancy, special attention will be given in early pregnancy to rule out an adherent placenta/ placenta that is stuck to the cesarean scar; the chances of which increase after a previous cesarean birth. Checks on the scar integrity will be made at each visit, especially in the later months of pregnancy.
Planning Birth After A Previous Cesarean Delivery
It is important to have a discussion with your obstetrician about your chances of having a vaginal birth after a previous cesarean section. The success rates of vaginal birth post a cesarean delivery are between 60-80%, with women who have had a prior vaginal delivery having the highest rates of success (85-90%). The incidence of cesarean scar rupture is as low as 0.5% during a subsequent vaginal birth.
Higher Rates Of Scar Rupture:
1. Women who have conceived within a short span of time post cesarean birth
2. Older women (>40years)
4. Women carrying a heavy baby
5. Pregnancy that has continued beyond the due dates
6. Thin scar on ultrasound
7. Induction of labour: Women who go into labour spontaneously have a lower chance of scar rupture and better success at vaginal birth as opposed to women in whom labour is induced or augmented
8. Previous uterine surgeries
9. Extension of uterine incision in the previous cesarean section: Doctores often ask the patient for her previous surgical records to know if there were any difficulties faced or extensions in the uterine scar during the operation, as this may influence our decision for planning a vaginal birth.
A detailed discussion with your doctor about the benefits of vaginal birth over a cesarean section at the first visit; evaluation of your previous records and the presence or absence of current obstetric/ medical complications will determine if you are an ideal candidate for a vaginal delivery. A vaginal delivery post a cesarean section requires continuous monitoring of the mother and fetus and has to take place at a well equipped hospital for optimal results.
Are You Aware Of These Complications Of Two Back-to-back Pregnancies?
Pregnancy spacing is mainly a matter of personal preference for a couple. When it comes to having a second child, there are not only physical, psychological, and economical considerations to look at, but also medical factors to think about. Research reveals that, on average, it takes roughly 18 months for a woman’s body to recover from the repercussions of childbirth. Experts believe that the foetus in the mother’s womb gets nutrients from the mother’s bones and blood for its own growth during gestation. During this process, the mother faces depletion of her own iron, folic acid, and calcium stores. Therefore, it is vital that the mother takes adequate supplements prescribed by the doctor during pregnancy and after delivery, especially till the time she is breastfeeding.
What Are The Main Risks?
Pregnancy within six months of a live delivery is linked to an increased risk of the following:
• Premature delivery
• Before delivery, the placenta partially or totally peels away from the uterus’ inner wall (placental abruption)
• Low birth weight
• Congenital issues
• Anaemia in the mother
“If the subsequent pregnancy happens too soon, say within six to eight months post-delivery, research shows there are increased chances of premature and intar-uterine growth retarded babies,” warns Dr Neena Bahl, Director – Obstetrics & Gynaecology, Fortis La Femme. She also mentions that it can lead to increased chances of placental abruption, that is, premature peeling off of placenta from the uterus wall.
Factor In Depletion Of Nutrient Reserves
With two consecutive pregnancies and childbirths, mothers can become anaemic, which can lead to backache due to calcium depletion. In case of folic acid deficiency, both the mother and the baby’s health can be affected.
How Soon Is Too Soon?
“As the average age of getting married goes up, the concern of spacing pregnancies is valid, especially when the woman is over 30. A minimum of 18 months should be a good idea between two pregnancies. In case the patient has delivered by caesarean section, the scar also heals within this time. Dr Bahl concludes by saying that if at all a couple conceives in a short inter-pregnancy interval despite taking precautions, they should support the pregnancy by taking the prescribed supplements and dietary advice for an optimal maternal and perinatal outcome.
Speed Up Recovery From Caesarean Section With These Expert Recommended Tips
Apart from the general health and well-being of the unborn, a couple’s primary worry during pregnancy is the manner of delivery. While the majority prefer vaginal delivery, some prefer caesarean section. Everyone has their own choices and preferences, as well as their own justifications for those choices and preferences.
Doctors explain specific criteria, contraindications, guidelines, and protocols to facilitate mode of delivery selection. The delivery method that is most beneficial to the mother and child is chosen, and appropriate counselling is provided.
