Caesarean Sections (C-sections) are on the rise throughout the world. In fact, they are the most common surgeries performed on females globally. In 2014, the rate of C-section deliveries was about 25% in Europe and 32% in the US. In 1970, there was a rate of only 5.5% in the US - a stark increase! These numbers are associated with increased maternal age, which could be in part due to more medical complications with labor among older women.
Emergency C-sections can occur due to breech presentation (baby is positioned feet first instead of head first), failure of labor, infection of the placenta, uterine rupture, low oxygen delivery to the baby, or any other reasons why a vaginal delivery is harmful or impossible. One of the primary reasons for a C-section is a previous C-section!
There is also an increase in elective C-sections (about 11% of C-sections in the US), where mothers request a C-section even though there may not be a medical necessity for mom or baby. The assumption for this is partly due to some evidence of reduced urinary incontinence, prolapse, and fecal incontinence after a C-section versus vaginal delivery, however the evidence is not strong. Other reasons for elective C-sections is “tocophobia” or the fear of childbirth and general lack of confidence in sustaining vaginal deliveries.
Complications and Benefits
Complications during a C-section surgery can include infection, organ injury, or the need for a hysterectomy. Complications after the surgery can include blood clotting, adhesions, or persistent pain. Complications for future deliveries can include uterine rupture, spontaneous abortion, or stillbirth.
Some evidence suggests that after an elective C-section, there is less risk for pain at the perineum or vaginal injuries. Alternatively, there is evidence that after a vaginal delivery, mothers may spend less time at the hospital and have less risk for hysterectomies or cardiac arrest.
As you can see, there are pros and cons to having a C-section versus vaginal delivery. There is absolutely no one-size-fits-all answer on whether C-sections or vaginal deliveries are better since there are a host of factors to consider. There are also several holes in the scientific evidence that are yet to be addressed. Based on your health history, it is best to speak with your obstetrician or midwife regarding what is best for you and your baby/babies.
With the clear rise in C-section surgeries, more surgical techniques are being explored to minimize complications and improve outcomes. For example, in Germany a modified C-section technique involves a slightly different positioning and length of incision that has a few proposed benefits: less injury to the baby, a better looking scar that is smaller and less perceivable, and fewer complications in future pregnancies.
However, a scar is a scar and there are several things that could go wrong. In one study, researchers found that scar defects increase with the number of C-sections and with scars that are lower on the uterus. Another study revealed an association between poor incision healing and C-sections that occured in advanced labor.
Mothers may develop irregularities or restrictions along the scar tissue. Adhesions occur when tissues become connected and restrict movement between organs, muscles, skin, and more.
It is also possible to develop pain at the scar site. Up to 18% of C-section scars in the US develop into chronically painful sites. Pain at your C-section scar can impact activities like squatting, reaching backwards, sexual activity, and bowel movements.
Sometimes, mothers have negative body image due to their new postpartum bodies, and the scar may serve as a constant reminder. This may impact intimacy postpartum.
Make Sure It Heals Properly.
Scar management is crucial. If your scar becomes redder than usual, warm to the touch, excretes pus/fluid, or is extremely painful, seek immediate medical help from your doctor. During your regular postpartum visits, have your doctor check to make sure your scar is healing correctly.
Massage Your Scar.
After the 6 week mark, with clearance from your doctor, it is typically safe to start massaging your scar. The most important thing to avoid is reopening your scar because this can lead to other complications. To learn C-section scar massage properly, see a pelvic floor physical therapist!
Massaging the scar addresses the 3 points made above: adhesions, pain, and fear/anxiety. Physically moving the tissues in and around the scar helps prevent adhesions and allows tissues to glide with better movement. It also decreases pain by reducing restrictions and improving mobility of your abdominal tissues. Lastly, your tactile input to the area is a form of self care and can help reduce fear and anxiety related to changes in body image.
Use Topical Treatment
Some evidence suggests that Aloe Vera, Onion Extract, and Green Tea extract can prevent abnormal scar formation. Check with a dermatologist on natural or over-the-counter options that might work for you.
When it comes to elective C-sections, it is important that mothers seek appropriate medical advice before making the decision. There are many factors to consider. If a mom does end up having a C-section, it is important to care for the new scar to prevent restrictions and pain.