Pregnancy and Childbirth: The answers
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Issues after a cesarean section

Most women having a cesarean section will have no complications of any kind. They can expect to be sitting up within hours, they will be on their feet within 24 hours and will be up and about by day two or three.

 

Length of hospital stay after a cesarean section

This may range anything between three and seven days. The average is five.

If the skin has been repaired using stitches or staples which need removing, this is usually done between days five and seven, depending on the type of incision that was made. It is not unusual to allow the mother home before the stitches are removed and to have the midwife visit her at home to take them out on the scheduled day if this type of service is available in the area. This is, if there are no problems, the mother has adequate help at home and that is her wish.

 

Resuming work after a cesarean section

Going back to work after a cesarean section depends largely on the type of work that the woman does. If it is a desk-bound job which is not physically demanding, she may be able to go back to full-time work within six weeks of delivery. If the job involves physical exertion, then twelve weeks is probably the minimum interval she requires. Every woman should pace herself and listen to her own body in whatever activities she wants to try.

 

Other factors that may play a part in this is whether there were any medical or even surgical complications that she may need time to recover from.

 

Future delivery after a cesarean section

A cesarean section in one pregnancy will inevitably influence mode of delivery in subsequent pregnancies.

 

If the indication for the original cesarean section was for a one-off reason, such as fetal distress, abnormal fetal lie or presentation, or maternal distress, then the standard advice is to try for a vaginal delivery, next time around. That is on the proviso that there is no new complicating factor.

 

Most women succeed in having a successful vaginal delivery, second time round. This is what is euphemistically known as VBAC. This stands for vaginal birth after cesarean. For a significant minority, however, the attempt is unsuccessful and they end up having a repeat cesarean section.

 

If the indication for cesarean section first time around was an unchanging factor, such as a narrow pelvis, then any future delivery will be by a cesarean section.

 

Success rate of vaginal birth after cesarean section (VBAC)

Research has consistently shown that successful vaginal delivery is achievable in 75 – 80% of cases. However, a mixture of lack of information and sometimes lack of opportunity means actual rates in hospitals in the UK are significantly lower than that, probably in the region of 30 -35%. In the United States, rate of vaginal birth after a cesarean  peaked at 28.3% in 1996 but has dropped steadily since and is now less than 10%. In some hospitals, mothers with a previous cesarean delivery are automatically  assigned a repeat cesarean.  The trend appears irreversible.

 

A previous cesarean section means the focus is on whether the scarred uterus will be able to withstand the rigors of labor or whether it could give way. The fact is; the risk of uterine rupture is small quoted at 0.35%. Moreover, under good supervision on a modern labor ward, that risk is minimized further.

 

It is clearly unfortunate that many more mothers do not get the opportunity to try for a vaginal delivery after a previous cesarean. This may partly be because they are not given adequate information to allay their concerns. There is no doubt, however, that, overall, vaginal birth is safer for these mothers, just like all mothers.

 

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