“In current days of increased average gestational age, increased mother BMI, and sedentary lifestyles, problems to safe delivery are to be expected. However, as specialist anaesthesia services have become more generally available, caesarean sections have increased in popularity, as they result in a better pregnancy outcome even in difficult situations,” Dr. Anu Joseph, Consultant Obstetrician & Gynaecologist and Specialist in High-risk Pregnancy & Fetal Medicine, Kauvery Hospital, Electronic City, Bangalore who answers few queries on caesarean delivery sharing few tips for faster recovery.
What To Expect?
Caesareans are performed as a planned mode of delivery for many women due to pre-existing reasons such as previous uterine surgery, incompatible infant position, numerous pregnancies, and babies larger than the birth canal. In such circumstances, the doctor counsels the couple about the surgery well in advance.
However, for some a planned vaginal delivery gets converted to an emergency lower (uterine) segment Caesarean section (LSCS) due to a variety of reasons, such as insufficient advancement of the birth canal opening or insufficient progress of the baby’s descent into the birth canal. Other factors, including as variations in the foetal heart rate (foetal distress), bleeding, or preterm symptoms, may also warrant an emergency LSCS.
What Happens Before The Procedure?
Prior to the procedure, the patient is taken to the operating room, where anaesthetists explain the process. In general, spinal anaesthesia is selected because it involves an injection of numbing drugs in the back and numbing the abdomen and legs. It is often a somewhat uncomfortable operation that takes only a few minutes to complete. Expect tingling, numbness, and a sense of heaviness in the lower limbs for around 4-5 hours. The woman can remain awake and expect to view the baby immediately following delivery with this type of anaesthetic. Depending on their health status, some women may require general anaesthesia.
What Happens Post- Procedure?
Following the procedure, the patient is typically advised to remain under observation for a period of hours, depending on pre-existing conditions and procedural risks. After that, the patient is returned to the room.
Post-operative recovery is typically painless, aided by early mobilisation, pain medication, and diet. Pain is frequently felt once the anaesthetic is withdrawn. However, during the early postoperative time, your doctor would have encouraged you to take drugs to help you feel better if necessary.
Each day is deemed to be more favourable than the preceding one in terms of post-surgical recovery. The superficial wound will heal in approximately 5-10 days. However, complete recovery takes approximately 5-6 weeks. Women are encouraged to avoid straining the abdominal wound during this time, refrain from heavy activities, and support the wound site during coughing or sneezing.
The following are few tips to foster faster and better healing:
• Pre-pregnancy health: proper diet, water intake, exercise and weight management make a great impact in post- delivery recovery. All nutritional and vitamin supplements prescribed are to be taken diligently and tests that are advised are to be done.
• Control of co-existing illnesses: in case of pre-existing issues like diabetes, low haemoglobin, infection etc, the doctor’s instructions are to be followed strictly, and make sure that the issues are corrected.
• Take medications on time and correctly.
• Exercise: once you are cleared to move about, do make sure that you follow the basic exercises that are recommended by the physio. Restricted movements after surgery delays recovery. At various stages of recovery, a physiotherapist can help you understand and practice the exercises that’s deemed fit for you.
• Adequate sleep and rest: the days post-delivery are filled with breastfeeding routines, medications, discomfort, visitors, phone calls etc. It is of great importance that the mother gets adequate time to rest and sleep.
• Nutrition and hydration: to begin with, the diet must be light and soft without strong spices and oil. As the mother recovers, the dietary changes can be adjusted as per the prevailing family diet patterns. Adequate hydration is important and restricted water intake is a definite taboo.
• Comfortable breastfeeding habits: initiation and continuation of breastfeeding can sometimes run into difficulties after cesarean. However, it is important to seek help from a breastfeeding counsellor if need be. Finding a comfortable feeding posture also is equally important to ensure a stress-free feeding routine. Take time to be with and bond with your baby
• Hygiene: in some societies, women are restricted from showering post-delivery, probably due to fear of disturbing the wound or other mis concepts. However, it is recommended that women take shower daily. Also make sure the sanitary pads are changed periodically. Breast care is also equally important. In case of any difficulties, review with your treating consultant.
• Relaxation techniques: each person has their own ways of relaxation, listening to calming music, breathing exercises, reading books etc. One can practice what one prefers immediately post-delivery.