Your body just had a big surgical procedure, so when is it safe to carry another baby?

When due to medical or non-medical reasons, a mum-to-be doesn’t have a vaginal birth, a Caesarean or C-section is her only other delivery option.

Although a Caesarean is technically surgery and has its own set of risks, medical advances have made it possible for women to go this route without much issue. This is probably why C-section numbers are continuing to climb in Singapore, with an estimated 40 to 45 per cent of births resulting in one. This is a startling increase, since only 10 to 15 per cent of babies were born via a C-section in the early 1990s.

With more and more couples wanting to their kids to be closer in age ― usually 18 months apart ― SmartParents explores the risks a woman has to be aware of before she decides to have another baby soon after a C-section.

We get details from SmartParents expert Dr Christopher Chong, an obstetrician & gynaecologist.

How long does a C-section scar typically take to heal?

The scar on the skin will close within a week, which is when the stiches will be removed. But the scar in the womb will take a much longer time. Your womb will take about four to six weeks after a Caesarean to regain strength. It will get stronger after three months and reach maximum strength six months post-partum.

How do the different C-section incisions affect healing?

The pregnant womb is divided into the upper and lower segment. The upper segment is mainly made up of muscle tissues, while the lower segment is made up of fibrous tissues. Doctors usually do their best to perform a Caesarean on the lower segment, as healing is much slower and not optimal when done in the upper segment.

Another reason why we try not to perform it on the upper segment is that there’s a risk of the womb rupturing when one goes into labour during the next pregnancy. The risk of rupture is less than 0.5 per cent with a lower segment C-section, and 3 per cent with an upper segment. Once the womb ruptures, the lives of the foetus and mum will be at stake.

Doctors only perform a C-section on the upper segment when the lower segment cannot be reached due to fibroids growing there or when a pregnant woman has cancer cells there.

How long should a C-section mum wait before trying for another baby?

My recommendation is at least a year. Allocate the first six months for the wound in the womb to heal well and the next six months to build up your health. Giving birth and looking after a newborn weakens a mum.

She is at risk of having an uterine rupture should she go into labour suddenly, as the scar of the previous surgery has not healed fully or regained full strength.”

Do C-section mums lose more blood during delivery than mums who’ve had a vaginal delivery? And how will this affect their next pregnancy?

A C-section is after all a surgery, so there will be more blood loss. Most of the time, it will be not more than 250ml and can be even lower than that if the mum is in good hands and the womb contracts well. More blood loss means mum is likely to be more anaemic. If a person is very anaemic from heavy blood loss during [her previous] delivery and hasn’t recovered from it, there will be less well-oxygenated blood and nutrition being transferred to the foetus. This will affect the foetus’s growth and could result in it not being able to handle the stress of delivery and possibly going into foetal distress. There’s also a chance of it being born smaller and weaker, likely to have jaundice and more prone to growth problems (such as feeding) and infections (falling sick easily).

If a C-section mum falls pregnant less than a year after her first baby, what kind of risks is she opening herself up to?

She is at risk of having an uterine rupture should she go into labour suddenly, as the scar of the previous surgery has not healed fully or regained full strength.

What extra steps should she take to ensure that her pregnancy and delivery is smooth and her baby grows well?

Have more regular and closer checks with your doctor. She should also be more vigilant for signs of early labour, remember not to over exert, rest well and think about having an elective C-section once baby has reached full term at 37 weeks. A good obstetrician will keep a lookout for signs of early labour, including an examination to assess if the cervix is dilating. They will also use a CTG machine to check if the womb is starting to get irritable and scans should can be done to see if the old scar is thinning out. This is not easy to detect though, as it depends on the position of the womb, foetus, placenta, size of the mum and the skill of the person scanning.

What are her delivery options?

If the medical reason for doing the first C-section remains ― such as low-lying placenta or if the foetus’s position is abnormal ― then a repeat C-section is usually done. Otherwise, the patient can try for a vaginal birth after caesarean (VBAC). However, after two C-sections, the third must be a C-section as the risk are too high. Not only is there a risk of a failed VBAC, every C-section also results in poorer healing of the scar, since we operate through the old scar.

Dr Christopher Chong is a urogynaecologist and obstetrician & gynaecologist at Gleneagles Hospital.

Photo: iStock

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